May 5, 2014 Was Nurses Day and the International Day of the Midwife
On May 5 each year we ask the world to focus on the role of midwives and midwifery.
The 2014 theme for the International Day of the Midwife 2014 is “Midwives changing the world one family at a time!” It sends a strong signal that midwives provide care that changes families, communities and the world by saving the lives of mothers and babies. International Confederation of Midwives (ICM) established the idea of the ‘International Day of the Midwife’ following suggestions and discussion among Midwives Associations in the late 1980s, then launched the initiative formally in 1992.
The International Confederation of Midwives (ICM) is about to meet in Prague, Czech Republic this June 1-5, 2014! This will be the 30th Triennial Congress. I was so excited to attend the 2011 ICM congress in Durban, South Africa. It was my first time traveling to South Africa, and I joined more than 3,000 midwives from a record 115 countries. I cannot wait to go meet the midwives this summer as Prague hosts us!
The aims of the congress are:
- to provide a forum where the advances in maternity, newborn and women’s health care can be shared, evaluated and monitored
- to provide an environment where midwives from around the world can draw on the skills, knowledge and experience, of colleagues for application in their own countries
- to focus on the development of midwifery knowledge and skills which will address the needs of women and their babies in the diverse health systems across the globe
- to highlight discrepancies in the provision of maternity care especially in the least developed nations and the strategies which could be employed to achieve improvements in maternal, neonatal and women’s health outcomes
- to celebrate midwifery as a profession in all its global diversity
- to generate funds to sustain the global work of the International Confederation of Midwives
The work of nurses and midwives is important, and ICM has gathered facts and figures related to maternal and neonatal mortality, inequality/ inequity, access to essential midwifery led care and effects of skilled attendance during pregnancy and birth. Please take a few minutes to read about our important work — and then think how we can all support our midwives and future midwives locally, nationally and globally!
The following is excerpted from the ICM 2014 resource guide: Midwives change the world by caring for mothers and babies. By caring for them, midwives help ensure that women are healthy, thus contributing to a strong community and economy. When babies survive, they start growing into healthy children and adults. In midwife-led care, women experience less preterm births, less assisted deliveries and greater satisfaction with care. Midwives educate families on how to delay, space or limit pregnancies and provide family planning services to achieve the healthiest outcomes for women, newborns, infants and children. This healthy timing and spacing of pregnancies leads to better outcomes for both mother and baby. Globally, approximately 290,000 women and over 3 million infants die each year as a result of pregnancy and childbirth complications. The death of a mother substantially increases the likelihood that her newborn child will die. Newborn deaths are usually linked to mothers’ health. If every childbearing woman received care with a well-educated, adequately resourced midwife, most of maternal and newborn deaths could be prevented — actually, up to two-thirds of maternal deaths could be averted if there was universal access to a well-educated, regulated midwifery workforce in a health system with adequate supplies.
FACTS AND FIGURES
– Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. This accounts to 287,000 women per year (i).
– The risk of maternal mortality is highest for adolescent girls under 15 years old. Complications in pregnancy and childbirth are the leading cause of death among adolescent girls in most developing countries (ii).
-11 percent of girls are married before they turn 15, jeopardizing their rights to health, education and protection (iii).
– 16 million adolescent girls give birth each year in developing countries, often missing out on years of education, which reduces their chances for adequate income and opportunity to escape poverty (iv).
– About 70,000 adolescent girls in developing countries die each year due to pregnancy and childbirth complications (v).
– Pregnancy, childbirth and their consequences are still the leading causes of death, disease and disability among women of reproductive age in developing countries (vi).
-Allowing women to plan their pregnancies leads to healthier outcomes for children. A recent study showed that if all births were spaced at least two years apart, the number of deaths among children younger than five would decline by 13 percent. The number would decline by 25 percent if there were a three-year gap between births (vii).
– The major direct causes of maternal death in developing countries are severe bleeding, infection, hypertension, obstructed labour and unsafe abortion, accounting for 80 percent of maternal deaths (viii).
– For every woman who dies, another 30 women suffer long-lasting injury or illness that can result in lifelong pain, disability and socio-economic exclusion (ix).
– More than 7,300 babies are stillborn every day that is 2.6 million every year. Nearly all of these deaths take place in developing countries, and most can be prevented (x).
– Every year 3 million infants die in the first month of life. Among those, nearly 3/4 die in their first week, and 1/3 die on their day of birth (xi).
-Adolescent pregnancies put newborns at risk. Deaths during the first month of life are 50 to 100 percent more frequent if the mother is an adolescent than if she is older. The younger a mother is, the higher the risk for the baby (xii).
