Gambia
needs urgently more Midwives than ever before
What
does Midwifery mean?
Midwives
are specialists who are dedicated to promoting the health of pregnant women and
babies. The World Health Organization recognizes the importance of midwives and
endorses them as the primary health care providers for pregnant women all over
the world.
As
the world celebrates another International Midwives’ Day, just as it was first
celebrated on the 5th of May 1991, it is important that we again look into the
significance of midwives in our hospitals, communities, and especially in the
most remote villages. There has been measurable success with midwife-led
maternal care at safeguarding and improving the survival chances of pregnant
women and babies.
In
general, there are three categories of midwives all over the world: those with
formal training who have attained one form of education or the other but have
not necessarily been trained in the field of nursing; nurse-midwives who after
having completed the required nursing program, go on to take courses in midwifery;
and finally, local women who practice in villages and remote areas, who in most
cases have not had any formal education.
However,
it’s important to note that they all play a vital role in promoting the health
of pregnant women and babies in the respective societies they belong. And we
all should be glad that the world has taken a day off to acknowledge these
unsung heroes who have helped to successfully usher us into the world with
their committed and dedicated hands.
Midwifery
encompasses care of women during pregnancy, labour (child birth) and the period
after labour as well as care of the new-born. It includes measures aimed at
preventing health problems in pregnancy, the detection of abnormal conditions,
the procurement of medical assistance when necessary, and the execution of
emergency measures in the absence of medical help.
Midwifery
services are key to a healthy and safe pregnancy and childbirth. Worldwide,
approximately 287 000 women die every year due to pregnancy and childbirth
related complications. Most of these largely preventable deaths occur in
low-income countries and in poor and rural areas. WHO supports countries’
efforts to make sure that every women and every newborn baby receive the best
possible health care.
Many
maternal and new-born deaths can be prevented if competent midwives assist
women before, during and after childbirth and are able to refer them to
emergency obstetric care when severe complications arise.
However,
the May 5 events were only the beginning. The celebration will continue for a
few more days as organizations around the world to make space for considering
the vital ways that midwives contribute to the health and well-being of mothers
and children everywhere.
10
facts on midwife
Competent
midwives decrease the risk of dying during childbirth
About
800 women and more than 8000 new-born die every day due to largely preventable
complications during pregnancy, childbirth and the immediate postnatal period.
In addition, every year, nearly 3 million babies are stillborn. Many of these
lives could be saved if every birth were attended by a midwife
More
than one third of all births take place without a midwife or other skilled
health staff
Millennium
Development Goal 5 (MDG 5) aims to improve maternal health. More midwives need
to be trained to achieve the MDG 5 target to increase the number of births
attended by skilled health personnel to 95% by 2015.
Midwives
also provide essential care after birth
After
childbirth, midwives support mothers to breastfeed and to prevent mother-to-child-transmission
of HIV. They check the health of the new-born and also counsel the mother on
new-born care, birth spacing and family planning.
Only
one in three rural women in developing areas receives necessary care
During
pregnancy and childbirth, women in rural areas, remote districts and smaller
health facilities in particular suffer from a lack of midwives and health
personnel with midwifery skills serving their communities. Therefore, countries
need to improve distribution and retention of midwives, especially in poor and
remote areas.
Midwives
need regular refresher training and support
They
need training to acquire and maintain competencies to provide high quality care
to women and new-born. In addition to providing opportunities for midwives to
update their skills, governments need to adopt policies that allow midwives to
use their full knowledge and expertise in communities, health centres and
hospitals.
Working
in teams with the necessary supplies is essential for midwives
Midwives
need more than just training to be successful. In order for them to provide
high quality care they also need adequate infrastructure, readily available
drugs and supplies, water and sanitation, communication, and a functioning
referral system if complications arise during childbirth.
Reliable
data on the numbers of practicing midwives are scarce
We
do not know how many trained staff are actually working in the delivery room
and how the workforce is distributed within regions and countries. This
information is needed to develop targeted national plans and programmed.
Many
trained midwives leave their home countries to work abroad
Countries
often have difficulties retaining trained personnel due to difficult working
conditions, poor remuneration, support and supervision and a lack of career
paths. Many trained midwives work abroad for better salaries and more
favourable working conditions. This creates a dearth of skilled staff in
countries that need them most.
WHO
advises countries on how to support midwives
WHO
works with countries to ensure that midwifery issues are addressed in national
health strategies and plans. WHO encourages countries to better recognize
midwifery as a profession and support midwives as an essential pillar of the
maternal and new-born healthcare workforce.
According
to recent estimates, countries require a minimum of six health workers with
midwifery skills per 1 000 births to make sure that 95% of women are attended
during childbirth and to accelerate the reduction of maternal and new-born mortality.
WHO supports countries to address the shortage of health workers.
