Of an estimated 139 million births globally each year, an estimated 289,000 women will die during pregnancy, labour or soon after, 2.6 million will suffer stillbirths and 2.9 million infants will die in the first month of life (Renfrew et al., 2014). Behind these figures lie individual stories of lives lost, bereavement, grief, family and social disruption, economic consequences. For many women and babies, ill health and morbidity will follow birth. Poor quality maternity and new born care is a factor. While many women have no or inadequate access to any care, others are exposed to unnecessary interventions, with underuse and overuse of treatment contributing to acute and chronic clinical and psychological morbidity for an estimated 20 m childbearing women (Renfrew et al., 2014). A significant contribution of the Lancet Series on Midwifery was to highlight the problems of inadequate or lack of care and high mortality and morbidity rates in some parts of the world but also to describe over intervention, to give prominence to a problem that often seems to be in a blind spot. It sets the foundation for a global approach to the provision of high quality care. Midwifery and midwives have the potential to resolve these problems. The Lancet Series on Midwifery offers a comprehensive evidence based framework for quality based on the needs of women and infants, supported by an explicit philosophy and framed by values and consideration of the organisation of care and the characteristics of care providers. This is a framework for quality care that has the potential not only to save lives, but to build better long term health and well-being, stronger family relationships and capability to care for the baby to adulthood. The aim of the Series was to ‘examine, comprehensively and systematically the contribution that midwifery can and does make to the care of women and infants, and the health system and other conditions for it to work effectively’. This examination started with the needs and wishes of women and babies, ‘to be healthy, safe, supported and respected to give birth to a healthy baby that can thrive’ (ten Hoope-Bender and Renfrew, 2014). The application of the evidence presented could avert more than 80% of maternal and new born deaths including stillbirths. Midwifery has a pivotal, yet widely neglected part to play in accelerating progress to end preventable mortality of women and children (Horton and Astudillo, 2014). The definition of midwifery proposed is of a package of care that can be provided by a number of caregivers, with an emphasis on ensuring that women receive the complete package of midwifery. This definition may be contentious, because it is proposed that it is not only midwives who can provide this package of care, however it is a pragmatic approach to ensure effective quality care for women and babies in services which are provided by a number of personnel, and situations in which there are no midwives, or where midwives are unable to implement their full scope of practice. Nevertheless ‘midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed and regulated’ (Renfrew et al., 2014) and integrated into a functioning health system as part of a multidisciplinary team (ten Hoope-Bender and Renfrew, 2014). The crucial part that midwives play is very clear. Importantly, this framework takes us beyond ‘a focus on essential and emergency interventions for the minority to skilled care for all’ to emphasising and arguing convincingly of the need for improvement in the quality of care alongside universal coverage. The approach described will provide lifesaving skills more effectively, but also ‘identifies the value of promoting and supporting the normal processes of pregnancy, birth, post partum and the early days of life, and of strengthening women's own capabilities to care for themselves and their families’. It highlights the important balance that midwifery brings to the care of mothers and infants, preventing expensive and potentially harmful interventions (ten Hoope-Bender and Renfrew, 2014). There is evidence of the effectiveness of midwifery and midwives, particularly when working in systems of care where there is continuity, where services are integrated across communities and facilities. Much of this evidence is based on high and middle income countries but modelling the scaling up of midwifery, particularly when family planning is included, could avert many maternal and infant deaths. The inclusion of specialist care in the scenarios resulted in a greater number of deaths being prevented (Homer et al., 2014). Where will the Lancet Series on Midwifery take us? How can we use the Series, which offers a quality framework (Renfrew et al., 2014), modelling of the effect of scaling up midwifery
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Jan 1, 2015
Sathya Jeganathan + 3
Open Access