This article was originally published by Sage Journals.
The World Health Organization assigned 2020 as the year of the midwife. Midwifery is a commonly misunderstood profession. A frequent view of midwives is that they assist childbirth; even though it is a part of their role, professional midwives are skilled in the holistic care of women and their newborn infants. Midwives are knowledgeable and provide “compassionate care for childbearing women, newborn infants, and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum, and the early weeks of life” (Horton & Astudillo, 2014, p. 1075). Additionally, midwifery care includes family planning and other reproductive health services that could be set not only in hospitals and outpatient clinics but also in the community—thereby essential midwifery services are a core part of universal health coverage.
Midwifery practice is crucial in achieving high-quality maternal and newborn care in all settings and countries. It was estimated that midwifery with both family planning and maternal and newborn health interventions could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths in the world (Homer et al., 2014). Low- and middle-income countries with high maternal mortality deployed midwives in early 1990, producing a drop in maternal mortality ratio of 63% over 20 years (Lerberghe et al., 2014).
Better health outcomes have been described in high-resource countries (Canada, Australia, Spain, among others) when a higher percentage of births are attended by midwives (50%-75%) compared to the United States that has a lower rate (midwives attend less than 9% of births). The minimal percentage of midwifery care in the United States could be one reason why globally, the United States ranks 57th in the world for infant mortality and 48th for maternal mortality, despite being the country with the most significant health expenditure. States with greater integration of midwives across all settings were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, breastfeeding, and significantly lower rates of cesarean, preterm birth, low-birth-weight infants, and neonatal death (Vedam et al., 2018).
Midwifery plays a crucial role in enabling access to cultural care to women. Black and American Indian/Alaska Native (AI/AN) women had significantly more pregnancy-related deaths per 100,000 births than White women. The pregnancy-related mortality ratios for Black and AI/AN women aged ≥30 years were approximately four to five times that of their White counterparts during 2007-2016. Moreover, Black infants are over two times more likely to die in their first year compared with white infants. A growing body of evidence indicates that stress from racism and racial discrimination influences maternal mortality and morbidity among Black and AI/AN women, regardless of socioeconomic status. Perhaps one of the crucial strategies to improve the continued crisis in the United States health system concerning racial and ethnic disparities in pregnancy-related deaths could be the need to incorporate midwifery care in women’s health settings. Hopefully, the National Perinatal Task Force lead by a midwife, has initiated a movement to incorporate health care models that provide community-located and culturally based health resources. A critical point of the philosophy and model of midwifery care includes the promotion, protection, and support of the women’s reproductive and sexual health and maintenance of rights and respects of ethnic and cultural diversity, enhancing informed decision making, and flexible care (International Confederation of Midwives, 2014). Increasing the number of midwives in ethnic minorities and diversifying the maternity care workforce with individuals who represent the lived and cultural experiences of the patients they serve is warranted. New challenges are ahead to achieve the newly Healthy People 2030 target of reducing maternal deaths of 15.7 per 100,000 live births, and infant death reduction of 5.0 infant death per 1,000 live births within the first year of life. The overwhelming evidence shows the increases in health outcomes when midwives are incorporated in the health care team. We must welcome and support efforts to increase the number of midwives in the health professional team.
Let us celebrate this year of the midwifery by understanding their role not only in countries with low or middle resources but also the incredible difference that they are making in countries with high resources. Let us respect and support their work as part of the health professional team, celebrate their commitment to saving lives, and defending women’s rights to assure safe and positive reproductive health.