Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care

This is the first of four articles published in the Lancet Midwifery Series. The article examines the contribution midwifery can make to quality care for women and newborns globally by developing an evidence-informed framework of quality maternal and newborn care interventions. The authors used a multimethod approach to synthesise the evidence. They analysed 461 systematic reviews to develop and test the framework. The framework was used to structure the assessment of the evidence and to identify the scope of midwifery practice.After defining the terms midwife and midwifery, the authors use the framework to test the contribution midwifery can make to the quality of care of women and infants globally. In particular, midwives can make specific contributions to the following aspects of quality care identified by the authors’ framework: education, health promotion and information provision; assessment, screening and planning of care; the promotion of normal processes of childbirth and prevention of complications; and providing women-centred care.Key findings:

• Some countries with high economic growth, such as China, Brazil and India, are seeing unnecessarily high caesarean section rates where obstetricians are increasingly relied upon to provide maternal and newborn care
• Care provided by obstetricians without the balance of midwives may reduce morbidity and mortality, but may also reduce quality of care and increase costs
• Several different types of healthcare providers are active in providing midwifery care, however there are few benefits to health systems relying solely on less-skilled healthcare workers
• The tendency of low-income health systems to focus on treating obstetric complications to reduce maternal and newborn mortality must be expanded to include skilled care for all
• Midwives – educated, licensed, regulated, and integrated into interdisciplinary teams – therefore fill a key gap in health systems
• Midwives have the skills to support and encourage the natural process of birth as much as possible and the training to refer essential cases of complications for surgical intervention
• If midwives work as part of interdisciplinary teams providing integrated care across community and facility settings, they can contribute significantly to many dimensions of quality care for women and newborns

This is an open access article upon free registration. To read the article, click here.To read the Lancet Midwifery Series, click here.Renfrew, M.J., McFadden, A., Bastos, M.H., Campbell, J., Channon, A.A., Cheung, N.F., Delage Silva, D.R.A., Downe, S., Kennedy, H.P., Malata, A., McCormick, F., Wick, L. & Declercq, E. (2014). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, published online 23 June.