Recently, I read news of carbetocin, a heat-resistant oxytocic that could mostly be used in developing countries where refrigeration facilities are beset with issues (Matthews-King, 2018). Problems can include inconstant power supply, a lack of money to afford the fridge or a lack of facilities where drugs and medical supplies can effectively be stored. Additionally, the absence of skilled birth attendants who can administer effective care in the event of a postpartum haemorrhage can hamper maternal mortality and morbidity. This is only one of the issues that affect women's survival in pregnancy and childbirth.
Maternal mortality continues to be a serious issue worldwide, and access to healthcare is not a universal right. More than 340 000 women and 3 million infants around the world die each year from preventable causes. The majority of these deaths could be prevented with enough properly trained and adequately resourced midwives. It is remarkable how much the effect of a trained midwife can have upon infant mortality: for every £1 invested in a midwife, £16 is saved in public health costs. Where there is a midwife, infant and maternal mortality fall (International Confederation of Midwives, 2018).
Worldwide, many people exist in extreme poverty having less than $1.90 a day to survive (The World Bank, 2018). In these circumstances, it is unsurprising that maternal mortality is as high as it is in certain places. Lack of access to suitable food, as well as to affordable healthcare, affects the choices that families can make and the health of mothers as they embark on pregnancy.
Hearing Joy Kemball speak at a recent conference, she reminded me that midwives have the skills to resuscitate a baby, control a postpartum haemorrhage and build the very foundations that a woman's journey into motherhood is built upon. Midwifery is widely acknowledged as a vital and cost effective contribution to high standard maternal care, however this is far from the case in all countries (Renfrew et al, 2014).
In the countries where access to care for mothers and babies is not inadequate, the concern is over medicalisation of pregnancy and birth. Mothers and babies who are otherwise healthy live with lasting effects of interventions that they may not necessarily have needed. Financially, the consequences of these actions include increased medical bills, which can leave women vulnerable to poverty and bankruptcy (Renfrew et al, 2014). One report suggests that one-quarter of Americans experience difficulties in paying back medical bills, although the challenges they face extends across a broad range of circumstances (Hamel et al, 2016). Here, the issue is that when patients are consumers, there is competition between midwives and doctors to provide care.
However, the world is slowly coming round to the value of midwifery as a profession: the World Health Organization (WHO) has more recently started to use the word ‘midwife’ in their literature instead of ‘skilled birth attendant’. While one may argue that perhaps this is an unnecessary change, certain research (Adegoke at al, 2012) suggests that the title ‘skilled birth attendant’ holds differing meaning and skillsets, depending upon the country in which they work.
However this care is given, I would think that the data from the Albany model (Albany Midwifery Practice, 2018) shows how much a midwife can influence and provide good quality care, especially in a model where the midwife is part of the fabric of the community and women's lives during pregnancy, providing continuity and gentle hands that guide. As midwives, we do not just look after a woman's physical needs. Instead, we meet women where they're at and nurture them socially, emotionally and physically, preparing and guiding women and their families through pregnancy into parenthood in ways that no other professional does.