Midwifery - “A vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries”

Within the Centre for Maternal and Newborn Health (CMNH), we have a multi-disciplinary team that includes midwives, obstetricians and paediatricians. We recognise that each member plays a vital role in providing quality care for pregnant women and newborns. International Day of the Midwife is 5th May and this year's theme is ‘Midwives leading the way with quality care’, so throughout this week we are going to take this opportunity to highlight how important midwifery is.

It is a common misconception that midwives concern themselves only with the actual act of childbirth and that their responsibilities don’t extend far beyond the maternity ward. In reality, this couldn’t be further from the truth. Midwives are an incredibly important part of a complex continuum of care that stretches from the moment a woman begins to think about having a child to the 42nd day after that child is born. That’s more than 10 months of care that should be received by each family, every time a child is born.

In 2014, The Lancet published a series on Midwifery. The Series outlines a framework for quality maternal and newborn care (QMNC) that firmly places the needs of women and their newborn infants at its centre. It is based on a definition of midwifery that takes account of skills, attitudes and behaviours rather than specific professional roles. Within this series, midwifery care is defined as “Skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life”.

It also highlights core characteristics of midwifery care which includes “optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with, and referral to, other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families”. Midwives and nurse/midwives who are educated, trained, licensed, and regulated can provide the full scope of midwifery as defined in this Series.

The research reported within the Lancet series showed that outcomes improved by midwifery care include reduced maternal and newborn mortality, reduced stillbirth, reduced perineal trauma, reduced need for intra-partum analgesia or anaesthesia, less severe blood loss, fewer preterm births, fewer newborn infants with a low birth weight, and less hypothermia. The analyses also found increased spontaneous onset of labour and increased rates of initiation and duration of breastfeeding. Importantly, women reported a higher rate of satisfaction with care in general and with pain relief in labour, and improved mother-baby interaction was also identified.

Research undertaken by the authors of the series showed that midwifery care with both family planning and interventions for maternal and newborn health could avert up to 83% of all maternal deaths, stillbirths, and neonatal deaths that occur globally. The research showed that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care. Globally, multiple cadres of healthcare providers are active in providing midwifery care, but where reliance is solely on less skilled healthcare workers, the reported benefits are limited. Care led by midwives and nurse/midwives who are educated, licensed, regulated, integrated in the health system and working in interdisciplinary teams had a positive impact on maternal and perinatal health even when compared with care led by other health professionals in combination with midwives.

Globally, there are numerous challenges to women and their families receiving the care that they need to survive and thrive before during and after pregnancy. The State of the World’s Midwifery Report notes that of the 73 countries from which data was gathered, only four countries had the workforce capacity to provide the care needed by women in their reproductive years, as well as for newborns. Many of the midwifery education programmes reported a lack of basic training such as infection prevention and respectful care. This can lead to the possibility of links between poor education, poor clinical care, and sepsis as well as mistreatment of women in facilities. Due to the varying quality of education available, the preparation of healthcare providers and the provision of maternal and neonatal care is variable, across low-, middle- and high-resource countries. Barriers to achieving high quality sustainable midwifery education programmes include economic and political restrictions to exercise the full scope of midwifery practice, as well as social and cultural norms which mitigate against women’s rights, education and employment.

Maternal and Newborn care can be scaled up globally by addressing systemic barriers to high quality midwifery care eg, lack of understanding of what midwifery is and what it can do, the low status of women, inter-professional rivalries, and unregulated commercialisation of childbirth. Throughout this week, and to celebrate International Day of the Midwife, the team within the Centre for Maternal and Newborn Health will be highlighting through a series of blogs how midwives globally are overcoming these barriers, leading the way with quality care and how CMNH is contributing to improving the quality of care women and their newborn infants receive.