In this first paper in a series of four papers on midwifery, we aimed to examine,
comprehensively and systematically, the contribution midwifery can make to the quality
of care of women and infants globally, and the role of midwives and others in providing
midwifery care. Drawing on international definitions and current practice, we mapped
the scope of midwifery. We then developed a framework for quality maternal and newborn
care using a mixed-methods approach including synthesis of findings from systematic
reviews of women's views and experiences, effective practices, and maternal and newborn
care providers. The framework differentiates between what care is provided and how
and by whom it is provided, and describes the care and services that childbearing
women and newborn infants need in all settings. We identified more than 50 short-term,
medium-term, and long-term outcomes that could be improved by care within the scope
of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth
and preterm birth, decreased number of unnecessary interventions, and improved psychosocial
and public health outcomes. Midwifery was associated with more efficient use of resources
and improved outcomes when provided by midwives who were educated, trained, licensed,
and regulated. Our findings support a system-level shift from maternal and newborn
care focused on identification and treatment of pathology for the minority to skilled
care for all. This change includes preventive and supportive care that works to strengthen
women's capabilities in the context of respectful relationships, is tailored to their
needs, focuses on promotion of normal reproductive processes, and in which first-line
management of complications and accessible emergency treatment are provided when needed.
Midwifery is pivotal to this approach, which requires effective interdisciplinary
teamwork and integration across facility and community settings. Future planning for
maternal and newborn care systems can benefit from using the quality framework in
planning workforce development and resource allocation.
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