Midwifery matters - Lancet midwifery series
The Lancet series identifies untapped potential of midwifery to improve
outcomes through collaborative practice, writes Deirdre Munro
IT was a privilege to attend the International
Congress of Midwifery in Prague
where the prelaunch of the Lancet Midwifery
Series took place. The lead authors provided
an overview of their international research
and answered numerous questions. The
atmosphere in the hall was electric as global
midwives proudly witnessed the world honour
our profession; midwifery.
The Lancet midwifery series featured
exciting and invigorating international
studies. The series provides a framework
for quality maternal and newborn
care (QMNC) placing women and their
newborn at the centre of care. The series
facilitates a shift in the delivery of care
moving away from a focus on pathology
towards a whole-system skilled teamwork
approach. This series highlights the need
for effective integration of care crossing
the community and hospital arena.
There were four papers included in the
series, all published in June 2014:
- Midwifery and quality care: findings from
a new evidence-informed framework for
maternal and newborn care (Mary Renfrew
et al)
- The projected effect of scaling up midwifery
(Caroline Homer et al)
- Country experience with strengthening
of health systems and deployment of
midwives in countries with high maternal
mortality (Wim Van Lerberghe et al)
- Improvement of maternal and newborn
health through midwifery (Petra ten
Hoope-Bender et al).
Key messages
- Findings support a system-level shift
from providing maternal and newborn
care based on identification and treatment
of pathology to a system of skilled
care providers for all, featuring multidisciplinary
teamwork and integration
across community and hospital settings.
Midwifery is now recognised globally as
being fundamental in this whole-system
approach
- Planning for maternal and newborn
care systems can now utilise the evidence-
based framework for quality
maternal and newborn care specifically
to distribute and organise workforces and
resources
- The views of women, their families and
communities, are crucial for future planning
of health services in all countries
- Midwifery is associated with more efficient
use of resources and improved
outcomes when provided by educated,
trained, licensed and regulated midwives
and are only effective when integrated
into the health system referral mechanism
with sufficient resources and
effective teamwork
- Strengthening a mother’s capabilities
is essential to prolonged survival and
infant wellbeing through midwifery,
this means supporting, respecting
and protecting the mother during the
childbearing years through the highest
quality care
- Building a robust midwifery workforce
strengthens health systems and differentiates
between success and reversal in
maternal and newborn health. Since 1990,
21 countries that substantially increased
deployment of midwives and facility birthing,
were the most successful reducing
maternal mortality rates (2.5% per year)
- Effective reproductive, maternal and
newborn care requires three specific
actions; i) Facilitate women’s use of
midwifery services, ii) meeting women’s
needs and expectations more, iii)
improving the quality of care women
and newborns receive
- Evidence to date identifies midwifery
care provided by midwives is cost effective,
affordable and sustainable. The
return on investing in education and
deployment of community based midwifery
is as cost effective as the cost per
death averted for vaccination
- Increasing coverage and qual ity
improvements in reproductive, maternal,
and newborn healthcare are of
equal importance in achieving better
health outcomes for women and newborn
infants. Investing in midwives their
education, regulation, work environment
and management can improve quality of
care in all countries
- Addressing systematic barriers (lack of
understanding of midwifery, low status
of women, inter-professional rivalry, and
unregulated commercialism of childbirth)
is advised to scale up quality of
maternal and newborn healthcare.
Midwives are the essential link in the
continuum of care
The midwife addresses the full continuum
of care from the community though to complex
clinical care a where medical specialist
may not. Midwives are the enablers, the
initiators, the organisers and catalysts. Midwives
are the ‘essential-link’ bringing women
to the healthcare system at the most effective
time. Referral effectiveness maybe
affected by lack of finance and services such
as; specialist medical care and transport services.
Midwives need to be valued as part
of a team within a functioning and enabling
health system. The health system needs a
competent and skilled workforce, based in
the community as well as the hospital.
The Lancet midwifery series is the most
intensive exploration of midwifery to date.
It includes ‘a broad range of clinical, policy
and health system perspectives’, delivering
four evidence summaries based on
systematic reviews, case studies and modelling
deaths averted. Midwifery is a ‘vital
solution’ to all women and newborns in all
countries. Midwives promote longer-term
survival and wellbeing for the infant.
The Lancet ser ies identi f ies the
untapped potential of midwifery globally
to improve outcomes through collaborative
practice, working along a continuum
of care. So midwives, we really do matter...
and now the world knows.
Deirdre Munro is the education officer of the INMO
Midwives Section, a member of the Executive
Council and works for the National Communication
(Handover) Project UCD
