Strengthening the skills of future midwives

No matter the context or country, midwives across the WHO European Region operate in diverse work settings and situations that require them to adapt their knowledge and expertise to deal with the unexpected, to ensure the best care for mothers and babies before, during and after birth.

"Midwifery is a vital solution to the challenges of providing high-quality maternal and newborn care for all women and newborn infants, in all countries," says Maggie Langins, Technical Officer at WHO/Europe. "But midwives must be well-trained, properly supported, and the profession fully regulated."

The Cardiff University WHO Collaborating Centre (CC) for Midwifery Development, based in Wales, United Kingdom, is one of 300 specialized CCs in the Region that carry out activities in support of WHO. The Cardiff CC is the only one solely dedicated to midwifery and works with WHO to build capacity in countries to strengthen the education and training of future midwives from Europe and further afield.

"We know that midwives, when supported with the right education, can support 80% of births," explains Maggie, who points to the Cardiff Centre's global focus despite its base in the Region. The CC supports WHO/Europe to work with countries in scaling up and transforming midwifery education and training to ensure it is evidence-based and fit for purpose, across all 53 WHO/Europe Member States.

"On one hand, this is a no-brainer, but on the other hand, it takes bold political commitment and, so, it is vital that we deliver the facts, the evidence and, crucially, the capacity to raise the bar for midwifery education in our Region," she emphasizes.

Learning to handle emergencies

Director of the Collaborating Centre for Midwifery Development, Grace Thomas, notes that midwives are also the first to respond if there are obstetric and neonatal emergencies. At the Cardiff CC, student midwives work towards a Bachelor of Midwifery Honours degree, and an integral aspect of this comprehensive programme involves equipping them to handle emergencies concerning both mothers and newborns.

Students are educated to react expertly and immediately in any emergency situation for both maternal and newborn care, and to understand when to refer appropriately to other professionals.

"First, students must understand the normal physiological processes for labour, birth, and the postpartum period, so they can clearly identify when there is a deviation. That is key to education. If you don't know the normal, you can't know when something is wrong," stresses Grace.

The curriculum is meticulously crafted based on the latest evidence, and learning is facilitated through simulation exercises. This is paired with practical training alongside seasoned midwives across various practice settings, ranging from home births to hospital deliveries. Under close mentorship and guidance, students develop the skills needed to become qualified midwives.

Preventing maternal and newborn deaths

In addition to sudden medical emergencies that may occur, midwives may also need to cope with extremely challenging situations in times of turmoil, such as during conflict or along migration routes, putting their skills to the test and pushing their resilience to its limits. To better ensure readiness levels in these challenging situations, the CC has developed an educational module that focuses on global issues, placing human rights and fundamental freedoms at its forefront. Preparation of this kind enables midwives to act with confidence in high-stress, high-stakes environments.

"During emergencies, it doesn't mean our work stops. Babies will continue to be born and expectant mothers will continue to need care, no matter the circumstances. But in all situations, the midwife is there. We are the first to step in and the last to leave in times of trouble," stresses Grace. "The unique truth in midwifery is that every woman giving birth is vulnerable and must be treated with compassion, dignity and respect. Students are given the opportunity to work directly with qualified midwives in emergency situations to gain critical hands-on experience."

The educators understand the inherent difficulty in putting oneself into chaotic situations and imagining how to behave in reaction to others in distress.

Midwives, once educated to international standards, must be enabled to practice the full scope of their role as a part of a multiple disciplinary team. Governments can contribute to this through regulation establishing midwives as trusted and viable medical professionals, and encouraging partnerships with other professionals, such as obstetricians, neonatologists and anesthetists.

Tailoring education, exchanging knowledge

Midwifery education and practice varies significantly within the Region - straddling 53 Member States across Europe and central Asia - due to differences in health-care systems, cultural contexts, and resource availability. By involving CCs, such as the one in Cardiff, in cross-country efforts related to midwifery policy, governments, regulators, educational institutions, and health-care facilities can obtain valuable insights. This approach ensures a holistic focus on midwifery education, practice, regulation, and workforce development.

"Exchanging knowledge allows countries to learn from each other's successes, leading to the identification of strategies that can be adapted and implemented to improve the capacity of educators, decision-makers and midwifery leaders to improve midwifery care," says Maggie.

Midwives provide skilled, knowledgeable, and compassionate care for childbearing women, newborn infants and families throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life. ​Core characteristics include:

• optimizing normal biological, psychological, social, and cultural processes of reproduction and early life;
• timely prevention and management of complications;
• consultation with and referral to other services, respecting women's individual circumstances and views; and
• working in partnership with women to strengthen their own capabilities to care for themselves and their families​.

Communicating the value of midwifery

During a visit to Tajikistan in 2023, the Cardiff CC contributed to a discussion with educators about midwifery education around the world. As a result, WHO will now be working with the governments of Kazakhstan, Kyrgyzstan, and Uzbekistan, as well as the Government of Tajikistan, to roll out the Midwifery Assessment Tool for Education (MATE) in all of central Asia.

This tool, commissioned by WHO/Europe, is a part of the Action Plan to Strengthen Nursing and Midwifery in Central Asia. It is designed to inform in-country discussions at the early planning stage, support Member States wishing to develop midwifery education, and strengthen the midwifery and nursing workforce in the WHO European Region and beyond.

"Working closely with WHO, the tool gives us the insights to communicate effectively on the importance of midwifery to the health of women, newborns and families. The evidence is clear: midwives who are educated to international standards, regulated and recognized as a separate and distinct profession, and enabled to practice according to the full scope of their profession, can reduce maternal and newborn deaths," says Grace.

"Midwifery is a best buy for enabling health for all and our Collaborating Centre works to support its development in all countries," she adds.

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