Midwives provide antenatal and postnatal care - but are we missing the point?

Globally, it is estimated that just over 80% of all pregnant women seek care from a healthcare provider on at least one occasion, and only 56% attend for antenatal care (ANC) four times or more. These very often represent ‘missed opportunities’ and do not address the comprehensive health needs of women and newborns. Underlying complications during pregnancy account for 27.5% of maternal deaths globally. ANC aims to identify and treat underlying illness as well as provide advice on how to stay healthy and how to recognise the danger signs for women.

Most maternal and newborn deaths occur in the first week after birth, yet currently it is estimated that only 48% of women and babies globally receive postnatal care (PNC). Most healthcare providers are trying to deliver quality care to women within a poorly supported health system, with challenges including shortage of staff, equipment, drugs and poor health system infrastructure. Current pre-service training often does not fully equip healthcare providers for the roles they are in and there is generally a lack of competency based in-service (on the job) training available. This leaves many healthcare providers feeling poorly supported and unaware or uninformed about new evidence based care packages which they could implement.

Experts within the Centre for Maternal and Newborn Health have developed a new competency-based workshop package to increase the capacity of healthcare providers working in low- and middle-income countries, to address the identified health needs of mothers and babies during and after pregnancy with integration of care across three main diseases – HIV/AIDS, TB and malaria. The new workshop package covers what is needed to meet the physical, mental and social aspects of maternal and newborn health. The focus is on evidence-based screening, therapeutic interventions and health promotion during and after pregnancy. It also supports healthcare providers regarding how they can provide respectful maternity care, and screen for and manage domestic violence and depression during and after pregnancy.

Hannah McCauley, a midwife working within the Centre for Maternal and Newborn Health, is leading the implementation of the workshop. She feels that this programme is a key example of midwives leading the way with quality care which is this year’s International Day of the Midwife theme. She says: “Whilst a multi-disciplinary approach to childbirth is essential, we also recognise midwives and nurse-midwives in low-and-middle-income countries have a leading role in ensuing high quality woman and baby-friendly ANC and PNC can and is provided to meet the identified health needs of mothers and babies, and ensure these are not missed opportunities. This workshop will support the preparation of healthcare providers including midwives and nurse-midwives to provide high quality, evidence-based, holistic and integrated maternal and neonatal care before, during and after pregnancy across low- and middle-income countries”.

Lucie Baylis a midwife who has travelled to Ghana to deliver the training, says: “Volunteering for CMNH has been the most rewarding and exciting opportunity of my career. Travelling to low- and middle-income countries to deliver the ANC and PNC programme gave me a new perspective and enthusiasm for my work in the UK.  The course allowed students to practice on mannequins over and over again until they feel confident with their techniques. The students often start the week a little anxious and nervous, watching them grow in confidence and grasping the practical skills we taught was fantastic”.

Kirsty Lowe, one of our UK volunteers, is passionate about her role as a midwife. She states: “Birth is at the heart of every culture, every population around the world, and as a midwife, I have a unique experience of these intimate and formative times in a woman’s life. The care that a woman has in her pregnancy, birth and after her baby is born is intrinsic to how her and her family will function. Being a part of this care as a midwife is an honour, and I’m grateful to midwives all around the world, as they are essential in their support and protection of our mums and babies”. Kirsty recently travelled to Ghana as part of the demonstration workshop and added that “the ANC and PNC workshops are an essential part of improving quality of care, by working in partnership enhancing the skills of healthcare providers who often work in demanding situations. Incorporating training on psychosocial elements of care, such as screening for domestic abuse and mental health, also helps staff to feel skilled and empowered in providing holistic care for women. The workshop in Ghana was a great success and I’m very excited about where CMNH will take this next.”

CMNH’s approach to implementation research and training of healthcare providers is to ensure there is sharing of expertise and discussion with partners and colleagues in low- and middle-income countries of how we can all provide better care. We firmly believe that all our programmes should be sustainable and working in partnership is essential to the success of any initiative. One of the participant’s in Togo stated that “The lectures helped us to consolidate the knowledge we had acquired and we also gained new knowledge on screening for domestic violence and depression in pregnancy. The group sessions allowed us to exchange knowledge between colleagues first and with facilitators from elsewhere and how to improve rapid diagnosis and management of malaria, HIV/Syphilis and tuberculosis.” Alison Perry a UK volunteer echoed this transfer of knowledge by stating that ‘This project is a fantastic contribution to the ongoing development of evidence-based and respectful maternity care. My time in Togo threw open the doors to the wider world view and sharpened my global perspective. I learned a lot and hope to be involved more in the future.’

CMNH is committed to ‘leading the way with quality care’. To find out more about the new Antenatal and Postnatal workshop package and how you could help please contact us on CMNH@lstmed.ac.uk.

 About the author
Hannah McCauleyHannah McCauley has been practising as a dual trained nurse and midwife for over 13 years, both in the UK and in low and middle income settings. Prior to her appointment in LSTM, she was a Clinical Sister and Manager in a midwifery led unit and labour ward in Northern Ireland. She worked in Uganda with VSO as a Maternal Health Specialist for 2 years. She is passionate regarding improving the quality of care for women and their new-born babies, supporting women’s choices in pregnancy and childbirth and promoting and empowering midwives in their professional role, both in the UK and internationally.