Advocacy, Model of Practice

Women and midwives need to be at the table, not on the menu

13 February 2018

Did you know that the word ‘midwife’ means ‘with woman’? On this year’s International Women’s Day, midwives stand shoulder-to-shoulder with women to #PressForProgress towards humane and equitable maternity care for all women worldwide. For too long, women and new-borns have suffered and died for preventable reasons during pregnancy and childbirth, and midwives are saying: “Enough is enough!”

IWD Time is now 2018

There is overwhelming evidence from policy, research, professional and academic institutions that the care of a midwife can mitigate the risk of harm to women and new-borns dramatically. There is consensus that if midwives stand with women, and women stand with midwives, we can turn around this unacceptable situation.

As the President of the International Confederation of Midwives (ICM), I have the privilege of being able to listen to the voices of many midwives worldwide. Despite their diverse contexts, our 500,000-plus midwives– who are predominantly women – have the shared understanding that the connection between a midwife and women is intrinsic. This also rings true for myself: as a midwife, I can only be a feminist, and I believe that this is vital in ensuring that women receive high-quality and respectful maternity care.

Despite the magnitude of women working in healthcare, the essential role of #MidwivesForWomen has endured immense pressure within the bio-medical model, which is still predominantly male-dominated. The current medical status quo tends to perceive childbirth not as a natural and normal life experience, but as a medical procedure that warrants intervention. This does not always gel with what a woman wants or needs, which can lead to a situation in which a woman can feel violated or traumatised by her medical care.

As midwives, we believe it is the right of all women to decide what happens to their own bodies, to decide their own future, to decide what is best for their baby, and to decide to have their own midwife by their side.

In this last month, I have met midwife leaders from around 25 different Midwifery Associations (MAs), including Zambia, Ireland, Rwanda, Ethiopia, Luxembourg, Sierra Leone, Slovenia and France. The overarching theme in our conversations was not, as you may expect, our colourful diversity. Midwife leaders from ICM MA’s are noticeably well-informed and well aware of the most recent evidence about their specific role in leading the way for quality midwifery care for women and their new-borns.

Midwife leaders understand that over- and under-medicalisation (‘Too Much, Too Soon’ and ‘Too Little, Too Late’) in their countries are indicative of one and the same issue: That women worldwide are being disempowered in asserting their rights to respectful quality care, appropriate to their context. These midwife leaders know that they can make the difference for and with women and are ready to #PressForProgress, but inclusion can be a key barrier for midwives who advocate for women.  A recurring theme that every single one of these midwives shared with me was that at the decision-making table, midwifery care is on the menu, but women and their midwives at not permitted to sit at that same table! How are we supposed to represent the interests of women if we cannot partake in the conversations that impact us?

As with the miracle of childbirth itself, midwives are patient when necessary. But it is also an inherent skill of midwives to know when we have waited long enough.

On behalf of more than half of the world’s population and our 132 Midwifery Associations that make up ICM, I call upon decision-makers worldwide to ensure that women and midwives are seated at the table when it comes to conversations around sexual, reproductive, maternal and new-born care. We will support midwives and women to take the lead in conversations that impact them first and foremost, because when women and midwives stand together, we can and will make the difference.

Let’s #PressForProgress together so there can always be #MidwivesForWomen!