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

Midwifery matters - Lancet midwifery series