Wednesday, June 04, 2014

Midwives: improving Women's Health Globally

This week the world's midwives are meeting in Prague, for the 30th International Confederation of Midwives' triennial congress.  Many Australian midwives have gone, and will be visible with  distinctive red Akubras (hats) and pashminas.

I am 'following' (to use social media language) from my desk, via twitter 
I am a twitter newcomer, and haven't yet come to appreciate or enjoy the tiny grabs of information and links that come up.  But, I have joined, and I'm ready to learn from the experience.

The theme for the 2014 Congress is ‘Midwives: Improving Women’s Health Globally’, a theme which reflects Millennium Development Goal  (MDG) 5: 'To improve maternal health.'  Governments and global health organisations have recognized that midwives are an essential workforce to achieve MDGs 4&5 by 2015.

Midwives: Improving Women's Health Globally

Midwives save lives

There is sound logic in this statement.  Midwives work to promote health and wellness in the mother and baby, during and after pregnancy, and during the climax of birth, as well as to provide and access appropriate emergency assistance when the need arises.

It is estimated that almost 90% (87% to be precise - see IMPACT poster above) of the essential maternity care for women and newborns can be provided by midwives.  These statements seem hollow in Melbourne, Australia, where the majority midwives have no idea of how to practise their profession outside a hospital, with high rates of every intervention being the norm.  I live within 30 minutes drive of three tertiary hospitals (Women's, Monash, and Mercy), and several slightly smaller public hospitals which provide emergency obstetric services (Box Hill, Angliss, Dandenong), as well as a gaggle of private maternity services.

Most midwives in Australia would run in the opposite direction if they were asked to be responsible for 87% of the essential maternity care in their communities.   Most midwives in Australia have no concept of health promotion. 

Even the (growing) group of midwives who are eligible to provide (publicly funded) Medicare-rebated services, and who have authority to prescribe medicines, are required, by law and strict regulation, to 'collaborate' with the medical profession, whether the woman in our care needs it or not.   We are forced into a pattern of over-servicing of those who least need it.

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The poorest outcomes in pregnancy and birth occur in parts of this world where women do not have access, firstly to midwives and then to other basic maternity services: particularly parts of Africa and Asia.  These are communities where the burden of disease, such as anaemia, linked to poverty, malnutrition, intestinal parasites, malaria, ... place women at higher risk of poor outcomes.  A friend of mine who has worked with MSF in several poverty-stricken war-torn locations told me she has never before seen so much blood, or so many dead mothers!




There is little or no acknowledgment in the Australian mainstream hospital models of maternity care, of the extra-medical (the part unknown to the medical community) contribution of midwifery to maternity care, and health promotion.  The hospital protocols are dictated by the medical/obstetric faculty, in close collaboration with the insurer.  These protocols are not wrong!   Hospital insurers report costly payouts:
  • when babies suffer hypoxic brain injury that is linked to induction of labour with synthetic oxytocin, leading to hyperstimulation of the mother's womb
  • when continuous electronic fetal monitoring (CTG) is mis-understood by the midwives caring for the women, or 
  • when appropriate action is not taken in response to changes in the CTG, or 
  • when perineal tears or cuts are poorly repaired 
The insurer of Victorian public hospitals, VMIA, reports that although obstetric claims account for only 16% of claims processed, they are responsible for 33% of the costs incurred (statistics given at a VMIA webinar on Litigation, 3/6/2014).   [I have been writing at this site recently about maternity care dictated by the insurer, and it's easy to understand why it's in the insurer's interest to minimise potential litigation.]


In this context, I consider that biggest problem in hospitals is the failure to protect pregnancy, birth and the nurture of the newborn as precious, natural processes.    The fact that never ceases to amaze me is that our bodies are so wonderfully made.

Pregnancy, birth, and the nurture of children are processes driven by an incredibly powerful orchestration of hormones and physical features that support and interact whether we understand the processes or not.

Midwives work to improve women's health firstly by
protecting,
promoting,
and supporting
the natural, healthy processes of women's and babies' bodies.  This is the non-medical, non-interventionist, non-therapist side of midwifery.  Yes, there is an aspect of midwifery that demands timely and effective intervention when indicated.  It's the other side of the same coin.

'In normal birth there should be a valid reason to interfere with the natural process.' (WHO 1996)

The phrase 'protecting, promoting, and supporting ...' has been used many times in the past 2 decades with reference to the Baby Friendly Hospital Initiative (BFHI), introduced around the world by WHO and UNICEF. 

This is good.

But, the protection, promotion and support of breastfeeding does not begin when the newborn baby is taken into the mother's arms and cradled at her breast.  The response of a newborn child to the stimuli during and after birth depend on many other aspects including mother's health and nutrition, and the presence of inhibitory substances such as narcotics and regional anaesthesia that causes temporary paralysis.  The response of a woman to her newborn child is also changed by physical and chemical changes that over-ride of obliterate the mother's feelings and reactions in birth.  These medical procedures and substances need to be restricted, for use only when indicated, and with extreme caution.

I am blown away by the statistic quoted earlier in this post, that
It is estimated that almost 90% of the essential maternity care for women and newborns can be provided by midwives.
From my sphere of knowledge and influence, in Melbourne's middle class, leafy Eastern suburbs, I find it difficult to believe, yet I know that this statistic has been made on reliable information.

!!!

Welcome to our newest grandchild, born this week!

In concluding today's post, I want to acknowledge and thank God for a wonderful young mother, Anna, and her husband Josh, who this week have welcomed our newest grandchild: a healthy baby born at Term, spontaneously, into the loving arms of a strong, healthy mother.






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