Midwifery – 100 years of progress

The International Day of the Midwife celebrates 100 years since the International Confederation of Midwives (ICM) was formed striving to ensure all women and their newborns have access to a trained midwife. The ICM has strengthened midwives’ associations globally to advance the profession of midwifery worldwide by promoting autonomous midwives as the most appropriate caregivers for childbearing women and by keeping birth normal to enhance the reproductive health of women, their newborns and their families.

Internationally, midwives’ contributions toward achieving the 2030 Sustainable Development Goals of reducing maternal mortality and ensuring universal access to sexual and reproductive health care and universal health coverage cannot be underestimated. Midwives have been strengthening primary health care for decades and will continue to play a vital role in women, children, and adolescents’ health and well-being (United Nations Population Fund 2022).

The Australian College of Midwives has adopted the ICM Model of Midwifery, founded on the principles and practices of primary health. Midwives promote and respect women’s and newborns’ health rights. Midwives respect and have confidence in women and their capabilities in childbirth. Midwives promote and advocate for non-intervention in well women during pregnancy. Midwives provide women with appropriate information and advice to promote participation and enhance informed decision-making. Midwives offer respectful, anticipatory and flexible care, which encompasses the needs of the woman, her newborn, family and community and begins with primary attention to the nature of the relationship between the woman seeking maternity care and the midwife. Midwives empower women to take responsibility for their health and well-being and their families’ health. Midwives practice in collaboration and consultation with other health professionals to best serve the needs of the woman and her newborn, family and community. Midwives maintain their competence and ensure their practice is evidence-based. Midwives use technology appropriately and affect referrals promptly when problems arise. Midwives are individually and collectively responsible for developing midwifery care and the education of the new generations of midwives in the concept of lifelong learning.

Pregnancy, childbirth, and birthing for women and their babies are considered “safe” experiences in Australia. Midwives are the profession that is “with women” 24/7, supporting each woman, their babies, their families and support people. As we acknowledge these achievements, we must also recognise more is required to ensure women have the opportunity to experience Respectful Maternity Care. Physically surviving is considered a good birth; however, this is not enough. Instead, care should be respectful, provided within a continuity of care approach, preferably with a known midwife, include comprehensive postnatal care, and information on all care options should be routine.

How do we know women do not have the experience they want and seek Respectful Maternity Care? The Mother’s Tale, Women’s Experience of Maternity Care in Australia (2020) delivered the message. According to The World Health Organization, Respectful Maternity Care is “care organised for and provided to all women in a manner that maintains dignity, privacy, confidentiality, ensures freedom from harm and mistreatment, and enables informed decisions/choice and continuous support during labour and childbirth”. Respectful Maternity Care stresses the provision of high-quality, evidence-based, and informed services, procedures, and care while considering the specific needs and preferences of the individual woman and her baby.

The single biggest issue is midwifery-led continuity of care. Overwhelming evidence demonstrates midwifery continuity of care, with a known midwife, results in optimal outcomes for a woman and her baby and results in outstanding clinical, financial and consumer satisfaction outcomes that benefit families and the community. To make real progress, a target of 50% of women receiving this care by 2025 and 100% by 2030 is needed—Respectful Maternity Care for all women.

Australia has always relied heavily on midwives and nurses from overseas. Of the OECD countries, data collected from 2017 to 2018 showed only Switzerland and New Zealand were more reliant on a foreign-trained workforce. Now more than ever, Australia must not rely on other nations to provide a sustainable health workforce. Many countries where large numbers of internationally qualified midwives travel to work in Australia, such as the Philippines and India, desperately need to maintain the size and capacity of their health workforces. It is unethical to depend on other countries to provide Australia with midwives when there is potential to increase the employment of locally trained midwives.

The solution to our midwifery workforce’s woes also lies in respect. Midwives deserve respect to work to their full scope of practice. Australia has a skilled and highly qualified midwifery workforce that is vastly under-utilised while critical in determining national health outcomes. Midwives do not have opportunities to realise their full potential and optimally contribute to the health of all Australians in the maternity, mental health, and primary health care sectors.