Why India needs midwives in the coronavirus fight more than ever
The theme of this year’s World Health Day (WHD) – honouring and recognising nurses and midwives for their vital role in keeping the world healthy — observed on April 7, couldn’t have been more poignant, pertinent and powerful. With 2020 declared as the International Year of the Nurse and the Midwife by the UN, the spotlight is on frontline workers — chiefly nurses and midwives who serve in large numbers and as a critical link for sick persons and even healthy communities in the healthcare chain.
All around the world, trained midwives are equipped to provide primary and advanced levels of maternity care services. In the time of a health crisis like the coronavirus pandemic, such support is much-needed. The World Health Organization (WHO) State of the World’s Nursing report 2020, released last month, states that the world needs six million more nurses to achieve global health targets. Specialist midwives can significantly reduce overburdened secondary and tertiary care facilities that are struggling with a strained pool of doctors and nurses and other key allied healthcare staff.
As hospitals continue to report Covid-19 positive patients, there is a need to ensure that uninfected women and expectant mothers do not risk being infected while receiving essential maternal and newborn care.
A recent report of a pregnant woman being denied ambulance service and adequate maternity care indicates how public health emergencies, be it a Covid-19, HIV-positive status or any other cause, can lead to confusion among healthcare workers, denial of services and even active discrimination. Therefore, shifting the focus to primary and community-centric maternity care to contain chances of rapid transmission and maintaining the continuum of care for maternal and newborn health is the need of the hour. We do not need to reinvent the wheel, as containment plans are already in place, but we must work actively to ensure that rights of all, especially those most vulnerable such as pregnant women, are in place.
India has been leading in the fight to bring down its maternal and newborn mortality rates, which we must not let go now. Mothers form the basis of society and ensuring their rightful care should remain a pillar of services during such pandemics. In an official statement, the International Confederation of Midwives (ICM) has stated that the human rights of pregnant women, their newborns and their midwives are being violated by the introduction, in many countries, of inappropriate protocols for management of pregnancy, birth and post-natal care in response to the Covid-19 pandemic. India must ensure that this does not happen in our health system.
Midwives matter because as per WHO data, 83 per cent of maternal deaths and newborn deaths could be averted with midwifery care. A fully trained and certified midwife comes with the requisite national qualifications to be registered legally and licensed to practise midwifery. Experts agree that midwives considerably lower the need for caesarean sections, which reduces unnecessary risks to women and their babies and improve the quality of maternal and infant health overall, as testified by several global and Indian reports. Midwives are able to allow women to labour in a position of their choice. They emphasise physiological birth and can support birth in the semi-squatting or upright position if so desired. This considerably shortens the duration of labour and the need for analgesia and as a result, more women report a positive birth experience.
Medical care is based on the clear principles of zero discrimination and disrespect. Midwifery-led care, which runs on the tenets of primary promotive and preventive care, if given with adequate dignity, privacy and compassion for women, can become the most vital way of organising maternity care so that all women, mothers and newborns continue to receive respectful maternal care, especially during a pandemic like Covid-19.
The government of India announced the Guidelines on Midwifery Services in December 2018, and this move indicates a big shift in India’s maternal healthcare policy, which although geared to reduce maternal and infant mortality rate, adds the importance of women-centred and respectful care for a “positive birth” experience. The government has taken the initiative to introduce Nurse Practitioners in Midwifery licensed as NPMs. This means that they will specialise in routine maternal and reproductive healthcare and will handle early problems before referring women who are at high risk or require specialist care to trained obstetricians and paediatricians.
In India, currently, all registered graduate and diploma nurses are trained for four or three years respectively, to provide basic midwifery care. Once qualified, they receive an RNRM license and are registered by their State Nursing Midwifery Council. Auxiliary Nurse Midwives or ANMs train for two years post Class 12. Once employed by the government health system and posted to a primary or community health centre, they receive additional training on Skilled Birth Attendance that equips them with the skills to provide obstetric first-aid services before referrals for maternity complications.
NPMs will receive additional 18-month training and mentoring so that they can provide global standards of midwifery care. The guideline suggests that 85,000 specialised nurses will be trained and posted so that they can provide quality midwifery services that meet the Indian Nursing Council and International Confederation of Midwives standards.
As India paces its midwifery training and recognises its contribution to society, the new cadre of midwives are crucially needed to support and work closely with the currently overburdened secondary and tertiary care health systems. This is even more apparent during these turbulent times of Covid-19, which requires facilities to make urgent changes in the way they function and prioritise their services to respond to this pandemic. Midwives are integral to the professional pool of providers such as obstetricians and nurses who provide round-the-clock maternity and reproductive healthcare services.
Midwifery is not a short-term solution. In the long run, their addition to the health workforce will help India meet its commitment to Universal Health Coverage and Sustainable Development Goals (SDGs).
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