The publication, Transitioning to midwifery models of care: A global position paper, outlines the benefits and key components of midwifery care models, where midwives serve, within broader teams, as the main healthcare provider for women and babies during pregnancy, childbirth and the postnatal period. It was published by a WHO working group co-led by ARC South London’s Professor Jane Sandall CBE and draws on evidence produced by the ARC’s maternity and perinatal mental health theme.
Expanding and investing in midwifery care represents a cost-effective and urgently needed solution to save and improve the lives of women and newborns globally.
Recent modelling shows that universal access to midwifery care could avert more than 60% of all maternal and newborn deaths and stillbirths – amounting to 4.3 million lives saved annually by 2035 – and that even a more modest 10% increase in coverage could save 1.3 million lives each year.
Evidence shows that these types of care can also provide greater opportunities for women to access information and emotional support, and to be actively involved in decision making around pregnancy, childbirth and the care of their newborns.
A study of more than 18,500 women, led by Professor Sandall, looked at the impact of having a consistent team of midwives providing support through the maternity period. Crucially, these women were more likely to report a positive birth experience and greater satisfaction with the services they received. Additionally, among women receiving this type of care, rates of spontaneous vaginal deliveries increased, while episiotomies and use of forceps during childbirth declined, indicating potential reductions in the use of unnecessary medical interventions.
When midwives are skilled and empowered to provide high-quality respectful care, they can provide the vital ongoing support that women and newborns so much need and value. Building close and trusted partnerships between women and midwives is one of the critical opportunities from reorienting health systems towards midwifery care models, in addition to providing clear health benefits and greater access to lifesaving healthcare
The publication stresses the importance of ensuring high-quality training for midwives alongside regulation, licensing, and essential infrastructure, supplies and other kinds of support, to ensure high-quality services. It is also essential that midwives work within well-functioning interdisciplinary teams, so that they can collaborate with other healthcare workers such as nurses, obstetricians, community health workers and paediatricians.
Investing in midwifery models of care provides benefits in all countries, but is likely to provide the most impact in poorer countries, and humanitarian and crisis settings. It will also have a positive impact in disadvantaged areas of wealthier countries, says the ARC's professor Jane Sandall.
Our researchers are currently examining the impact of midwifery continuity of care models for women with social risk factors, those at higher risk of complications and living in disadvantaged areas of London and have found a range of positive health outcomes. This WHO position paper highlights the benefits of midwifery models of care for women and babies in countries around the world
Despite their critical role in providing maternity and newborn care, there is a shortage of around 900,000 midwives globally today. Many face challenges in terms of pay, access to education and working conditions – with this largely female workforce often among the lowest paid cadre of health workers.
Currently, an estimated 287,000 women die due to pregnancy and childbirth each year; 2.3 million babies die within their first month of life and nearly 2 million more are lost to stillbirth.
To facilitate the adoption of midwifery models of care in countries, WHO is currently developing a detailed guidance document for implementation that will be released in 2025.