Room for improvement in midwives’ quality of care
May 5 is the recognised day for highlighting the work of midwives. International Day of the Midwife was launched in 1992 when the International Confederation of Midwives asked the world to focus on the role of midwives and midwifery, and to widen the knowledge of what midwives do for the world.
The theme this year is “Midwives leading the way with quality care”.
It could be argued that a developed country such as Bermuda already has quality care in maternity, but how do you measure quality? The World Health Organisation suggests that quality includes:
• Maternity care based on best-researched practice
• Satisfaction for individuals
• Optimal outcomes
Many women are satisfied with their care, and outcomes for mortality statistics are good. However, we could do even better and there is always room for improvement.
The ICM urges action and collaboration with colleagues in maternity care and education, so better care can be achieved. Midwives hold the key to high-quality care for normal pregnancy, birth and the postnatal period.
Midwives help women to make decisions based on their clinical needs, values and preferences, using the research evidence for their situation.
This role has been recognised in a recent survey in the United States, where the impact on state regulatory environments across the country were examined, on access to midwives, and on the association with perinatal outcomes across populations.
Results demonstrated that where midwifery was integrated, and there is access to midwives in all types of maternity settings, there were significantly lower rates of race-specific, neonatal mortality, reduced preterm and low-birth-weight infants, and lower Caesarean section rates.
Where midwives practise their full scope of practice, there were higher rates of vaginal delivery, vaginal birth after Caesarean, and breastfeeding at birth and at six months.
The term “midwife” — a protected term — means “with woman”.
So the midwives scope of practice is recognised as the responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.
This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures in the absence of a doctor.
Additionally, midwives have an important task in health counselling and education; not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood, and may extend to women’s health, sexual or reproductive health and childcare.
A midwife may practise in any setting, including the home, community, hospitals, clinics or health units.
Satisfaction around giving birth is a highly personal experience, influenced by choice of carer and place of birth. Some women would prefer hospital, others a community setting, home or birth centre, and evidence demonstrates the latter are generally safer for low-risk, normal pregnancies — although women with complicated pregnancies will need a doctor and hospital care.
The Royal College of Midwives suggests improvement is important because when care does not go well, there are high human and financial costs. Problems usually result from a combination of failures in a health system, rather than the isolated actions or omissions of a single professional.
The underlying causes may be related to limited choice being available, in reality, and a lack of women’s involvement in decision-making, unnecessary medical interventions, staff shortages and poor training, lack of capacity, poor skill mix, and organisational structures and cultures that do not support best practice.
Midwives play a role in ensuring women and their newborns navigate pregnancy and childbirth safely, but also receive respectful and well-resourced maternity care that can create, as evidence shows, a lifetime of good health and wellbeing beyond the childbirth and that of society as a whole.
• Tandy Deane-Gray is a Bermudian midwifery lecturer at the University of Hertfordshire in England. She has been a midwife for more than 30 years and has been registered both in Bermuda and in Britain