Recall the midwife

It’s time for the return of the midwife and a return to the pivotal role they played in delivering low-risk pregnancies safely.

So says renowned local midwife Sydney Grove, who has championed the profession and its role in the health sector for nearly 40 years.

As the country and world grapples with increasingly high Caesarean-section rates and with more private gynaecologists closing their obstetric services as a result of high liability insurance fees, Grove said it was time for the midwife to come back.

According to the Council for Medical Scheme’s 2017 annual report, six out of 10 births in the private sector are via C-section.

The latest District Health Barometer says 26% of babies in the public sector were delivered through the procedure.

“In terms of South Africa the shift – from primarily midwives being at the forefront of birthing and maternal care to gynaecologists now delivering more babies – happened from the late 1970s to the early 1980s when more private hospitals opened in the country and specialists moved from the public sector to the private,” Grove told City Press this week, speaking in light of February being Pregnancy Awareness Month.

“There was also a change in the training of midwives from the 1980s, which resulted in a move from a sister (professional nurse) having to complete a one-year course, after qualifying as a nurse, to be a midwife.

“The course became integrated into the nursing studies and slightly watered down because the rationale at the time was that a nurse must be trained and able to do everything,”he said.

And, as this shift occurred, as well as the assimilation of the professional training, Grove said midwives lost their empowerment and slowly their role became lowered to being obstetric nurses – there only to assist gynaecologists in theatre rooms.

“So the strength of working independently, delivering low-risk babies and practising pure midwifery decreased,” Grove said.

However, numerous studies have sought to reinforce the importance of midwives and their role in the active, safe delivery of babies.

A new study published in the latest SA Medical Journal found that in midwife-led obstetric units using the “Clever” approach, there were significant declines seen in stillbirths, meconium aspiration and birth asphyxia.

Clever is the acronym for Clinical care, Labour ward management, Eliminate barriers, Verify care, Emergency obstetric simulation training and Respectful care; and is a context-specific, multicomponent, clinically focused intervention package.

The three-phase, mixed methods study resulted in researchers implementing the intervention in five midwife-led obstetric units in Tshwane, with another five being the control units.

A year after the intervention, they found a significant decrease in the previously mentioned perinatal outcomes.

Internationally, a 2016 Cochrane Review of 15 studies on 17 674 women using professionally qualified midwives showed that women who received midwife-led continuity of care were less likely to have an epidural. In addition, fewer women had episiotomies or instrumental births.

“We know, based on research, that women in labour who are looked after by a midwife and are low-risk have a lower risk of complications,” Grove said.

But there is a countrywide shortage of midwives.

“When I qualified in the 1980s, there would be 1 000 to 2 000 students in midwifery a year. Nowadays it’s more like 300 a year. The need for midwives has become bigger and bigger, but the availability has become less and less,” he said.

Grove said that midwives were not getting the recognition they deserved and needed to band together to give the SA Nursing Council regular feedback on how to advance the profession again.

“I have been a nurse for 42 years and a midwife for 38 years and I am still learning to this day. My heart still beats faster when I am involved in birthing. It’s sad what’s happenedto our profession and it’s a shame we’re not aggressive enough as a profession to speak up. We need to reboot the entire system,” said Grove.

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