– 99 percent of all maternal deaths occur in developing countries, in sub-Saharan Africa and South Asia (xiii).
– Maternal mortality is higher in rural areas and among poorer and less educated communities (xiv).
– Less than 60 percent of all women in developing countries and only 34 percent in the least developed countries have access to a midwife when giving birth, and even fewer are delivering in a health facility providing skilled care (xv).
– The risk of a woman dying as a result of pregnancy or childbirth complication during her lifetime is about 1 in 7 in Afghanistan and Sierra Leone compared with about 1 in 29,800 in Sweden (xvi).
– 95 percent of adolescent births occur in developing countries (xvii).
– 2/3 of all newborn mortality occurs in 12 countries, 6 of which are in sub-Saharan Africa (xviii).
Access to Essential Midwifery Services
– Every year, 40 million women give birth at home without access to any care (xix).
– On average, in the least developed countries 59 percent of births have no midwife present; in Ethiopia the figure is 94 percent and in Bangladesh 76 percent. By comparison, only 1 percent of women in the United Kingdom give birth without a midwife (xx).
– Nearly all newborn and maternal deaths (98 and 99 percent respectively) occur in developing countries where pregnant women and newborn babies lack access to health care services — before, during and after delivery (xxi).
– Currently less than 1 in 6 countries with the highest burden of maternal and newborn mortality reaches the minimum benchmark of 23 doctors, midwives and nurses per 10,000 population that is necessary to provide a basic package of care. Severe shortages of midwives exist in at least 38 countries (xxii).
– Women who have access to midwife-led care are less likely to experience preterm birth and fetal loss before 24 weeks gestation (xxiii).
– Globally the lack of midwives is estimated to be 350,000 (xxiv).
Effects of Skilled Attendance in Pregnancy and Birth
– Skilled midwives, with the equipment and support they need, can spell the difference between life and death for close to 300,000 women each year, and ten times that many infants (xxv).
– Midwives are trained to help babies start breathing immediately after birth, and help prevent one of the major causes of newborn deaths. Birth asphyxia kills 710,000 babies each year (xxvi).
– If all women delivered with a midwife in a facility capable of providing basic emergency care, is it estimated that 56 percent of maternal, fetal, and newborn deaths could be prevented. This estimate is based on reductions of 61 percent of maternal deaths, 49 percent of fetal deaths, and 60 percent of newborn deaths, which equates to as many as 3.6 million lives saved (xxvii).
-The presence of a well-trained midwife can prevent many cases of infection, including neonatal sepsis, which kills 521,000 newborns a year (xxviii).
ICM International Day of the Midwife 2014: resource guide.
i WHO, Maternal Mortality, Fact sheet N°348, May 2012.
ii Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004. 192:342–349.
iii Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet, 2009, 374:881–892.
vii Guttmacher Institute, “Costs and Benefits of Investing in Contraceptive services in the Developing World,” June 2012.
x Healthy Newborn Network, 2014
xii PMNCH Factsheet: Maternal Mortality (updated September 2011)
xiii WHO, Maternal Mortality, Fact sheet N°348, May 2012.
xiv PMNCH Factsheet: Maternal Mortality (updated September 2011)
xv UNFPA, State of the World Population Report, 2013
xvii Save the Children, State of the World’s Mothers Report, 2013
xviii Unicef, The State of the World’s Children 2011.
xix Save the Children, State of the World’s Mothers Report, 2013
xx WHO. Global Health Atlas of the Health Workforce, 2013
xxi UNFPA. State of the World’s Midwifery Report: Delivering Health, Saving Lives, 2011
xxii Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub3.
xxiii UNFPA. State of the World’s Midwifery Report: Delivering Health, Saving Lives, 2011
xxiv UNFPA, Statement for IDM 2013.
xxv Save the Children, State of the World’s Mothers Report, 2013
xxvi UNFPA. State of the World’s Midwifery Report: Delivering Health, Saving Lives, 2011
xxvii Black, R E et al (2010), ‘Global, regional and national causes of child mortality in 2008: a systemic analysis’, The Lancet, vol 375, issue 9730.
xxviii Mark D’Monte, Leslie (April 29, 2009). “Swine Flu’s Tweet Tweet Causes Online Flutter”. Business Standard.
Katie Moriarty (CNM, PhD, CAFCI) is a Clinical Assistant Professor and Associate Director of the Nurse Midwifery education program at the University of Michigan. She has been a nurse-midwife since 1992. Her undergraduate degree is from the University of Windsor, and her Master’s and PhD degrees are from the University of Illinois at Chicago.
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