Midwifery matters to women, babies and families worldwide. Many people and organisations know that – but there are many who are not aware of what midwifery is and what it offers because they live and work in countries where midwifery is not practised, or where it is weakened by a lack of support.
I am a UK-based midwife and researcher who has worked in this field for over 30 years. In the past few years, I have had the privilege of working with 35 colleagues from 20 different countries to look at the evidence for the contribution of midwifery globally. We have been developing a series of papers for The Lancet, the leading medical and health journal. What we found has surprised many people.
It was surprisingly difficult to make sense of the evidence at the start. Midwifery is implemented differently in different countries – care can be provided by midwives, or by others including doctors, nurses, community health workers, and traditional birth attendants. In some studies, the focus was on provision of emergency responses and midwifery was overlooked. In others, the focus was on specific tasks or practices provided.
There are barriers to strong midwifery practice, including a lack of good education and professional regulation, and professional territorialism where professional interests of others over-ride the needs of women and babies. We had to start by creating a definition of midwifery, and then building an understanding of what women, babies and families need – wherever they live in the world. To do this, we re-examined hundreds of different types of studies.
We found that childbearing women and babies need much more than the essential tasks such as blood pressure monitoring or blood tests, or interventions when things go wrong. We found that an emphasis on preventive and supportive care is needed, to prevent complications from developing or to help in a timely way. We found that the way in which care is organised and provided – integrating services across community and hospital settings, with respect for women and their individual circumstances, is really important. We found that working with women to optimise the normal processes of pregnancy, birth, postpartum and the early weeks of life prevents the routine and expensive use of unnecessary interventions – in some countries, rates of caesarean section are over 50%, which is not beneficial for mothers or babies and which is not going to be sustainable. We found that strengthening women’s own capabilities to care for themselves and their babies is a positive part of good care. All of these elements are core to midwifery.
Our re-assessment of the evidence showed us that midwifery can improve over 50 outcomes for mothers and babies, as well as making health services more cost-effective and sustainable. Implementing midwifery could reduce over 80% of current mortality among childbearing women and newborn babies, as well as stillbirths. Midwifery, properly implemented, does even more than that – it improves health, and well-being too. It prevents unnecessary interventions such as caesarean section and episiotomy, and saves money for the health system.
When we looked at studies of who should provide midwifery, we found that many different practitioners can provide some components. But to provide the full scope of midwifery practice, avoid fragmented care, and offer the most cost-effective solution, midwives educated to international standards, integrated into the health system and working with other health professionals, are needed.
The evidence we analysed has shown that wherever they live, women who are pregnant, in labour or during birth, postpartum, and babies in their early days and weeks of life, need midwifery. We now understand that although it has often been overlooked, midwifery provides the fundamental care that all women and babies need. Midwifery is a vital solution to the problems faced by health services in providing good maternal and newborn care. This wonderful new campaign, midwives4all, will bring this knowledge to the attention of women, man and families worldwide, and to the politicians and decision-makers who plan services. Over the next few months, many people will contribute their stories, experiences, and knowledge to build an international understanding of the huge importance of midwifery.
Midwives4all could transform the lives of women and children worldwide.
–Professor Mary Renfrew, University of Dundee
Principal investigator, Lancet Series on Midwifery