This document discusses the role of midwives in improving maternal and newborn health in the Western Pacific region. It notes that properly trained and supported midwives can deliver many important interventions to reduce maternal and newborn mortality, such as safe childbirth practices and newborn resuscitation. However, there is a scarcity of midwives across the region due to issues like lack of education, regulation, and health system infrastructure. The document advocates for strengthening midwifery through improved education, regulation, and professional associations in order to help achieve health targets and save women's and newborns' lives.

1. Maternal
health
care
in
the
western
Pacific:
The
role
of
midwives
Caroline
Homer
Faculty
of
Health
UTS

2. Objec9ves
• Discuss
the
role
of
midwives
in
newborn
survival
• Discuss
training,
standards
and
advocacy
across
the
Pacific
to
strengthen
midwifery

3. Saving
newborn
lives
….
• Saving
newborn
lives
means
star9ng
with
women
• The
provision
of
care
that
is:
– Safe
and
effec9ve
– Accessible
– RespecJul
– Based
on
evidence
• Need
a
workforce
to
deliver
the
care

4. Maternal
mortality
Source:
SoWMR,
2011

5. Giving
birth
safely
is
largely
a
privilege
of
the
rich
Source:
UN
MDG
report
2012

6. • Nearly
two
thirds
of
births
in
the
developing
world
are
a>ended
by
skilled
health
personnel
• Lots
of
quesBons
about
what
consBtutes
‘skilled’
Source:
UN
MDG
report
2012

7. Source:
SoWMR,
2011

8. More
pregnant
women
are
receiving
care
with
the
recommended
frequency,
but
gaps
sBll
exist
in
regions
most
in
need
Source:
UN
MDG
report
2012

9. Fewer
teens
are
having
children
in
most
regions,
but
progress
has
slowed
Source:
UN
MDG
report
2012

10. Family
planning
• Plays
a
cri9cal
role
in
reducing
maternal
mortality
• Has
child
health
benefits
too
– Less
women
are
pregnant
– Greater
spacing
between
births

11. Reasons
that
newborns’
die
• Birth
asphyxia
• Preterm
or
low
birth
weight
• Infec9on

12. Saving
newborn
lives
…
• Cross
the
con9nuum
– pre-­‐pregnancy
care
– pregnancy
care
– care
in
labour
– care
at
birth
and
immediately
aXer
birth
– care
in
the
early
days
and
weeks

13. Preven9ng
preterm
birth
or
s9llbirth
PrevenBon
or
improvement
EffecBve
intervenBons
Prevent
preterm
births
smoking
cessaBon
Prevent
sBllbirths
balanced
protein
energy
supplementaBon
screening
and
treatment
of
syphilis
intermi>ent
presumpBve
treatment
for
malaria
during
pregnancy
birth
preparedness
emergency
obstetric
care
elecBve
inducBon
for
post-­‐term
pregnancy
Improve
survival
of
preterm
newborns
prophylacBc
steroids
in
preterm
labor
anBbioBcs
for
PROM
delayed
cord
clamping
vitamin
K
supplementaBon
at
birth
case
management
of
neonatal
sepsis
and
pneumonia
room
air
(vs.
100%
oxygen)
for
resuscitaBon
hospital-­‐based
kangaroo
mother
care
early
breasUeeding
thermal
care

14. All
interven9ons
need
…
• A
professional
workforce
– Midwives
– Community
health
workers
– Specialist
services
• Family
and
community
health
care
– Village
health
volunteers
• A
func9onal
integrated
health
system
– Commodi9es
– Communica9on
and
referral

15. The
role
of
midwifery
• Properly
trained
and
supported
midwives
can
deliver
many
of
the
interven9ons
needed
to
improve
maternal
and
newborn
health
• The
lives
and
health
of
millions
of
women
and
newborns
could
be
saved
with
greater
investments
in
midwives,
emergency
midwifery
and
obstetric
care
and
family
planning

16. WHO’s
essenBal
care
packages
and
the
role
of
midwifery
competencies
across
the
conBnuum
of
care
State
of
the
World’s
Midwifery
Report.
Adapted
from
WHO
(2010)
recommended
‘Packages
of
Interven9ons
for
Family
Planning,
Safe
Abor9on
Care,
Maternal,
Newborn
and
Child
Health’
and
ICM
(2010)
Essen9al
competencies
for
basic
midwifery
prac9ce

17. Obstacles
to
midwifery
• Scarcity
of
midwives
– few
midwives
at
hospitals
or
health
centres,
especially
in
rural
areas
• Lack
of
high
quality
midwifery
educa9on
• Poor
regula9on
• Lack
of
professional
recogni9on
and
status
• Lack
of
support
for
con9nuing
professional
development
• Poor
health
system
infrastructure
– supplies
of
drugs
is
oXen
limited

