Midwifery has a crucial part to play in saving the lives of millions of women and children who die during and around the time of pregnancy, according to a new study.
A major new Series, published in The Lancet, produced by an international group of academics, clinicians, professional midwives and policymakers shows the scale of the positive impact that can be achieved when effective, high-quality midwifery is available to all women and their babies.
Apart from saving lives, it also improves their continuing health and wellbeing and has other long-lasting benefits, researchers said.
The authors also produced evidence of a trend towards the over-medicalisation of pregnancy, and the use of unnecessary interventions such as cesarean sections, in high-income and lower-income countries, with consequent hazards and costs.
"Although midwifery is already widely acknowledged as making a vital and cost-effective contribution to high-quality maternal and newborn care in many countries, its potential social, economic and health benefits are far from being realised on a global scale," said Professor Mary Renfrew of the Mother and Infant Research Unit, School of Nursing and Midwifery, at Dundee University, Scotland.
Every year, nearly 300,000 women are thought to die during pregnancy, childbirth or soon after. Around 2.6 million women suffer stillbirths, and 2.9 million infants die in the first month of life, researchers said.
Millions more women and their families suffer long-term health, financial, and emotional problems, simply because they have not received adequate health care before, during, or immediately after pregnancy.
New estimates produced for the Series suggest that in the countries with the highest burden of infant and maternal deaths, over three quarters of stillbirths and maternal and newborn deaths could be prevented in the next 15 years if effective midwifery was available to all women.
Even if improvements in the coverage of midwifery services were much more modest, the potential for saving lives is huge - if coverage of midwifery services increased from current levels by just a quarter, the authors estimate that the current rate of maternal deaths could be halved by 2030.
While most maternal and child deaths occur in low-income and middle-income countries, the Series also says that overmedicalisation of pregnancy is increasingly threatening the health and wellbeing of women and their families in both high-income and lower-income countries.
The Series authors argue that routine use of unnecessary interventions, including cesarean sections, limited mobility in labour, and episiotomy can have a lasting effect on mothers' and infants' health and wellbeing.
"Both under-use and overuse of medical interventions in pregnancy contribute to short- and long-term illness for an estimated 20 million childbearing women," said Professor Caroline Homer, of the Faculty of Health at the University of Technology, Sydney.
