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Loice Vavi-Health Matters

Attendants for women going through childbirth have always been there since time immemorial. Tradition has seen this role of attending women being done by older and wise women in the family or community. Advances in knowledge, technology and gender roles has witnessed changes in traditions. The term Midwife has been contended lately. I hope through this article I will be able to shed more light on these issues as the world commemorates International Day of the Midwife on 5 May.

As we know today, a midwife is a person who graduated from an approved program that meets the essential competencies of International Confederation of Midwives (ICM). But midwifery is an ancient profession that is as natural and critical to humanity as birth itself, upholding and reflecting the cultural practices of women and their families.  

A brief glimpse into the history of midwifery profession: 

•The practice of midwifery can be traced back to the palaeolithic era (40 000 B.C.), where pregnancy and childbirth required women to give birth in challenging and often life-threatening environments. Women supported themselves during birth based on knowledge and skills they learned from observing other mammals.  

•Indigenous cultures all over the world practised various traditions around birth, many of them spiritual and rooted in nature and herbal medicine. The Māori people of New Zealand, for example, used supplejack and flax root for contraception, and would typically burn the designated birthing spot after labour. 

•From 3500 B.C. to 300 BC, the Egyptian and Greco-Roman eras saw enormous progress in the development and acknowledgement of midwifery as an autonomous, scientific and respected paid profession. But in late 300 BC, the social attitudes about female midwives changed, and midwifery became a profession under the hierarchy of male-supervised medicine. 

•In Europe and the Mediterranean, the biblical era (2,200 BC – 1,700 BC) saw the empowerment of women play a large role in building professionalism in midwifery. However, by the arrival of the High Middle Ages (1,000-1,250 AD), female midwives or healers were considered heretics or witches and would therefore be hung or burned to death. 

In China, female midwives practiced midwifery by means of traditional Chinese medicine — like qi, yinyang and wuxing principles — for thousands of years. These women were often illiterate, and most of these practices were confined within small communities and performed in the home. These practices remained the same until the 13th century, when male medical practitioners began to formalise and control medicine and obstetrics. 

In both Thailand and Chile, centuries-old practices of midwifery were originally and historically services reserved for the poor and underprivileged, although today, women and birthing people of all socioeconomic backgrounds access midwives. 

All over Africa, traditional midwives and other healers have been an integral part of medicine for centuries. But when Europeans brought African people to the United States and enslaved them in the 17th century, some African women were enslaved to train and serve as midwives. Midwives were still the main healthcare providers in birth on the colonies, and they continued to serve African and white women in birth — until the turn of the 19th century, when the male physician replaced midwives with the introduction of male-supervised obstetrics. 

Midwifery has come a long way since its early origins. Each region, country and community has its own history of midwifery, unique to its respective history, belief systems and political context. 

Midwifery competencies

A midwife has a set of competencies that he/she should possess according to the International standards.

There is a set of general competencies. This group of competencies outline the self-awareness that the midwife should possess. The professional responsibility and legal implications around her practice. It outlines the relationship the midwife holds with the women under her care and the need to work with other health care workers as appropriate.

The second set of competencies is around pre pregnancy and antenatal care. The midwife should be able to guide and support women and families seeking to going through childbirth. Support is given to monitor the health of the woman, the baby in the womb and the progress of the pregnancy. The family is supported to prepare for the arrival of the baby. 

If any ill health is identified, the midwife involves other health care workers as appropriate.

The third set of competencies are care during labour and birth. This set of skills involves midwife supporting women to have a natural childbirth. The midwife is adequately trained to handle any immediate complications arising in the natural birth. Referral to other health care workers is instituted appropriately. The midwife helps the new-born adjust to the environment outside the mother.

Ongoing care of women and new-borns is the fourth set of competencies possessed by midwives. These skills enable the midwife to support the woman and baby to bond and grow well. Women and families get support to plan their families from the midwife.

Difference between Midwives and other birth attendants

Midwives are clearly trained, qualified and certified persons to support women and families throughout childbirth, sexual and reproductive health care and rights. Midwives are thus distinct from other birth attendants.

There are traditional birth attendants who in the days of old would attend birthing women basing their expertise on experience, age and personal experience. Then there are skilled birth attendants. This would include other cadres of health care workers who undergo training to support birthing women.

Midwives are the best suited cadre to support women and families throughout the reproductive life. Happy International Day of the Midwife.

 

Your reference notes

Midwifery Competencies from ICM

1.a Assume responsibility for own decisions and actions as an autonomous practitioner.

1.b Assume responsibility for self-care and self-development as a midwife

1.c Appropriately delegate aspects of care and provide supervision

1.d Use research to inform practice 1.e Uphold fundamental human rights of individuals when

providing midwifery care

1.f Adhere to jurisdictional laws, regulatory requirements, and codes of conduct for midwifery

practice

1.g Facilitate women to make individual choices about care

1.h Demonstrate effective interpersonal communication with women and families, health care teams, and community groups

1.i Facilitate normal birth processes in institutional and community settings, including women’s

homes

1.j Assess the health status, screen for health risks, and promote general health and well-being of

women and infants

1.k Prevent and treat common health problems related to reproduction and early life

1.l Recognise conditions outside midwifery scope of practice and refer appropriately

1.m Care for women who experience physical and sexual violence and abuse

2. Pre-pregnancy and antenatal

2.a Provide pre-pregnancy care 

2.b Determine health status of woman

2.c Assess fetal well-being

2.d Monitor the progression of pregnancy

2.e Promote and support health behaviours that improve wellbeing

2.f Provide anticipatory guidance related to pregnancy, birth, breastfeeding, parenthood, and

change in the family

2.g Detect, stabilise, manage, and refer women with complicated pregnancies

2.h Assist the woman and her family to plan for an appropriate place of birth

2.i Provide care to women with unintended or mistimed pregnancy

3. Care during labour  and birth

3.a Promote physiologic labour and birth

3.b Manage a safe spontaneous vaginal birth; prevent, detect and stabilise complications

3.c Provide care of the new-born immediately after birth

4. ONGOING CARE OF WOMEN AND NEWBORNS

4.a Provide postnatal care for the healthy woman

4.b Provide care to healthy new-born infant

4.c Promote and support breastfeeding

4.d Detect, treat, and stabilise postnatal complications in woman and refer as necessary

4.e Detect, stabilise, and manage

4.f Provide family planning services

Published October 2019

1. Essential Competencies for Midwifery Practice. https://www.internationalmidwives.org/our-work/policy-and-practice/essential-competencies-for-midwifery-practice.html  

2. Section on the glimpse into the midwifery profession is taken from the ICM website: The Origins of Midwifery.  https://internationalmidwives.org/icm-news/the-origins-of-midwifery.html