The State of Maternal Health Worldwide
“When you are working with the pregnant mothers in any society you are reaching into the core of that society; improving the way mothers are treated, nurtured, heard, respected and medically supported will deeply effect family life and the society as a whole.” ~ Jacky Bloemraad de Boer, Midwife International Program Director
Around the world, we are experiencing a maternal health crisis. According to the 2011 State of the World’s Midwifery Report by the UNFPA, approximately 350,000 women die while pregnant or giving birth every year— almost 1,000 a day. Of these women, 99 percent die in developing countries. An estimated 8 million more suffer serious illnesses and lifelong disabilities as a result of complications at the time of childbirth. Every year up to 2 million newborns die within the first 24 hours of life. In addition, there are 2.6 million stillbirths of which approximately 45 percent occur during labor and birth. Millions more newborns suffer birth traumas that impair their development and future productivity.
Experts from the WHO and UNFPA agree that these dismal maternal health outcomes result from a “triple gap, consisting of competencies, coverage and access.” In most countries there are not enough fully qualified midwives and others with midwifery competencies to manage the estimated number of pregnancies, the subsequent number of births, and the 15 percent of births that generally result in obstetric complications.
The WHO estimates that 38 countries have severe shortages in maternal health services. A few countries will need more than a 10-fold increase in the number of midwives, with most needing to either double, triple or quadruple their midwifery workforce to improve quality and coverage. Several countries have no existing midwife training program and fewer have a formal certification and monitoring process. Second, coverage of emergency obstetric and newborn care facilities is low and existing facilities are often insufficiently staffed and poorly equipped. This is most acute in rural and/or remote communities. Third, access issues from women’s perspectives are often not addressed.
Comprehensive midwifery education can change these maternal health statistics. Considering that 40% of under-five mortality occurs in the first 28 days of life, improving accessibility to skilled birth attendants has the potential to dramatically impact child-mortality around the world. Furthermore, skilled maternal and immediate neonatal care as delivered through a trained midwife is estimated to be one of the most cost-effective interventions to reduce maternal and neonatal mortality. If implemented internationally with 95% coverage, it is projected to advert more than 100,000 DALYs on an annual basis.
The Midwives Model of Care
The Midwives Model of Care™ treats birth as an essentially healthy process and a significant life event. This model is woman-centered and empowers women to make their own choices about the care they receive. (Midwives Model of Care, 1996).
The Midwives Model of Care™ holds true that the majority of women are perfectly equipped to safely deliver at home, close to their loved ones, with the care of a professional midwife, and without unnecessary interventions or the use of invasive electronic equipment. If the mother is in control and is empowered with an enabling environment, the birth process develops successfully and mother and baby are safe. Within the Midwives Model of Care, the professional midwife is also well-prepared to respond to the eventuality of time-pressed emergencies, to recognize when higher-level medical care is required, and to facilitate the transition to that care.
The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. It includes: Midwife Certification
- Monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle; Midwife Certification
- Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; \
- Minimizing technological interventions; Midwife Certification
- And identifying and referring women who require obstetrical attention. Midwife Certification
The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section. To lower the maternal mortality rates, we must improve the safety of homebirth (see below for more on homebirth). The safety of mother and child rests on the accessibility of a well-trained midwife, as well as emergency care. It is the right of women and families to make informed choices about how and where they want to give birth. Midwife Certification
Source: Citizens for Midwifery Midwife Certification
Certified Professional Midwives (CPMs)
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for midwife certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.
Most CPMs own or work in private home or birth center based practices throughout the United States, Canada, and Mexico. Providing continuous care for women throughout their childbearing cycle, CPMs generally carry a relatively low client load (averaging 3-6 births per month) which allows for more personalized and comprehensive care than typical obstetrical practices. The scope of practice of the CPM is derived from the NARM Job Analysis, state laws and regulations, and individual practice guidelines developed by each midwife according to her skills and knowledge. Midwife Certification
Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. In partnership with their clients they carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary. The key elements of this education, monitoring, and decision making process are based on Evidenced-Based Practice and Informed Consent.
