A new series of studies published in The Lancet urges worldwide leaders to recognize the importance of midwifery services in saving the lives of millions of expectant mothers and their infants.
According to the research team involved in the studies - made up of an international group of clinicians, academics, professional midwives and advocates for women and children - the series is the "most critical and wide-reaching examination of midwifery ever conducted."
They say the series demonstrates the positive impact midwives can have, not only for saving lives, but also for the ongoing well-being of mothers and their children.
A midwife is a health care professional who provides individualized care for a woman during and shortly after pregnancy.
According to the American Pregnancy Association, midwives follow the Midwives Model of Care, which requires them to monitor the physical, psychological and social well-being of the mother during pregnancy, provide the mother with personalized education, counseling and prenatal care, one-to-one assistance during labor and delivery, and postpartum support.
In addition, midwives strive to limit the use of technological interventions for expectant mothers and help identify women who are in need of obstetrical attention.
One of the series authors, Prof. Mary Renfrew of the School of Nursing and Midwifery at Dundee University in the UK, notes that many needs of pregnant women, their babies and their families are not being met, "despite long-standing recognition that women and their babies need access to health care that provides more than just emergency interventions for acute medical problems."
She adds that although midwifery is widely acknowledged as a "vital and cost-effective contribution to high-quality maternal and newborn care in many countries," its potential social, economic and health benefits are far from recognized on a global scale.
'75% of infant and maternal deaths could be prevented in next 15 years'
Figures from the World Health Organization (WHO) reveal that every day, around 800 women die from preventable causes associated with pregnancy and childbirth, and every year, 3.3 million neonatal deaths occur.
Researchers estimate that if effective midwifery was offered to all women in low- and middle-income countries, 75% of infant and maternal deaths could be prevented over the next 15 years.
But according to the series authors, these figures could reduce dramatically if midwifery services were increased globally.
Approximately 90% of all maternal deaths and 99% of newborn deaths occur in low- and middle-income countries, where mothers and their babies receive little or no skilled care during their pregnancy or birth.
But in the new series, experts estimate that if effective midwifery was offered to all women in these countries, 75% of infant and maternal deaths could be prevented over the next 15 years. They add that even if the coverage of midwifery services were increased by a quarter, the present rate of maternal deaths could be halved by 2030.
In addition, the series authors point out that in low- and middle-income countries that lack midwifery services, overuse of medication and unnecessary interventions - such as cesarean sections and limited mobility during labor - are common and negatively impact the health and well-being of expectant mothers, their infants and their families.
Prof. Caroline Homer, of the Faculty of Health at the University of Technology in Australia and another of the series authors, says:
"Both underuse and overuse of medical interventions in pregnancy contribute to short- and long-term illness for an estimated 20 million childbearing women. This not only effects their health and well-being, but may also result in their needing to pay for ongoing health care costs, and on the ability of their families to escape poverty."
Hope that new framework will boost global midwifery services
Even though the series authors have reflected the significant benefits that an increase in global midwifery services could have, they note that there are still a number of barriers that stop this from being actioned, such as a lack of understanding of what midwives can do, unregulated private sector care for the health of mothers and infants, the low status of women in society and interprofessional rivalries.
Fast facts about midwifery in the US
- In the US, there are 13,071 certified nurse midwives (CNMs) and 84 certified midwives (CMs) - a newer equivalent to a CNM
- In 2012, CNMs/CMs attended 313,846 births in the US
- More than 50% of CNMs/CMs list physician practices or hospitals/medical centers as their main employer.
However, the team has detailed a framework that details the needs of expectant mothers, infants and their families before, during and after pregnancy, how these needs should be met, where they should be met and by whom.
The series authors hope the framework will help increase midwifery services worldwide - particularly in countries with high maternal and infant death burden - as well as measure the success of these services.
"The knowledge and methods are available to achieve quality maternal and newborn care. Political will and commitment are increasing, women's and families' voices are growing louder, and economic growth and education for girls are on the rise," say the authors.
"The opportunity to transform health, education, and social systems and to make maternal, newborn, and child health a reality for all, is here."
Last year, Medical News Today reported on a study published in The Cochrane Library, which found that expectant mothers whose main care is provided by a midwife throughout pregnancy are less likely to experience pregnancy-related complications.