Midwifery care remains key in managing complications of pregnancy and childbirth

While most of the pregnancies and births are uneventful, all pregnancies are at risk.
According to the World Health Organisation (WHO), around 15% of all pregnant women will develop a potentially life-threatening complication that calls for skilled care provided by a skilled healthcare provider.

The rise in medicalisation of childbirth and the increase in women being treated for complications of childbirth create a need to ensure the presence of midwifery services in the care of all women in order that the ethos of normal childbirth is maintained as much as possible. It is important to ensure that women experiencing complications in childbirth receive the best possible care from a multidisciplinary team, which should include a midwife.

The WHO states that childbirth is an event that easily lends itself to over medicalisation. The worldwide increase in the number of caesarean sections where there is no clinical indication is an example of this and the potential for unintended adverse consequences for both infant and mother is real. The International Confederation of Midwives (ICM) believes that a woman who develops complications during pregnancy, birth or the post-partum period requires care from a midwife in addition to care from specialist(s). 

It is appropriate that the midwife is always involved in the obstetric care and any other specialised care and in the treatment relevant to the mother or newborn.  In Uganda, this is highly practiced in public health facilities, and rarely is it practically seen and practiced in high-end private health facilities. The presence of the midwife always can provide continuity of care and support in a situation where the woman may receive care from several health professionals not previously known to her, leading to increased fears and anxieties. It is also important to appreciate that the midwife’s approach to childbirth as a physiological and psychosocial process will optimise the woman’s experience of childbirth and help her to prepare for motherhood and nurturing her newborn with the best possible physical and mental health.

Wherever women are treated for medical disorders such as hypertension, cardiac, renal and liver diseases, diabetes mellitus and anaemia in pregnancy or in obstetric complications such as assisted deliveries of vacuum, caesarean section, preterm delivery or complications of the postnatal period, they should be offered care by a midwife, as stated in the ICM Essential Competencies for Basic Midwifery Practice. The worldwide acceptance of midwives acknowledges that they are the appropriate skilled professionals in normal childbirth and they also play an important role in the care and treatment of pregnant women experiencing complications.

I, therefore, recommend the Government of Uganda through the Ministry of Health, top management of health facilities and relevant associations to further advocate for the involvement of midwives as part of the multidisciplinary teams for those women who develop complications before, during and after giving birth.

The author is; Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist working with Aga Khan University & is the Heroes in Health Award Winner-Midwife of the year 2021