Midwives play a crucial role in saving the lives of women and infants worldwide. That is the conclusion of “Midwifery matters”, a series by an international group of leading researchers published in the prestigious scientific journal, The Lancet. ITM’s Prof. Vincent De Brouwere and Dr. Fabienne Richard contributed to the series with the article “Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality”.

Produced by an international group of academics, clinicians, professional midwives, policymakers and advocates for women and children, “Midwifery matters” is the most critical, wide-reaching examination of midwifery ever conducted. It shows the scale of the positive impact that can be achieved when effective, high-quality midwifery is available to all women and their babies. Apart from saving lives, midwifery also improves the overall health and wellbeing of women and babies and has other long-lasting benefits.

The contribution of Prof. De Brouwere and Dr. Richard is rooted in research that started in 1990 in Morocco with the development of the Unmet Obstetric Need (UON) concept. The UON became an indicator and was measured in about 20 countries and included in the WHO Emergency Obstetric & Neonatal Care indicators in 2009.

“In general, midwives are more patient-centred, meaning that they also focus on the patient’s general wellbeing and not only on their medical condition. They are not running from patient to patient as doctors often do,” says Prof. De Brouwere. “They are most successful when the maternal and neonatal care they provide is integrated into a fully functioning health system. This ensures the continuum of care.”

Midwives are most successful when the maternal and neonatal care package is integrated into a fully functioning health system.

“However, simply increasing the number of midwives to reduce maternal mortality would not be enough,” says Prof. De Brouwere. “We have to improve their training as well. Traditionally, midwives have taken up a rather supervisory role in the delivery process. They need to take a broader and more active role. In Morocco, we see the situation steadily improving up to the point where the country is referred to as a model for other low- and middle-income countries.”

In addition, increasing the number of midwives should be seen as only one in a number of strategies to improve maternal and neonatal health: “We saw the series in The Lancet as an opportunity to highlight that  it is also about expanding the network of health facilities, reducing financial barriers, and improving the overall quality of care, ” De Brouwere adds.

The authors also provided evidence of the over-medicalisation of pregnancy, and the use of unnecessary medical interventions: “We see a trend where medical doctors prefer a caesarean section over a natural birth. In urban China, for example, more than 60% of the new-borns are delivered by C-section. Among the richest Brazilians, the number has risen to 80%. It goes without saying that this drives up the cost of medical care, but also the number of complications. In countries with delivery centres where medical doctors are not part of the staff, a midwife will only make the decision to transfer a woman to a hospital when the health of the mother or child is in danger. And even when midwives are supervised by medical doctors, we often see fewer complications because the doctors show up too late to the delivery to make the call for a C-section.”

More information on the series: www.solution98.org