In principle, midwifery means: ‘being with women’. But midwifery as defined in the Lancet series is so much more. It provides the information and practices that women need to remain healthy and safe during pregnancy and childbirth, it can fit with their culture or religion and with what they need at that point in their life. It strengthens their capability to learn for themselves what they and their family need and how to provide that. And it leaves them in the driver’s seat of their life and their care. The series suggests that midwifery can make specific and cost-effective contributions to education, information, health promotion, assessment and screening, the planning of care, promoting normal processes and preventing complications.
To be able to make midwifery available like that we need quite a few big changes. These need to be pushed by health workers (midwives, doctors and others), health systems, governments and development agencies, but even more by women themselves. Because quality midwifery strengthens and supports women, because it can be a career path for many women, because it makes economic sense and because it is at the heart of quality health care, the access to which is part of the human right to life (ref).
And the changes? Some start as early in life as primary and secondary school. Girls who finish their secondary education often have less children and later in life, when they are better prepared for it, and they make sure those children attend and complete their secondary education too (ref). And with that diploma, many girls can chose midwifery or nursing as a profession.
For midwifery to function at its best, midwives need to follow an accredited education programme and be provided with enough practical experience to hit the ground running once they graduate. They should be enabled and allowed to provide all the elements of the scope of practice, from before pregnancy through to the early months of the newborn life, specifically those practices that promote normal processes in pregnancy and childbirth rather than medical interventions. They need to work in close collaboration with colleagues they can refer to when complications arise that they cannot manage, which means that they are recognized and treated as full members of a collaborative team that together covers what women need in a respectful, personalized, non-abuse way.
When women experience pregnancy and childbirth with safety and support, it enables them to carry out their other roles in life with confidence and trust in their own capabilities. This leads to stable, healthy families and communities and the economic growth* and development of nations. The contribution of midwifery carried out by all those who provide maternal and newborn health care is crucial to this process and must be at the heart of the global development agenda.
Petra ten-Hoope Bender
Director ICS Integrare and author of the Lancet series on midwifery
*Nussbaum M, Women’s capabilities and Human Development, Journal of Human Development, Vol 1, No.2, 2000.