Midwifery Education: A Global Perspective

By Vicki Penwell

Published: Midwifery Today (Winter 1991-92, No. 20)

In a home in the Philippines, a new mother scoops up her newborn daughter, still attached by the pulsing umbilical cord, and hugs her daughter to her breast.

A Lahu tribeswoman in the North of Thailand squats beside a fire to cook rice, her baby strapped to her back with a bright length of cloth.

In a hospital in the war ravaged country of Laos, a young woman strains stoically, soon to deliver her third child.

What makes these women different from their American and European sisters? The fact that over one million of them will die this year while trying to perform their God-given gift of bringing forth new life.

The developing world accounts for 99 percent of all maternal mortality-an average of three thousand women each day die of pregnancy related causes. For mothers in developing countries, the risk of dying is 50 to 200 times higher than that of a woman in a developed nation. A typical woman in Africa or South Asia faces a lifetime chance of one in 20 of dying while pregnant or in childbirth.

The World Health Organization (WHO) has been tracking the problem of maternal deaths, and looking for solutions. Their data is pointing to the need for more trained midwives. In their publication, Safe Motherhood, a recent article carried the headlines Midwifery Education: A Life Saving Solution.

Could it be that midwifery education can really save lives, and on such a large scale? The answer is a resounding yes, according to Dr. Barbara Kwast, midwife and scientist with WHOÕs Safe Motherhood program and a former lecturer in community obstetrics in Ethiopia. Midwives could safely handle 70 to 80 percent of deliveries and more if they were adequately trained, Dr. Kwast says. They are also able to fill the gap in health services between the village and district hospital.

Dr. Mark Belsey, Chief of WHOÕs program of Maternal and Child Health, told a recent conference in Geneva, Switzerland, The number of nurses and midwives is falling, and mid-level care- where the midwife should be- is disappearing. The meeting called particular attention to the need for effective training initiatives to combat the increasing global shortage of midwives.

The world is in need of midwives, midwives who know how to work outside of the hospital. Over 70 percent of mothers in the developing world give birth with no trained assistance, with 85 percent receiving no prenatal care at all. The prediction is that without a reordering of priorities, the annual number of deaths from reproductive causes will double by the end of this decade, reaching at least two million

There are many problems related to training midwives for effective service in the underdeveloped world that must be overcome. It is vital that the midwife be trained to recognize the traditional beliefs and traditional practices of the people group she is caring for. She develops strategies to close the cultural gaps between the midwife and the community. The midwife must present health education to communities within the context of that culture (often through skits or storytelling), teaching the preventable factors that lead to maternal death.  And she must be competent in skills to identify and successfully manage the five major causes of maternal death-hemorrhage, illicit induced abortion, sepsis, obstructed labor, and eclampsia.

One of the problems of midwifery education was summed up in a recent article in Midwifery: An International Journal, by Barbara Kwast. Author Kwast wrote, Unfortunately too few midwife teachers have relevant experiences in rural areas and have little practical appreciation of the problemsÉThe teachers have little contact with the midwives practicing OUTSIDE hospitals, and that is where most midwives should be working, if lives are to be saved.

I have seen the women of the Third World. I was there when the Philippine woman gave birth. I cared for the Lahu motherÕs baby when he was sick. I received the little Lao baby into my hands, in that dirty, forsaken hospital in the capital city of Laos.

The other side of the world is not so far away. Are we willing to share? What resources, what knowledge, what hope?

References:

World Watch Institute Report, June 1991

Postpartum Hemorrhage: Its Contribution To Maternal Mortality

Kwast, Barbara, in Midwifery: An International Journal, Vol. 7, No. 2, 1991

Preventing The Tragedy Of Maternal Deaths, Starrs, Ann, 1987. A report on the International Safe Motherhood Conference held in Nairobi, Kenya.

Challenge for the Nineties Starrs, Ann with Diana Measham, 1990. Proceedings of a Safe Motherhood South Asia Conference held in Lahore, Pakistan, 1990.

Midwifery Education: Action for Safe Motherhood, Report of a collaborative ICM/WHO/UNICEF pre-congress workshop, International Confederation of Midwives Conference, October 1990, Kobe, Japan.

WomenÕs Health and the Midwife: A Global Perspective. Report of a collaborative pre-congress workshop, International Confederation of Midwives Conference, August 1987, The Hague, Netherlands.