Sensitive Midwifery - Issue 44 - October 2019

Professor Marie Hastings-Tolsma , PhD, CNM, is a visiting professor at the University of Johannesburg and teaches in the Midwifery Doctor of Nursing Practice programme at Baylor University in Texas, USA. Do you see the best midwife of all? Guest voice Mirror, mirror on the wall … D espite questionable improvement in maternal and infant health, the main reason for hospital admission in most countries is childbirth – and caesarean birth is among the top in-patient surgery. Powerful players seek to lay claim to the birth industry. With the continued climb of unnecessary surgical births, real money is at stake. While obstetricians play a central role in the e ff ort to mechanise birth, midwives have just as surely played a definitive role in failing to protect women from unnecessary intervention and a lack of compassionate, woman-centred care. Owning midwifery neglect Despite being the largest group of maternity care providers in South Africa, as well as across the globe, midwives have largely abdicated their responsibility to protect women from unnecessary interventions. We have failed to provide safe, supported birth, and to take our rightful role at the policy table, demanding that women receive compassionate, skilful midwifery care. Midwives have long considered themselves the vanguard of normal birth but it is impossible to justify our collective failure to ensure safe passage for mother and fetus in more recent years. It is frightening to see the speed with which the memory of normal birth is being lost – by both women and midwives. Midwifery leadership is needed now! It is time for midwives to consider strategies which promote our role as the experts in normal birth. Needed are workforce studies which detail the actual numbers of midwives and the nature and scope of midwifery practice. This is a need confirmed by the World Health Organization as an important component to ensure meeting 2030’s Sustainable Development Goals. A growing shortage of midwives is likely masked where nurses and midwives are not di ff erentiated. Also needed is an upscaling of midwifery education to ensure expert knowledge and skills to manage women during parturition. Such upscaling will also be important in providing a midwifery voice in the development of policies which promote woman-centred care and the presence of companions during childbirth. And finally, midwives need to promote and ensure fundamental, non-invasive, low-tech practices which promote normal birth. What reflection do you see? So I ask you, when looking in the mirror, does the midwife you see provide care that protects women from unnecessary interventions, in a manner that promotes safety, comfort, support and shared decision-making? Does this midwife advocate for women in a manner that brings to life the meaning of midwife – ‘ with woman’? Anterior 8 eSensitive Midwifery Magazine Issue 44