Could a Regulated midwifery training programme in India help reduce the maternal and Neonatal mortality rate ?
It is a sad fact of life that India has one of the highest maternal and neonatal mortality rates in the world! Why in the 21st century is this still the case ?
Evidence suggests several factors:
- Social factors.Girls are married very young and have little knowledge of early
pregnancy.Dr Nandita Palshetkar.(cited in Indian Express 2014).
- Convenience: Doctors cannot meet the emotional, psychological and physical needs of the mother. They are simply too busy and overworked.
- “The major challenge is lack of information ” Dr Lale Say (WHO 2014).
- There is no regulated national programme of Midwifery in India, to international standards to my knowledge .
This article explores the benefits of such a programme that i have experienced as a British midwife for the last 22 years.
The UK has one of the lowest maternal mortality rates in the world. A midwifery model of care programme is in practice there.
“In the UK it is recognised that all women need a midwife and some need a doctor.”
Cited by Kiran Kumbhar.( Quartz India )2016.
The midwifery model of care makes the presumption that all pregnancies and births are a normal physiological process,that only sometimes require Medical intervention.
In the UK mothers expect to see a midwife. There is an acceptance in our society that a mother will only attend a Doctor if there is a medical reason to do so. We are trained to a level of expertise that gives us the knowledge and ability to detect when things are no longer normal.
We work in partnership with Doctors and have mutual respect. Some of our roles do overlap. Doctors diagnose and treat problems arising from pregnancy. Midwives look after the emotional, physical and psychological needs of the mother.
We are hands on autonomous practitioners.
We provide care antenatally, during labour and the postnatal period. We carry out births on our own, (supported my midwifery colleagues), in hospitals and at home.
“Our role is to provide comfort, support and a secure environment”.
(Royal college of Midwives).
It is because of our high standard of training that our clinical judgment is respected.
There is enough evidence which supports the fact that a midwifery model of care is more cost effective.This is because midwives keep the birth process normal ,which of course in turn results in no unnecessary intervention.This is probably the most pivotal point to the argument for wanting a midwifery model of care in India. Doctors need to be available to look after high risk woman.These are the mothers who are more likely to develop problems in labour . These are the mothers who need the Doctors valuable time ,input and expertise!!
The Answer Is Education And Training.
“Midwives who are educated and regulated to international standards can provide more than 80 percent of care necessary” WHO.
There are three key words here. Educated, regulated and international.
UK midwives have a minimum of three years training (if they are not nurse trained). We are regulated by the nursing and midwifery council. We are required to do mandatory update training. This includes understanding electronic fetal heart monitoring and managing obstetric emergencies.
Because low risk mothers attend the midwife for all their antenatal care, a bond and trust is built between them. We are the first point of contact.Mothers will continue to have midwife care only from pregnancy to the postnatal period if everything remains low risk.This would be true for team midwifery or caseload midwifery.
Team midwifery and case load midwifery basically means that the mother will see the same midwife or several midwives from a team during her pregnancy. These midwives are usually both hospital and community based. The mother may even have a midwife from the team helping her to birth her baby.
Some midwives stay hospital based and have expertise in managing labour, antenatal and postnatal wards. Because midwifery is so established in the UK, time has allowed other specialist roles to evolve such as breastfeeding, mental health and safeguarding.
A big part of our role is education.Midwives will talk to the mothers about how to remain healthy during their pregnancy.This will include things like the benefits of a good diet ,exercise, healthy eating , and the adverse effects of smoking and alcohol consumption to name a few. They will also talk to them about any emotional or psychological issues that they are concerned about and try to offer solutions ,or appropriate referral to another health professional who can offer their expertise. This holistic approach to care is a mandatory part of the midwives role.
Preparation for childbirth classes. Mothers will attend classes on their own or with a partner or friend. Topics such as labour, managing pain, coping strategies , breathing techniques and breastfeeding will all be discussed.They are then armed with enough knowledge and information to allow them to to discuss their birth plan.
Giving the mothers information helps them to feel empowered. Having knowledge gives them the ability to make informed choices. It also removes some of the fear that surrounds childbirth. They can then talk to the midwife about the type of birth they would like to have. However not everything in life goes to plan. Its the same with birth. I am also mindful as I am writing this ,that for some mothers they do not always achieve the outcome that they had hoped for.There are times when we also have to act as their advocate . However having a midwife there to give comfort and support to the mother and make her feel secure is the most important role of all in my opinion.
Not everything in the UK is perfect . Some women still have to fight for their choices.
However having worked in the British system for so long I do know that it works very well most of the time.
I am not looking at the prospect of having a global training programme for midwives in India through rose tinted glasses. Also this is by no means intended to be critical of the setup in India. It is simply to give you some understanding of the benefits of a regulated midwifery model at international standards, that I have experienced in my career. There is also a huge amount of job satisfaction .
Birthing a baby is the most powerful life changing event for any woman. The way she is treated on that day by her care providers will remain with her for the rest of her life!!!
It should be a good memory. Not one filled with horror and resentment.
“Delivering high quality care is the responsibility of every midwife “
(Royal college of midwives).
There are enough passionate people out there who want to make a difference.
It will take time. Lots of time. Lets be united and make it happen.
Give women a voice, the respect, choice and empowerment they deserve.
Whatever walk of life they come from. It should make no difference!!!!
I trained as a general nurse in London.I spent the first 10 years of my career as an oncology nurse. After I gave birth to my first son the decision was made.I wanted to be a midwife!I was totally fascinated by their role.In 1994 I did my midwifery training and have been in practice for the last 22 years. I have worked both as a hospital and community midwife. My last job before coming to India with my husband was a more specialised role working as a mental health midwife. I found this fascinating and absolutely loved it. At present I am continuing with my studies into this subject.
Being a midwife is the most rewarding and wonderful job. Actually it is not just a job .It is a vocation . It becomes part of your everyday life and requires dedication . There is no better job satisfaction than being with a women and helping bring a new life into the world.Its amazing !!
I have been in India for 2 years now. During this time I have been very lucky to have had some volunteering work with Lina Duncan and Nhing Castillo.(Mumbai Midwife).
I am married and have 3 sons.
Footnote. Take a look at “I am a Midwife”. New videos by ‘Woman in the moon films.’
It sums us up beautifully.