Kunduz Almazbek kyzy has been working in the maternity ward of the Issyk-Kul Regional United Hospital (Karakol) for four months. She graduated from medical school in Karakol in 2018. After a two-year maternity leave, Kunduz started her professional practice in the maternity hospital in 2020, first in the admitting department and then in the postpartum unit.

Today, Kunduz is one of the young midwives who have been trained in the new clinical protocol for providing medical care in cases of postpartum hemorrhage. She has already encountered challenging cases that have become real trials and lessons for her.

"Previously, according to the old protocols, we infused the woman with the necessary solutions, up to 3 liters depending on the blood loss. Now, according to the new ones, it's one-to-one. We gained this knowledge during the training and now apply it in practice," Kunduz shares.

One of the most intense moments occurred when a woman arrived at 39 weeks of pregnancy—her sixth pregnancy, everything had been on schedule, but the placenta did not separate 30 minutes after delivery. Severe blood loss began—a liter of blood in a short time, 14% of the total circulating blood volume.

"It was the first such case in my practice. I was scared. I was trembling. But there was an experienced midwife beside me. We worked as a team: we inserted two catheters, gave oxygen, monitored blood pressure and pulse, and called the resuscitator and the laboratory. The doctor monitored the process. We took on this challenge—and we coped."

The woman survived, her uterus contracted, the baby was in the hands of the neonatologist—everything turned out well. But the fear that Kunduz faced did not become a weakness but a point of growth for her.

"My mentor joked that after this case, I would want to go back to the admitting department. But in fact, this experience only gave a strength to me."

Midwifery is not just about protocols. It’s also about mental fortitude and supporting all women at the most vulnerable moment of their lives.

"In medical school, we were not taught to manage emotions. But the experienced midwife I work with now teaches me: if you are afraid, the woman giving birth will feel it, and it will only make her worse. You need to verbally explain each of your actions to her, repeat that we are there, that we are helping her. But still, inside you are afraid—for every woman, and you pray that her children will not be left without a mother."

At the training sessions on postpartum hemorrhage, organized with the technical support of the United Nations Population Fund (UNFPA), Kunduz first saw an anti-shock garment—a simple but effective means of saving lives in case of massive blood loss.

The principle of the anti-shock garment is as follows: it tightly wraps around the legs and abdomen, creating pressure. This pressure helps constrict blood vessels, including those around the uterus, and slows bleeding. The garment raises blood pressure in the body and improves its supply to vital organs such as the heart and brain, stabilizing the woman's condition. This is a temporary measure, but it gives a chance for survival, buying up to two hours to receive all the necessary help. For Kunduz and her patients, even minutes give an invaluable opportunity to win time and save the mother's life.

"We now look at platelets in advance, we know the norms. We assess the uterine tone, observe the contraction after childbirth. We know the causes of bleeding—4T: tissue, tone, trauma, thrombin."

Repeat births, insufficient uterine contraction, clotting disorders—now Kunduz knows how to diagnose and prevent all of this, and take the necessary measures.

Today, Kunduz works with the midwife who delivered her first child. And this is a special symbolic cycle in her professional history.

"During my own second delivery, six years after the first, I didn't cry anymore. I knew how to breathe. I knew when I needed to come to the maternity ward, what to do. And now I help other women—just like once I received help here."

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The training sessions on postpartum hemorrhage, in which Kunduz and her colleagues from five pilot maternity hospitals in Kyrgyzstan participated, were conducted within the framework of the UN South-South Cooperation project on quality assurance to improve maternal health indicators.

This project, funded by the India-UN Development Partnership Fund, aims to reduce preventable maternal morbidity in Kyrgyzstan by expanding access to quality medical care through the Obstetric Surveillance and Response System (OSRS) and teleconsultations.

The project is supported and implemented by the Ministry of Health of the Kyrgyz Republic and the United Nations Population Fund.