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midwife

mid·wife / ˈmidˌwīf/ • n. (pl. -wives ) a person (typically a woman) trained to assist women in childbirth. ∎ fig. a person or thing that helps to bring something into being or assists its development: he survived to be one of the midwives of the Reformation. • v. [tr.] assist (a woman) during childbirth. ∎ fig. bring into being: revolutions midwifed by new technologies of communication. DERIVATIVES: mid·wife·ry / midˈwīf(ə)rē; -ˈwīf(ə)rē/ n.

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midwife

midwife (mid-wyf) n. (in Britain) a health-care professional who, having undertaken a three-year period of study, is qualified to provide advice, care, and support for women and their families during the antenatal, intranatal, and postnatal periods. Midwives work in a variety of care settings. See also community midwife.
midwifery (mid-wif-ri) n.

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midwife

midwife XIV. prob. f. mid (prep. and adv.) with, together + WIFE in the sense ‘woman’, the notion being ‘a woman who is with the mother at the birth’.
Hence midwifery XV.

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midwife

midwifefife, Fyfe, knife, life, pro-life, rife, still-life, strife, wife •shelf-life • midlife • wildlife •nightlife • lowlife • afterlife •jackknife • penknife • paperknife •spaewife • alewife • midwife •fishwife • housewife • goodwife

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Midwife

Midwife

The term midwife means with woman. Traditionally, midwifery describes the art of assisting a woman through childbirth. The International Definition of the Midwife (International Confederation of Midwives [ICM] 2005) is:

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery.

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and child care.

A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

Exclusion of traditional midwives from this definition is controversial because sometimes they are the only people available to assist women in birth. The World Health Organisation (WHO) and other groups refer to traditional midwives as traditional birth attendants or lay midwives to distinguish them from registered/licensed midwives as defined above.

REGULATION OF PRACTICE

Prescribed courses of study leading to registration as a midwife, for those with nursing qualifications, include postgraduate degree programs conducted by universities, or twelve- to eighteen-month midwifery certificate courses conducted by a hospital. Another course is the two- or three-year direct-entry undergraduate program that allows midwives to be educated in the discipline of midwifery without prior nursing qualifications. In the United Kingdom, Australia, Europe, and Scandinavia, practicing midwives must be licensed. Legislation in 1990 restored midwifery in New Zealand and legally established midwifery and nursing as separate and distinct professions. Between the late 1940s and the 1950s, Canada did not regulate midwifery. It was regulated again in the 1960s and became part of the health system in British Columbia, Alberta, Manitoba, Ontario, Quebec, the Northwest Territories, and Nunavut. Midwifery is not yet legally recognized in the Atlantic provinces of Canada. Cultural safety and appropriate care is gaining prominence across the world. There are very few indigenous midwives in Australia, but programs are beginning to emerge, and a program for First Nations midwifery students will open soon in Manitoba (Manitoba Health 2006).

Midwives are required to practice according to codes of ethics and professional conduct/practice and within the law. They should be capable, caring, and of good character and have no criminal record, personal health problems, or disabilities that impede practice. Licenses are usually renewed annually on payment of a fee. Debate continues over how to ensure that midwives maintain current knowledge and competency of practice before renewing their registrations, and many registering authorities require a signed declaration to this effect.

PREVALENCE AND IMPORTANCE OF MIDWIVES

Midwives are predominantly female. They make a vital contribution to the health and well-being of women and infants and are a part of an integrated team of professionals providing maternity services. Having a child is an emotional and social event, and sexual health is a part of the woman's reproductive health; it is a state of physical, emotional, mental, and social well-being. The WHO has highlighted that the presence of midwives during birthing lowers maternal mortality rates; unfortunately, only about 60 percent of the women in the world receive professional help during childbirth (European Midwives Association 2004).

In 1954 when the number of trained midwives in Sweden increased, maternal mortality rates during childbirth fell despite Sweden being one of the poorest European countries at that time, the European Midwives Association (2004) reported. In 1997 Angola had the world's highest maternal mortality rate, with only 492 midwives (0.04 per 1,000 population) as recorded in WHO statistics (2006); and Afghanistan had the second highest maternal mortality rate in the world according to the United Nation's Save the Children (2006). To address their problem, Afghanistan established a nationwide, eighteen-month midwives' training program that gives skills to rural women to assist the community and improve prenatal healthcare.

Conversely, the United States, the Netherlands, and Australia, for example, with higher ratios of qualified midwives and medical staff, have low maternal mortality rates. There were 5,500 certified nurse-midwives practicing in the United States in 2006; more than 1,900 in the Netherlands in 2004 (Midwifery in the Netherlands, European Midwives Association); and 10,000 in Australia in 2001 (Commonwealth of Australia 2001). The prevalence of midwives and low maternal mortality rates in the United Kingdom and Europe are similar.

