Midwifery is a vital solution—What is holding back global progress?

A critical interpretive synthesis of the roles of midwives in health systems

“…the medicalisation of the birth process and associated valuing of physician and hospital-based care) • Ideas relate to both political and health system factors by influencing the values of citizens and either valuing or devaluing gender and the medical model • Social construction of gender — the status of midwives in a given jurisdiction often reflected the value placed on women within the society (i.e. ‘gender penalty’) [ 8 , 11 , 41 , 43 , 46 , 48 , 61 , 71 ] • Some cultures did not allow women to receive care from men yet there were few health professionals that were women due to lack of educational opportunities [ 45 ] • Health system priorities as well as changing values were based on the medical model and normalisation of medical interventions, which favoured care by physicians and within hospital settings [ 41 , 48 – 50 , 75 , 78 , 99 – 101 ] • Incongruence between international recommendations for skilled birth attendants and needs of Mayan population in Guatemala for intercultural healthcare from traditional birth attendants [ 102 ] • Nordic maternity care systems’ non-medical models and women dominated professional groups [ 37 ]; respect of gender equality and informed choice [ 86 ] • Increasing consumer demand for midwifery-led care [ 77 ] • Reclaiming Indigenous midwifery and bringing birth back to the community (Canada and Guatemala) [ 35 , 103 ] [ 1 , 3 , 6 – 8 , 10 – 13 , 35 , 37 , 38 , 41 – 43 , 45 – 50 , 54 – 58 , 61 , ...…”

“…midwives collecting or sharing data) [ 43 , 65 , 90 ] • Midwives were unable to practice to full scope because of inconsistent standards of education and professional regulation [ 78 , 91 , 106 ] • Globally, there was a general lack of knowledge regarding the International Confederation of Midwives’ Global Standards for Midwifery Education, which was a barrier to the provision of quality midwifery education [ 53 , 66 , 87 , 107 , 108 ] • Midwives were not practicing to their legislated full scope of practice (Canada), barriers included (1) hospitals — scope restrictions; (2) capping of the number of midwives granted hospital privileges; (3) capping the number of births attended by midwives; and (4) inconsistent midwifery policies across hospitals [ 52 , 77 ] • Healthcare reforms increased the centralisation of decision-making, which created barriers to change (Australia) [ 95 ] • Combination of regulatory processes and health systems that promoted birth as a natural process; favoured professional midwifery care (Nordic countries) [ 8 , 62 , 86 , 91 , 99 ] • Accreditation mechanisms supported midwifery education programmes and institutional capacities [ 63 , 70 , 93 , 107 ] • Environments that allowed midwives to practice autonomously and to full scope of practice [ 74 ] • Expanded scope from providing skilled delivery care to include SRHR ranging from abortion, family planning, screening (diabetes and several forms of cancer), immunisations, palliative care, and public health and promotion [ 10 – 13 , 55 , 74 , 94 , 109 – 113 ] • Increased contraceptive prevalence rate (Nigeria) by engaging midwives in provision of family planning services [ 114 ] • Engagement of midwives within broader humanitarian emergency contexts (e.g. conflict, epidemics, and natural disasters) [ 46 ] •...…”

“…associated with improved health outcomes [3][4][5][6][7]. While midwifery care is associated with positive outcomes, it is an area that is under-researched [8]. This is particularly true in relation to how political and health system factors influence the profession's role in health systems.…”

Differential access to continuity of midwifery care in Queensland, Australia

“…Scaling up continuity of midwifery care among all hospital classification groups in Queensland remains an important public health strategy to address equitable service access. Providing universal access to continuity of midwifery carer for childbearing women, particularly those who are socially disadvantaged is a public health issue in Australia and many other countries around the world (1)(2)(3)(4)(5)(6). Mapping access to services is critical to plan and implement effective system change that can address social gradient health inequality at start to life (7).…”

Midwives’ Integration of Post-Abortion Manual Vacuum Aspiration in the Democratic Republic of Congo: A Mixed Methods Case Study & Positive Deviance Assessment

“…Our team gave strict attention to maintaining local collaboration, which is crucial in building trusting relationships and facilitating trustworthiness (44). We achieved local technical guidance by creating a stakeholder committee comprised of governmental and non-governmental experts in midwifery and abortion care and with a team of two Congolese midwife co-researchers .…”