For the Sake of Women and Newborns: Strengthen Midwifery

The preeminent medical journal The Lancet has just released its Midwifery Series, a major project to take stock of the contribution of midwifery to the well-being of childbearing women and newborns. All content from this remarkable Series is freely available after complimentary journal registration.

Four papers from large multi-national research teams are the heart of the Series. The authors present a new framework for quality maternal and newborn care, demonstrating that dozens of midwifery care practices have been found to improve the health of women and babies. They conclude that women and babies in all nations – from those with limited maternity care infrastructure to those such as our own with an overly medicalized approach to childbearing – can benefit from full integration of midwifery into their health care systems.

What are hallmarks of midwifery care? The Series definition references “skilled, knowledgeable, and compassionate care” of women, newborns, and families from before pregnancy through the postpartum and newborn period. The authors further clarify that quality midwifery optimizes biological, psychological, and social processes at this time; focuses on prevention; prevents and manages complications; arranges for other needed care; respects women’s views; and enhances their ability to take care of themselves and their families. This is precisely what the majority of childbearing women and newborns who are not facing serious health concerns need as primary, first-line maternity care.

Further, the Series includes an overview of research on what women want from their maternity care, which again matches closely with the midwifery approach to maternal-newborn care. Priorities for childbearing women include respectful, clinically competent care; good communication and information; responsiveness to individual needs; and being involved with their care.

I had the honor of contributing one of the invited Series commentaries, from the perspective of needs of childbearing women and newborns, with my co-author Mary Newburn. We express appreciation for core midwifery skills and knowledge that enhance innate, hormonally-driven processes of women and their babies around the time of birth. These processes optimize labor, birth, breastfeeding, and attachment, and limit the need to use costly external interventions with many side effects.

Our commentary also finds that such a cautious approach is prudent if not crucial, given the increasing understanding of human microbiome, epigenetic, and other evolving frameworks: exposures during this sensitive period of rapid human development can have unintended long-term effects.

And Mary and I express concern that many essential midwifery skills are devalued and becoming lost in the modern, technology-intensive approach to maternity care. Examples include non-drug help with labor progress and comfort, and skillfully attending the vaginal birth of breech or twin babies. All childbearing women need access to essential maternity services, and countries such as our own with considerable influence on maternity care globally need to step up our efforts for maternity care quality improvement for the sake of women and babies both here and worldwide.

Years in the making, the Midwifery Series is a timely contribution to growing efforts to improve the quality, outcomes, and value of maternity care. Those who care about the well-being of women and newborns will be rewarded by completing The Lancet website’s complimentary registration and delving into the rich new open-access resources in this Series.

Filed in Blog on Mon., Jun 23, 2014

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