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Strengthening midwifery

I attended a conference organised by the International Confederation of Midwives and the United Nations Population Fund (UNFPA) on 5 June on strengthening midwifery. It was really lovely to meet midwives from all over the world and discuss the issues around providing care for mothers and babies.

The conference spoke about the global need for more midwives and the central part midwives play in caring for women and newborns that is in many parts of the world the most risky times in their lives. Over the last few years the world stopped talking about midwives and spoke about skilled birth attendants and those with midwifery skills, seeming to forget that the most obvious person to provide skilled attendance at birth or be equipped with midwifery skills is, not surprisingly, a midwife.

UNFPA and the World Health Organisation has reaffirmed its commitment to midwives as a means to tackle high levels of maternal and newborn mortality. It’s generally agreed that there are not enough midwives, but the exact number required to meet the needs of women and their babies is not known.

A key issue is training. In the United Kingdom if you want to be a midwife there are two routes to qualification. You can first train as a nurse and then do an additional year and a half in midwifery or you can train directly as a midwife, which takes three years. I chose the direct entry route and, while I have every respect for my colleagues who trained as nurses, I like the fact there is choice. In many countries in the developing world with acute shortages of midwives, this choice does not exist. To be a midwife you must first be a nurse.

If we are so short of midwives do we really want to spend time having potential new recruits training as nurses first? It would be quicker to train directly as a midwife. Some people say “Ah yes, but if you train first as a nurse you have a wider skill set and can also provide other types of care.”

Is this really what is needed? We know when we look at care provided over the maternal child health continuum that one of the weakest points is the period of labour, birth and the first days of life. We need to intensify efforts in this area of care and not dilute them by having the most obvious care giver dividing her time between caring for mothers and babies and conducting an immunisation campaign, or not doing midwifery at all.

For example, in many of the countries where I have worked, I have met midwives in charge of the pharmacy department, running therapeutic feeding programmes and working in operating theaters. Is this really the best use of their skills and the most efficient use of training? If someone is trained solely as a midwife, all their work is focused on the mother and her baby, and her time is not as likely to be diverted to other tasks.

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