Key messages
• There is growing consensus that midwifery has an important contribution to make to
high-quality maternal and newborn infant care. However, understanding of midwifery
is restricted by a failure to apply consistent definitions in implementation of
midwifery, resulting in a mixed workforce of professional and non-professional staff ,
many of whom provide only some components of midwifery care.
• We agreed on a definition of midwifery and used a mixed-methods approach to
develop and test a framework for quality maternal and newborn care that describes
the characteristics of care that childbearing women, infants, and families need in all
countries.
• Analysis of 461 systematic reviews shows that 56 outcomes, including survival, health,
wellbeing of women and infants, and efficient use of resources can be improved by
practices that lie within the scope of midwifery.
• 62% of the 72 eff ective practices within the scope of midwifery show the importance of
optimisation of normal processes of reproduction and early life and strengthening of
women’s capabilities to care for themselves and their families.
• Findings of studies examining several providers active in provision of midwifery care
identified few benefits when reliance was solely on low-skilled health-care workers.
Midwifery was associated with improved efficient use of resources and outcomes
when provided by midwives who were educated, trained, licensed, and regulated, and
midwives were most effective when integrated into the health system in the context
of effective teamwork, referral mechanisms, and sufficient resources.
• Case studies from Brazil, China, and India show the tendency of health systems in
rapid development to adopt a model relying on the routine use of medical
interventions, without the balance brought by midwifery.
• These findings support a system-level shift, from fragmented maternal and newborn
care focused on identification and treatment of pathology, to skilled care for all, with
preventive and supportive care, and treatment of pathology when needed through
interdisciplinary teamwork and integration across facility and community settings.
Midwifery is pivotal to this approach.