PRESIDENT of The Jamaica Midwives’ Association, Aseta Hamilton has asserted that midwifery is still a relevant and crucial career to the sustained development of Jamaica.

Speaking with the Jamaica Observer on Friday, Hamilton said a reduction in the rate of maternal and infant morbidity and mortality hinges on the engagement of midwives with pregnant women.

“Midwifery is an age-old profession. It was from ancient times and will always be. Exodus, chapter one speaks about the Hebrew midwife, so it is an age-old profession. Midwifery in Jamaica started in 1886 where the first set of women were selected from each parish to commence training as district midwives, and the training lasted for two years. At the end of the training they were sent back to their parish of choice to practise. Prior to 1886, unskilled persons called ‘nana’ or ‘midi’ were attending births and as such [the] maternal morbidity and mortality rate was extremely high, hence the Government of the day decided to commence the training of midwives in order to lower the death rate,” Hamilton said.

Hamilton added: “Midwives and women have a unique opportunity to get to know each other. They build trust and have a reciprocal relationship through care, pregnancy, labour, birth, post-partum and post-natal period; also [through] family planning and childcare and immunisation. Through these relationships, midwives have become trusting members of families and communities. Midwives empower women and have a close relationship with women all over.”

Globally, every 1-2 minutes, a woman dies in pregnancy or childbirth, equating to some 1,000 women dying each day (an estimated 358,000 each year) from pregnancy-related causes. For each woman who dies, about 20 women survive (seven million women) but suffer from serious disease, disability or physical damage caused by complications of pregnancy or childbirth.

Ninety per cent of these maternal deaths occur in developing countries. Seventy five per cent occur during childbirth or in the post-partum period. The majority of maternal deaths are avoidable when women have access to quality reproductive health care, including skilled attendance at birth.

Due to the worldwide impact of COVID-19, Jamaica recently experienced a well-publicised maternal death which involved first-time mother Jodian Fearon, and led to a criminal investigation surrounding the circumstances of her death.

Maternal deaths result in some one million children being left motherless each year, making them three to 10 times more likely to die within two years compared to children who live with both parents. Almost half of the eight million infant deaths per year result from poor maternal health and inadequate care during delivery.

But according to the association’s president, while her colleagues are trained to deal with pregnancy complications, high-risk cases are not handled by midwives.

“Whatever complications they [pregnant women] have, midwives know how to handle it – whether to refer them to the hospital or high-risk clinics where obstetrician/gynaecologists work. There are three levels of midwives. Level one and two work in the community and level three is the midwife supervisors. They have the knowledge of how to handle any complication. But when a woman is having her first pregnancy, midwives don’t deliver them…those you send to the hospital. Also, if you have six or more children, if you are hypertensive or have any other complications, we call those high-risk pregnancies so we don’t take any chance to deliver them at home,” Hamilton said.

Other examples of high-risk classifications, according to Hamilton, include having a previous Caesarean(C)-section, diabetes, cardiac disease, anaemia, teenage pregnancy, advanced maternal age, twin pregnancy, triplets, troubling obstetric history, pelvic injury, viral illnesses, and any underlying health conditions.

With respect to the Millennium Development Goals, which ended in 2015, Jamaica had difficulty meeting the target of goal four, which sought to reduce infant and child mortality rates by two-thirds, and goal five which required a reduction of 75 per cent in the maternal mortality ratio.

While the goals were not met, over the years Jamaica has been successful in reducing its infant mortality from 26 per 1,000 live births in 1991 to 20 per 1,000 live births in 2012; under-five mortality from 28 per 1,000 live births in 1990 to 20 per 1,000 live births in 2012; and maternal mortality from 110 per 100,000 live births in 1990 to 83.1 per 100,000 live births in 2012.

In addition, there are continued efforts to reduce these figures under the Programme for the Reduction of Maternal and Child Mortality (PROMAC), an initiative spearheaded by the Ministry of Health under a Government of Jamaica-European Union bilateral agreement with funding support of approximately €22 million to combat infant and maternal mortality by improving five focus areas. The areas include newborn and emergency obstetric care, quality of primary health care services and referral systems, health workers’ training and research, support for the target population, and institutional support for project implementation.

Moreover, Hamilton appealed to women to engage the services of midwives once they are not at high risk.

“In some communities the relationship women have with midwives are close-knit, so they don’t want to go to hospitals, However, midwives will advise them what is best to do. Since COVID-19, some parishes have done more deliveries. Interestingly, we thought that because of COVID[-19] they would have gone to the hospital, but they still call the midwives to come and do home deliveries. This is a service available to you. Contact the midwives at the health centre or if you live in the community where the midwife lives, then you call her,” Hamilton said.

She further explained that the services stretch far beyond deliveries.

“Midwives don’t only do home deliveries. They work in the clinics, they manage the health centres, they have pregnant mothers to care for, babies to immunise, family planning, and they have to do the post-natal check-up, do the Pap smear, and they work on the maternity wards. The midwife has an important task in health counselling and education – not only for the woman, but also within the family and community. This work involves antenatal education and preparation to parenthood, and may extend to women’s health, sexual or reproductive health care. A midwife may practise in any setting including the home, community, hospitals, clinics or health units,” she said.

Further, Hamilton said engaging the services of a midwife creates greater family bonds.

“When you have a home delivery, the child’s father is there, the grandmother is there, other family members are there and they feel so good. It is a sentimental moment. When the babyfathers see what the mothers go through to have the baby, they love them more and love the children more,” she said.

Of equal importance, Hamilton also urged women to rid themselves of the belief that they have the freedom to choose to deliver naturally or by C-section.

“A C-section should be done only for complications; it is not a regular thing where you choose. If you have complications you have to have a Caesarian section. If a midwife is delivering and nothing is happening and she know it’s time, and the head is not descending and if she doesn’t act fast the outcomes can be fatal, she has to transfer the mother to the hospital. But it [C-section] is not something that is a choice – it is reserved for complications. As long as you can have the baby normal, then have the baby normal,” Hamilton said.

With regards to the profession’s popularity, Hamilton said while certificate courses are no longer offered, young people are opting to pursue midwifery degrees at the Caribbean School of Nursing, University of Technology (UTech).

“More people are doing it. They are now doing degrees and UTech has a good amount of midwives doing degrees and have graduated and are doing well,” Hamilton said.

But, before she bows out of the profession, her hope is to see more midwives pursue the discipline at the master’s level.

“Do the master’s and become midwifery educators in schools, become involved in policymaking, because sometimes persons who do not have any idea come up with plans that are not effective. I want to see midwives involved in research findings and I would love to see a regional midwife officer in each regional office.”

She will be there as a liaison officer for midwives and serve as their region representative.