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Despite the fact that we live in the 21st century, an appalling number of women and children die worldwide every day. In some countries, a woman dies from childbirth or a childbirth complication every minute. The World Health Organization has developed Millennial Goals, one of which was to improve maternal child outcomes.
What do you see as the major issues in international midwifery?
What should be broad and specific priorities for maternal-child health in developing countries?
What can we do here in the U.S. as nurse-midwives to support those priorities?
One of the largest issues in international midwifery is the lack of skilled and educated midwives. When examining the educational requirements of midwives worldwide, It’s shocking how little education is needed in most countries. In fact, worldwide the minimum educational requirement in 82% of countries to begin training as a midwife is simply a high school diploma, which is terrifying knowing what I know as a labor nurse and what can potentially go wrong if proper training isn’t available. Furthermore, less than half of the countries worldwide even have legislation that recognizes a midwife as profession, meaning they don’t have the governing body to ensure that minimum training and education requirements are met for those entering the profession. Finally, the average number of births a midwife must complete supervised by a preceptor throughout the world is only 33 (Castro Lopes et al., 2016). Again, as a labor and delivery nurse, that’s terrifying, especially knowing that one may not even experience something such as a shoulder dystocia in that few of births.
One of the most important broad priorities for improving maternal-child health in developing countries is education. In referring back to my example regarding a shoulder dystocia, through proper education and exposure to obstetric emergencies such as a shoulder dystocia, a midwife in training can learn and practice maneuvers such as McRobert’s, suprapubic pressure and more in order to help alleviate the impacted shoulder. As US nurse-midwives we have the opportunity to obtain an excellent education and be certified through a governing body such as the ACNM. With this education we are able to impact those in developing countries through educational outreach. For example, The Peace Corps has sent nurse-midwives to sub-Saharan African in order to educate local direct entry midwives there (n.d. Midwife.org).
When considering specific priorities when discussing international maternal-child health, immunizations for both mothers and children is hugely important. For example, the child to a mother infected with Rubella during pregnancy can develop congenital rubella syndrome (CRS) which can cause cataracts, deafness, heart disease and many other permanent afflictions (Cutts et al., 1997). The CDC reports that just one dose of the Measles, Mumps and Rubella vaccine (MMR) is 97% effective against rubella (Measles, mumps, and rubella (MMR) vaccination 2021). If we are able to educate developing worlds on the importance of vaccine compliance and ensure that they have vaccinations available to protect their population from preventable diseases.
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