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Lancet midwifery series: Saving the lives of mothers and babies through midwifery

The findings and recommendations of the Lancet Midwifery series were disseminated by the Royal Colleges of Midwives and Obstetricians & Gynaecologists (RCOG), in October. The Centre for Maternal and Newborn Health (CMNH) was invited to take part in this colloquium, held at the RCOG in London.

The series consists of four papers, originally published in 2014, and looks at midwifery’s contribution to the survival and wellbeing of childbearing women and newborn infants. This is demonstrated in the analysis of systematic reviews, case studies and modelling of deaths averted as summarised in the executive summary. The four papers are:

  1. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care
    This paper mapped the scope of midwifery globally and developed a framework for quality maternal and newborn care. It drew on systematic reviews of women’s views and experiences, effective practices and health care providers working in maternal and newborn care. They found that when midwives were educated, trained, licensed and regulated that resources were used more efficiently and outcomes improved. A shift in focus from the identification and treatment of pathology in the minority, to the provision of skilled health care tailored to meet the individual needs of all women and babies, was advocated.
  2. The projected effect of upscaling of midwifery
    The estimated number of lives that could be saved if midwifery care for antenatal, intrapartum, postnatal and family planning were scaled up globally, was calculated. Midwifery care has the greatest effect when provided within a functional health system, with effective referral and transfer mechanisms to specialist care.  They estimated that 83% of all maternal deaths, stillbirths and neonatal deaths could be averted with this provision.
  3. Experience strengthening health systems and deploying midwives in countries with high maternal mortality
    The experiences of four low and middle income countries: Burkina Faso, Cambodia, Indonesia and Morocco. It looks at the deployment of midwives as part of national efforts to improve maternal and newborn health. Interventions included increased provision and use of health facility for births, increases in the number of midwives, and a reduction in financial barriers. They also included, in the latter stages, steps to improve quality of care but with little or no focus on over-medicalisation or respectful women-centred care.
  4. Improvement of maternal and newborn health through midwifery
    Summarises the previous three papers in the series. It highlights future research priorities for provision of evidence and practical steps toward women, family and people centred care. It is hoped that this series will “support the move towards universal coverage of high-quality maternal and newborn care”.  

The colloquium brought together senior midwives (including some of the authors of the above papers) and others interested in the health and wellbeing of mothers and babies, to discuss the findings of the lancet midwifery series and its potential impact on the care of women both in the UK and around the world. The outcomes of the colloquium discussion will form the basis of Prof. Mary Renfrew’s presentation at the RCM Zepherina Veitch Memorial Lecture, to be held in December.

Food for thought: As midwives, is the emphasis on record keeping and avoiding the of risk and litigation at the expense of high quality, individualised care too great? How can we promote the increase of maternal care quality globally?

 

About the authors:

Fiona Dickinson is a Research Assistant and PhD student at CMNH. She qualified as a Midwife in the UK and has an interest in women centred care in low income countries.

 

Florence Mgawadere is a Post-Doctoral Senior Research Associate at CMNH, and Nurse-Midwife with over 12 years of international experience. Her interests include maternal health and the measurement of maternal mortality.