Learn more about how our programs serve NARM certification through the PEP Process.
In most cultures throughout history, women have given birth at home. The majority of women worldwide continue to birth their babies in non-hospital settings today. In many cultures birth is viewed as an integral part of family life. The advent of obstetrics in this century had a tremendous effect on childbirth customs in the United States. The birthing process became segregated from mainstream family life. Many were led to believe that the only safe birth was a hospital birth. Though doctors and hospitals took credit for statistics that indicated that birth was more successful than in previous centuries, in reality better nutrition, hygiene and disease control improved outcomes. Even today US statistics don’t support the premise that the only safe birth is a hospital birth. The US ranks 28th among industrialized nations for healthy births, at 7.0 infant deaths per 1000 births. (These data are based on 2002 statistics from the Maternal and Child Health Bureau: US Department of Health and Human Services.)
By the 1950s, most births in the US were taking place in hospitals. Cesareans, epidurals and heavy doses of pain medication became the norm. Women were denied feeling and experiencing birth through their bodies, and the drugs were having adverse effects on mothers and babies.
In the 1960s and ’70s, women began to question and challenge the way obstetricians were treating them—as though childbirth were a sickness. Women began to reclaim their power, and the homebirth movement was born.
The 1990s became a time of maternity awareness. People were concerned with making all of pregnancy and birth a family experience. Today – through midwife certification and utilization – a carefully monitored homebirth has been proven to be very safe and successful for women who have been helped to stay low-risk through nutrition and good prenatal care. (See Johnson,K.C., and B.A. Daviss. 2005. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 330: 1416)
For more information on why homebirth works, go to Jill Cohen’s article in Midwifery Today, The Homebirth Choice.
Expanded midwifery services could save millions of lives
According to the United Nations Population Fund (UNFPA) State of the World’s Midwifery Report, Up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded.
The study, The State of the World’s Midwifery 2011, estimates that an additional 112,000 midwives need to be deployed in 38 countries to meet their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required under the Millennium Development Goals (MDGs). Globally, 350,000 midwives are still lacking, it says.
The report, launched at the Triennial Congress of the International Confederation of Midwives (ICM) Durban, South Africa, says if adequate facilities were accessible to deal with complications at their onset, many deaths could be averted: 61 per cent of all maternal deaths; 49 per cent of all stillbirths; and three in every five newborn deaths.
The report adds that if midwives are in place and can refer the most severe complications to specialized care, up to 90 per cent of maternal deaths could be prevented.
“Ensuring that every woman and her newborn have access to quality midwifery services demands that we take bold steps to build on what we have achieved so far across communities, countries, regions and the world,” said Ban Ki-moon, Secretary-General of the United Nations, in his foreword to the report.
Each year, 358,000 women die while pregnant or giving birth, some two million newborns die within the first 24 hours of life and there are 2.6 million stillbirths, it says.
“The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children,” said Babatunde Osotimehin, Executive Director of UNFPA.
UNFPA supports midwifery training programs in 30 countries, including, for example, some 18 schools in Ethiopia. A UNFPA official said the agency will integrate the report’s findings in its current curricula and plans an expansion of UN midwifery training programs.
The report, a result of collaboration among 30 partners, including the UN Children’s Fund (UNICEF) and the World Health Organization (WHO), surveyed 58 countries, which together account for just under 60 per cent of births worldwide and yet 91 per cent of all maternal deaths.
Among the 38 countries most desperately in need of midwives, 22 need to double the workforce by 2015; seven need to triple or quadruple it; and nine – Cameroon, Chad, Ethiopia, Guinea, Haiti, Niger, Sierra Leone, Somalia and Sudan – need to dramatically scale up midwifery by a factor of between six and 15, it says.
“Midwife International is dedicated to creating a new generation of globally-minded midwives and they are working to do just that.” ~ Kesli Hines, MI Global Midwife Training student
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