1. The 13th International Conference of the Jordanian Society of Obstetricians and Gynaecologists – 31 August-2 September Midwives save lives, enhance health and help give the mother, baby and family the best start in life Professor Lesley Page, President, The Royal College of Midwives, United Kingdom

2. Giving the best start in life

4. State of the World’s Midwifery 2014
Midwives who are educated and regulated to international standards can provide most of the essential care needed for mothers and babies
Investing in midwifery education, with deployment to the community, can yield a 16-fold return on investment and is one of the "best buys" in primary health care
How to persuade the global community – donors, policy makers governments

5. The Lancet Series on Midwifery
@midwiferyaction #lancetmidwifery

6. The Lancet Series on Midwifery
Multidisciplinary group of 35+ specialists from 20+ countries
health systems analysts, demographers, statisticians, epidemiologists, health service researchers, social scientists, health economists, specialist midwife researchers, service user advocates, public health and policy experts, and clinical experts: midwives, obstetricians, paediatricians, other related disciplines
Input from close readers/critical friends, WHO, Gates Foundation, ICM, FIGO, Lancet editors and reviewers
Supported by the Bill & Melinda Gates Foundation + NORAD

7. The Lancet Series on Midwifery
Context - global developments
Sustainable Development Goals
Universal Health Coverage
Global Newborn Action Plan
Health workforce development
Beyond saving lives - improving the quality of care
State of the World’s Midwifery 2011, 2014

8. The global context Unacceptable rates of mortality and morbidity
Longer term and psycho-social outcomes overlooked
birth is the start of the journey
High rates of unnecessary interventions
Inequalities in outcomes and care
Care and compassion seen as less important
yet integral to system failures
Disrespect and abuse of women within the health system

9. Framework for quality maternal and newborn care
For all childbearing women and newborns
For women and newborns with complications
Effective practices
Education, information,
health promotion
Assessment, screening, care planning
Promotion of normal processes, prevention of complications
First-line management of complications
Medical obstetric neonatal services
Organisation of care
Available, accessible, acceptable, good quality services – adequate resources,
competent workforce
Continuity, services integrated across community and facilities
Respect, communication, community knowledge and understanding
Care tailored to women’s circumstances and needs
Values
Mary Renfrew says -And because the evidence was not in a form that could be used off the peg, we had to develop a framework – a different way of seeing it. - What, how, who
Integrated – not fragmented – including all needs and relevant across the health system and all the providers - One framework, one way of seeing
Our analysis used core concepts – continuity, normal processes, prevention as well as treatment – as an innovative way of looking at and assessing the evidence
Most evidence in the top right hand box
Optimising biological, psychological, social and cultural processes,
strengthening women’s capabilities.
Expectant management, using interventions only when indicated
Philosophy
Practitioners who combine clinical knowledge and skills with interpersonal and
cultural knowledge
Division of roles based on need, competencies and resources
Care providers
Renfrew, McFadden, Bastos et al The Lancet 384, I9948, 1129 – 1145, 2014

10. Scale of the impact of midwifery care
Universal coverage of midwifery would result in reductions in maternal deaths, stillbirths, and neonatal deaths in 78 countries
maternal mortality, stillbirths, and neonatal deaths
reduced by around 80%
Homer, Friberg, Bastos Dias et al The Lancet 384, Sept 2014

11. Midwifery – key to quality care Implications of The Lancet Series on Midwifery

12. Midwifery in the UK The Royal College of Midwives Regulation
Direct entry midwifery at degree level
Academic development
Every woman has a midwife-some have a doctor too
Woman centred policy-Better Births
Development of midwifery

13. Thank you
With thanks to Jess and Nick

14. For further information
Website:
Telephone:
@MidwivesRCM