UNFPA
estimates that 1,000 women die every day and 5,500 new-born die in the first
week of life for lack of adequate medical care and investing in human resources
to tackle the current global shortage of some 350,000 of these “unsung heroes”
of maternal and new-born health.
UN
World Health Organization (WHO) noted in her statement that midwives are
essential to the delivery of quality health services before, during and after
childbirth for women and new-borns.
“Despite
this vital role in improving maternal and newborn health, recent analyses
indicate that midwives and midwifery services are unequally distributed both
between and within countries,” she said.
“Direct
investment in midwifery education, regulation and association will create the
necessary conditions for the midwifery profession to achieve its full
potential.”
The
International Day of the Midwife, 13 August, is a day to celebrate the
life-saving work of the world’s midwives. Midwives are the primary care givers
for millions of women and new-born before, during and after childbirth, and
also offer women and girls essential counselling and education on family
planning and reproductive health.
Trained
midwives save lives, and, if deployed in larger numbers, could avert
approximately two-thirds of the nearly 300,000 maternal deaths and 3 million
new-born deaths that occur each year. However, the 73 countries that claim 96
per cent of these maternal deaths have only 42 per cent of the world’s
midwives, nurses and doctors.
Today,
nearly 800 women continue to die every day from complications of pregnancy and
childbirth,” “We must do more. And we must start with training and providing
more midwives. The future we want is one where midwives play their full role in
ensuring safe deliveries, promoting healthy birth spacing and protecting the
health and rights of women and girls.”
Midwives
deliver – and not only babies, they save lives and promote good health in
societies as a whole. They are an essential workforce in an effective
health-care system.”
United
Nations officially hailed the significant impact of midwives on the health of
women and new-borns, and called for greater investment to ensure their
life-saving services are available to all who need them around the world.
Who
could be a Midwife?
A
midwife is a person who, having been regularly admitted to a midwifery
educational program “in the Gambia at the School of Nursing and Midwifery “that
is duly recognized in the country in which it is located, has successfully
completed the prescribed course of studies in midwifery and has acquired the
requisite qualifications to be registered and/or legally licensed to practice
midwifery.
The
midwife is recognized as a responsible and accountable professional who works
in partnership with women to give the necessary support, care and advice during
pregnancy, labour and after birth period, to conduct births on the midwife’s
own responsibility and to provide care for the infant.
This
care includes preventive measures, the promotion of normal birth, the detection
of complications in mother and child, accessing of medical or other appropriate
assistance and the carrying out of emergency measures.
The
midwife has an important task in health counselling and education, not only for
the woman, but also within the family and community. This work should involve
antenatal education and preparation for parenthood and may extend to women’s
health, sexual or reproductive health and childcare, and to gain the knowledge
to counteract the lack of pain relievers and antiseptics.
A
midwife may practice in any setting including in the home, the community,
hospitals, clinics or health unit.
Midwives
in Africa and Gambia no exception
There’s
no doubt that Africa needs more midwives than ever before, considering the fact
that there is an increasing demand on the entire continent on delivering the
2015 Millennium Development Goals.
As
the deadline for the MDGs is fast approaching, and if African nations must
realize these goals, it is essential that the continent acknowledge the
important work midwives around the continent are doing. We need to creatively
look for ways to increase support for them with more funding so they can
actually save more lives.
Considering
the poverty level of many African nations, they need to support midwife led
care and recognize it as an effective tool in achieving the 2015 MDGs and post
2015.As the primary providers of antenatal and postpartum care in most low and
middle-income countries, midwives can be a cost-effective means to tackling the
prevalent maternal and new-born mortality in the continent.
A
report on midwife-led care in five countries, published by Support Summaries,
revealed that the use of midwife-led care may reduce costs when compared to
medical-led care, thus improving the delivery of health services to women and
babies. The report also provided evidence that in cases of limited resources,
midwives provide an affordable alternative to medical care with equivalent
outcomes.
Along
with being cost-effective, the midwife-led model assures continuity of care as
well as the constant examination of mother and child’s physical, psychological
and total well-being. With midwife-led care, counselling expectant women on
antenatal care, immunization and also the importance of breast feeding becomes
much easier. Midwife-led care also increases a woman’s chances of becoming
familiar with her midwife, such that she feels more relaxed and in control
during labour.
Community
midwives
Many
midwives also work in the community. The role of community midwives includes
the initial appointments with pregnant women, managing clinics, after birth
care in the home, and attending home births. Community midwife would typically
have a pager and be responsible for a particular area, contacted by ambulance
control when needed. Sometimes they are paged to help out in the hospital when
there are insufficient midwives available.
You
can find further information about Midwifery at the “School of Nursing and
Midwifery in Banjul”, send e–mail to azadehhassanmd10@gmail.com or send text to
002207774469/3774469
Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director Medicare Health Services.