The Lancet Series on Midwifery (2014) defines midwifery as a crucial aspect of compassionate care for expectant mothers, newborns, and families during the pre-pregnancy, pregnancy, birth, postpartum, and early weeks of life. The core features of midwifery care include optimizing natural biological, psychological, social, and cultural processes of reproduction and early life, timely prevention and management of complications, consultation and referral to other services as necessary, respect for women’s individual circumstances and opinions, and collaboration with women to enhance their abilities to care for themselves and their families.
Numerous studies have demonstrated that introducing midwifery care can significantly improve the quality of maternal and newborn healthcare services, leading to a marked reduction in maternal and newborn mortality and morbidity rates worldwide.
History
Midwifery has been around since the beginning of human civilization, as evidenced by archaeological findings of women being assisted by other women during childbirth as far back as 5000 BC. Shiphrah and Puah, two midwives who assisted Hebrew women in giving birth, are mentioned in Exodus, making them the first midwives identified in literature.
Over the years, midwifery techniques have evolved to live up to the term “with a woman” at birth. In 460 BC, Hippocrates, the “Father of Modern Medicine,” organized and supervised midwives, but they did not appreciate his efforts. In 1756, John Douglas suggested midwives receive appropriate training and take a test prior to receiving a certificate of practice, leading to an improvement in midwifery practice.
Advancements in obstetric practice, medical and nursing research, discoveries, and education occurred rapidly during the 1700s and 1800s. Obstetrical forceps were developed, technical developments reduced the risks associated with caesarean sections, obstetric anesthesia was improved, and puerperal fever was eradicated. William Smellie’s observations and teachings eradicated myths and misconceptions and led to the development of teaching manikins and the identification of the mechanics of labor.
In the United States, advancements in midwifery and maternal-infant healthcare were made in the first two decades of the 20th century. The Children’s Bureau in Washington, DC, and the Maternity Center Association in New York City were established to address the country’s insufficient maternity care. The establishment of maternity hospitals in New York City reduced mortality rates, and by 1930, legislation was passed to regulate midwifery practice.
In India, traditional “dais” provided midwifery services without formal training, but by the early 20th century, the practice began to change. The Rockefeller Foundation helped found the All-India Institute of Hygiene and Public Health in 1930, which offered courses in maternal and pediatric health. The Bhore Committee was established in 1943 to develop a framework for managing the health system, leading to the creation of primary health facilities to service a population of around 40,000 people. Training programs for dais and auxiliary nurse midwives (ANMs) were launched based on the committee’s recommendations. Nurse education programs were primarily found in mission hospitals, with the Christian Medical Association of India (CMAI) establishing the Nurses League in 1931, which later became the Mid India Board of Nursing Education and the Board of Nursing Education, South India Branch in 1964.
Who is a midwife?
The International Confederation of Midwives (ICM) (2015) defines a midwife as an individual who has successfully completed a midwifery education program that meets the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education. The midwife must also possess the necessary qualifications to be legally registered and licensed to practice midwifery and use the title of “midwife,” while demonstrating competency in midwifery practice.
As per ICM, a midwife is a highly skilled healthcare professional who has undergone rigorous training and education to provide comprehensive care to women throughout the continuum of pregnancy, childbirth, and the postpartum period. Midwives play a critical role in promoting maternal and newborn health, preventing and managing complications, and empowering women to make informed choices about their care. The ICM’s standards for midwifery education and competency reflect the importance of ensuring that midwives are adequately prepared to meet the complex and diverse needs of women and newborns worldwide.