In Hong Kong SAR, China, nurse-midwives are not independent professional practitioners, and in China midwives no longer work in rural areas such as Tianjin Municipality, where 99 percent of pregnant local women give birth in hospitals. Thailand also has very medicalized childbirth system. There is a strong sense of midwifery in Japan, but as in many industrialized countries, the number of midwives is diminishing due to retirements and a shortage of obstetricians: When midwives are employed by health services/hospitals, there must be an obstetrician for aspects such as ordering scans and blood tests, prescribing necessary drugs, and even diagnosing that the woman is pregnant. Birthing is concentrated in large hospitals, so midwife houses (mini birth centres) throughout Japan are closing.

MIDWIFERY PRACTICE, CONTEMPORARY OBSTETRICS, AND BIRTHING

Midwives in industrialized countries are employed by regional health services; specialized clinics such as in vitro fertilization, diabetes, and fetal medicine; or, especially in the United Kingdom, the Netherlands, and New Zealand, independently as private practitioners. In the United States nurse-midwives are advanced-practice nurses able to prescribe medications in forty-eight out of the fifty states and to provide care to women from puberty through menopause. In the rural and remote areas of New Guinea, Africa, India, and the Americas, midwives conduct childbirth preparation classes for indigenous women in their villages (Robertson 2003–2006).

Midwives specialize in normal childbearing according to the international definition. Obstetricians specialize in illness- and surgery-related childbearing. The two professions can be complementary but often are at odds, because obstetricians are taught to actively manage labour whereas midwives are taught not to intervene unless necessary.

The move away from home birth to hospital birth and the technological advances during the second half of the twentieth century have presented benefits and problems. They have improved the possibility of women and couples being able to plan their families and of having a healthy mother and baby. At the same time these changes have resulted in the cascade of intervention (where one intervention leads to, or requires, another intervention), the medicalization of childbirth, the risk of focusing on technology rather than women and infants, and the deskilling of midwives in the practice of midwifery.

Although midwives do not perform what industrialized countries consider harmful tribal and cultural practices, such as female genital mutilation and male circumcision, increasingly, with globalization, they are caring for women and infants who have undergone these procedures.

BIBLIOGRAPHY

Högberg, Ulf. 2004. "The Decline in Maternal Mortality in Sweden: The Role of Community Midwifery." American Journal of Public Health 94(8): 1312-1320.

International Alliance of Midwives. Available from http://www.midwiferytoday.com/iam/.

International Confederation of Midwives. 2005. Definition of the Midwife. Adopted by the International Confederation of Midwives Council Meeting, July 19th, 2005, Brisbane, Australia. Available from http://www.internationalmidwives.org

"Midwife Training Programme, Yushu, China." Children in Crisis. Available from http://www.childrenincrisis.org.uk/pages/midwife_training_programme.html.

"Midwifery Education—A European Perspective, Report from the Conference in Stockholm 16-17 April 2004." European Midwives Association. Available from http://www.europeanmidwives.org/_pdf/Report_EMA-Educa-Conf-Stockholm-04-04.pdf.

"Midwifery in Australia." sci.med.midwifery Newsgroup. Department of Information & Computing Sciences, Universiteit Utrecht, Utrecht. Available from http://www.efn.org/∼djz/birth/midwifefaq/australia.html.

"Midwifery in the Netherlands." Koninklijke Nederlandse Organisatie van Verloskundigen—KNOV—European Midwives Association. Available from http://www.europeanmidwives.org/uk/05Midwifery_in_Europe/The_Netherlands/.

"Midwifery in the United States." sci.med.midwifery. Available from http://www.efn.org/∼djz/birth/midwifefaq.

"Midwifery Services." Manitoba Health. Available from http://www.gov.mb.ca/health/midwifery/index.html

"Mortality Rates." International Caesarean Awareness Network, Inc. Available from http://www.ican-online.org/resources/statistics4.php.

"National Vital Statistics Reports." U.S. Department of Health and Human Services. Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. Available from http://www.cdc.gov/nchs/births.htm.

Robertson, Andrea. 2003–2006. "Andrea's Diary," Birth International, Acegraphics. Available from http://www.birthinternational.com/diary/archives/2004_07.html.

Shah, Chandra, and Gerald Burke. 2001. "Job Growth and Replacement Needs in Nursing Occupations." Commonwealth of Australia Department of Education, Science and Training. Available from http://www.dest.gov.au/archive/highered/eippubs/eip01_18/default.htm.

"Statement on the Reproductive and Sexual Health of Women." European Midwives Association. 2005. Available from http://www.europeanmidwives.org/_pdf/reproductiveandsexualhealthofwomen-sept2005.pdf.

"Tianjin Leads China's Rural Areas in Bidding Farewell to Midwives." 2001. English People's Daily Life. Available from http://english.people.com.cn/english/200104/26/eng20010126_68671.html

Troskie, T. R. 1997. "The Importance of Traditional Midwives in the Delivery of Health Care in the Republic of South Africa." National Library of Medicine and the National Institutes of Health. Curationis 20(1): 15-20.

United Nation's Assistance Mission in Afghanistan. United Nation's Save the Children. Available from http://www.unama-afg.org/news/_fs/2006/06jun21-midwives.htm.

World Health Organization. 1985. "How to Use Maternity Statistics: Appropriate Technologies for Birth." Lancet 2: 436-437.

World Health Organization Statistics. 2006. Available from http://www.who.int/whosis/en/.

                                            Faye E. Thompson

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