TODAY, May 5, is celebrated annually worldwide as International Day of the Midwife. This year the theme will be ‘Midwives: Defenders of women’s rights’. Unfortunately, not many people know the difference between a midwife and a nurse. The truth is these health practitioners are often referred to as nurses.

Who exactly is a midwife?

The term midwife is derived from the Latin word ‘obstetrix’, and is a person who, having been regularly admitted to a midwifery educational programme duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and legally licensed by a Nursing and Midwifery Council to practise midwifery (International Confederation of Midwives, [ICM], 2017).

Long-existing…

Midwifery is an ancient profession which has been around since biblical days and is captured in Genesis 35: 17 — “And as she was having great difficulty in childbirth, the midwife said to her, ‘Don’t despair, for you have another son.’ (2) Genesis 38: 28 — “As she was giving birth, one of them put out his hand; so the midwife took a scarlet thread and tied it on his wrist and said, ‘This one came out first.’ (3) Exodus 1: 15 – 21 — “The king of Egypt said to the Hebrew midwives, whose names were Shiphrah and Puah…”

In Jamaica…

Within the Jamaican context, midwifery practice dates back to pre-plantation era. Documented evidence revealed that the provision of maternal and child health services in the 18th century evolved around the physician, midwife, grandee (an elderly woman who took care of pregnant females before, during and after their confinement) and wet nurses (women who took care of the infants whose parents refused to suckle them).

Categories of midwives

In Jamaica, there are two categories of midwives:

(1) Direct Entry Midwives — persons who are not registered nurses who specialise in midwifery. These midwives typically work outside of the hospital setting in homes and birth centres and do not employ methods for childbirth that are commonly seen in hospitals, such as use of drugs, Caesarean section, forceps, and other types of equipment.

(2) Nurse Midwife — a registered nurse who has completed specialised theory and clinical courses in midwifery/obstetrics and gynaecology and is registered and licensed to practice midwifery by the regulatory body (Nursing and Midwifery Council).

Despite wearing white uniforms — as do nurses — midwives in various settings locally may be identified by a burgundy badge, a burgundy belt (signifies seniority), or a burgundy stripe around the cap.

Of note, only 372 of 942 midwives required in the Jamaican public health sector are in a post (MOH, 2019)

Regulatory framework

Midwifery has suffered political and social setbacks globally. Nonetheless, it remains an autonomous profession in a number of countries, for example, New Zealand, where they have their own scope of practice. It is important to point out that the level of autonomy is restricted in some jurisdictions.

In Jamaica, midwives practise independently in the community settings and work collaboratively in others. Practice is regulated by the Nursing Council of Jamaica through the Nurses and Midwives Act, 1964.

Functions

A midwife may practise in any setting including the home, community, hospitals, clinics or health units. The functions encompass the respectful care of a woman in the preconception period, antenatally, intranatally, and post-natally. Care of the newborn, infant, families and, by extension, communities are also their responsibility.

The midwife has important tasks in health counselling and education (preventive measures) as well as antenatal education (promotion of normal birth) and preparation for parenthood. This may extend to women’s health, sexual or reproductive health, and childcare. Additionally, care provided may also include the detection of complications in the mother and child, accessing medical or other appropriate assistance, and carrying out emergency measures.

Contribution to SDGs

Midwives have important roles to play if the UN’s Sustainable Development Goals (SDGs) are to be realised. For example, Goal 3 — Ensure healthy lives and promote well-being for all at all ages.

It is expected that by 2030 midwives’ work can:

(1) reduce the global maternal mortality ratio to less than 70 per 100,000 live births, and

(2) ensure universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes (ICM, 2017).

Of note is that Jamaica has to cauterise the maternal mortality rate, which in 2018 was estimated at 80 per 100,000 live births, and infant mortality rate at 25 per 1000 live births. Midwives are poised to change this scenario.

According to the ICM (2017), midwives also have roles to play in achieving Goal 5 — Achieve gender equality and empower all women and girls. They can assist to end all forms of discrimination against women and girls; ensure women’s full and effective participation and equal opportunities for leadership at all levels of decision-making in political, economic and public life; and ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action.

Defenders of women’s rights

In addition to SDG 5 above, ICM Bill of Rights for Women and Midwives (2017) purports that, on a daily basis, midwives uphold and protect the rights of women by ensuring:

(1) safe and enabling work environments;

(2) women, girls have the right to live safe from harm, violence, discrimination and abuse;

(3) women and girls have the right to access sexual and reproductive health services;

(4) women have the freedom and the power of choice regarding what happens to their bodies;

(5) every woman has a right to be free from any form of discrimination;

(6) that every woman has a right to privacy;

(7) every woman has a right to up to date health information;

(8) women have the right to make choices about their care during childbirth;

(9) midwives have the right to provide care across their full scope of practice;

(10) women have the right to access educated and competent midwives; and

(11) every woman has the right to choose the place where she gives birth.

I endorse the theme for the 2019 International Day of the Midwife and deem it timely. Notably, midwives have pivotal roles in advancing women’s rights, eliminating discrimination and preventing human rights violations against women generally. They are strategically positioned to defend the rights of women, tackling violations where necessary. This they can be achieve by utilising a multisectoral approach. Every woman has a right!

Adella Campbell, PhD, JP, is an associate professor and head of the Caribbean School of Nursing at the University of Technology, Jamaica. She is the author of the recently published The Jamaican Public Health System from the 17th-21st Centuries. Send comments to the Observer or adcampbell@utech.edu.jm.