Today, at the London School of Hygiene and Tropical Medicine, The Lancet launched its newest series Midwifery. This series provides concrete actions for stopping preventable maternal and newborn death and ensuring perinatal health. The knowledge that midwives are key to preventing perinatal death is not new. However, scaling up the utilization of midwives on a systems level is lacking, which has prevented this solution from becoming a reality.
The Midwifery Series was created to provide concrete guidance and frameworks on how to utilize midwives and a new standard of care for Quality Maternal and Newborn Care (QMNC). At the center of this model of care are the needs of women and their newborn infants. Even though the needs of women across the world seem to differ greatly, this series clarifies that no matter where a woman lives, care led by a midwife is the answer to ensuring health. The series comprises four separate papers which were created by a multidisciplinary group, including academics, researchers, advocates for women and children, clinicians, and policy-makers. This multidisciplinary approach is necessary for addressing current gaps in perinatal care.
The current maternal and newborn health landscape often offers fragmented solutions and interventions to address the needs of women and their newborns. This fragmentation is a barrier to adequate perinatal care. These gaps in care lead to 98% of the annual 289,000 maternal deaths, 2.6 million stillbirths, and 2.9 million neonatal deaths. In order to mitigate these preventable deaths, improvements in the quality throughout the continuum of care and emergency services are imperative. The series supports a whole-system approach to improving perinatal care by ensuring skilled care for all.
The Lives Saved Tool (LiST) was used in the series to model different levels of scale-up of essential interventions for reproductive, maternal, and newborn health (RMNH) which are within the scope of practice of a midwife. In low-resource settings even a 10% increase in the interventions covered by midwifery would decrease maternal mortality by 27%. Therefore, more rigorous scale-up could have an incredible impact on reducing maternal mortality.
The standard for QMNC presented in the series is globally applicable as it not only focuses on the scale-up of essential interventions, but also the harmful effects and necessary mitigation of over-medicalization of birth and perinatal care. Professor Petra ten Hoope-Bender, of the Instituto do Cooperación Social Integrare, Barcelona, Spain, said, “Although the level and type of risks related to pregnancy, birth, postpartum and the early weeks of life differ between countries and settings, the need to implement effective, sustainable, and affordable improvements in the quality of care is common to all, and midwifery is pivotal to this approach. However, it is important to understand that to be most effective, a midwife must have access to a functioning health-care service, and for her work to be respected, and integrated with other health-care professionals; the provision of health care and midwifery services must be effectively connected across communities and health—care facilities.”
In order to assist the development of health systems and their integration of midwives, the series provides three new tools:
- The Framework for Quality Maternal and Newborn Care is applicable to all countries on not only what needs to be implemented, but how to implement strategies to reduce maternal, neonatal, and infant mortality and morbidity, improve quality of care, and increase efficiency of health systems.
- Country diagrams can be used to identify the most important elements required to strengthen a country’s health systems to provide quality midwifery services.
- Pragmatic steps provide a guide to initiate or further develop their midwifery services.
Midwives not only provide care at the time of birth, but work with women from before their pregnancy through their newborns infancy to prevent death and ensure health. This life course approach is essential for having a large impact on the needless numbers of deaths and morbidities. Check out The Lancet’s Midwifery Series for more details on how midwives will make a large difference in the lives of women and their children in the coming years as the post-2015 agenda is implemented.