18. Components
of
effec9ve
midwifery
EducaBon
–
developing
and
maintaining
competencies
RegulaBon
–
protec9ng
public
and
professionals
Professional
associaBons
—
giving
midwives
a
voice

19. Strengthening
midwifery
in
PNG
Controversy
over
these
data
–
household
survey
data
show
MMR
increasing
form
360
to
733
per
100,000
live
births
from
1996-­‐2006
PNG
needs
to
triple
-­‐
quadruple
its
midwifery
workforce
Source:
SoWMR
2011

20. Maternal
and
Child
Health
Ini9a9ve
• Funded
by
AusAID
– Ini9ally
2
year
project
• Undertaken
by
WHO
PNG
• UTS
WHO
Collabora9ng
Centre
sub-­‐contracted
to
provide
par9cular
ac9vi9es
including
recruitment,
employment
and
monitoring
and
evalua9on

21. Aims
• Improving
maternal
and
child
health:
by
equipping
midwives
and
midwifery
educators
with
appropriate
and
up-­‐to-­‐date
knowledge
and
competencies
• Increasing
the
quality
of
the
health
workforce:
by
contribu9ng
to
improving
the
quality
of
midwifery
training
• Improve
services
in
priority
provinces:
by
increasing
obstetric
service
delivery
in
two
regions

22. Capacity
building
in
midwifery
educa9on
• Four
midwifery
schools
in
PNG
– University
of
PNG
in
Port
Moresby
– Pacific
Adven9st
University
in
Port
Moresby
– Lutheran
School
of
Nursing
in
Madang
– University
of
Goroka
• 8
interna9onal
midwives
recruited
to
each
of
the
schools

23. Improving
maternity
care
in
the
districts
• Two
obstetricians
for
district
hospitals
– St
Mary’s,
Vunopope
– Kundiawa
• Provide
clinical
care,
teaching
and
mentoring
to
PNG
medical
officers
nurses
and
midwives

24. Other
parts
of
(E)RA…
• RegulaBon
– The
PNG
Nursing
Council
is
working
towards
na9onal
accredita9on
of
midwifery
educa9on
and
na9onal
registra9on
of
midwives
• AssociaBon
– The
PNG
Midwifery
Society
has
been
reinvigorated,
joined
ICM
and
is
in
a
twinning
program
with
the
Australian
College
of
Midwives

25. Collabora9ons
for
training,
standards
and
advocacy
across
the
Pacific
• Midwifery
associa9ons
and
donors
working
together
– NZ
College
of
Midwives
– Australian
College
of
Midwives
– UNFPA
– World
Vision
– Others

26. Midwifery
Educa9on
QualificaBon
Length
of
programme
Total
hrs. Theory
hrs. Clinical
hrs.
Fiji Post
Grad
Diploma
52
wks 1960 680 1280
KiribaB Post
Grad
Cert
35
wks 1065 490 575
PNG
Degree
Degree
Degree
52
wks
52
wks
50
wks
2789
1992
2000
1344
312
720
1445
1680
1280
Samoa Post
Grad
Diploma
52
wks 1120 480 640
Solomon
Islands
Adv
Dip
Nursing
(Midwifery)
52
wks 1169 504 665
Tonga Cer9ficate 40
wks
Not
available Not
available Not
available
Vanuatu Diploma
Not
available
Not
available Not
available Not
available

27. Midwifery
in
the
Pacific
• Lack
of
appropriate
legisla9on,
regula9on
and
scope
of
prac9ce
for
midwifery
• Countries
agree
on
the
need
for
midwifery
competencies
that
are
contextualised
for
the
Pacific
and
include
a
primary
health
care
focus
• There
was
also
a
strong
call
from
Pacific
countries
to
have
a
standardised
midwifery
program
that
could
be
used
across
Pacific
countries
or
where
midwives
could
be
educated
for
mul9ple
countries
Source:
AUT
Mary
MacManus
,
JCU
Kim
Usher
SPCNMOA
–
PHRHA
Nov
2012

28. Midwifery
-­‐
mee9ng
global
standards
• ICM
Essen9al
Competencies
for
Basic
Midwifery
Prac9ce
• ICM
Global
Standards
for
Midwifery
Educa9on
• ICM
Global
Standards
for
Midwifery
Regula9on
• And
more
….

29. Pacific
Society
for
Reproduc9ve
Health
• Collabora9ve
network
• Mee9ng
in
Samoa
in
July
to
progress
this
work

30. Finally
….
• Bold
steps
are
needed
to
ensure
that
“every
woman
and
her
newborn
have
access
to
quality
midwifery
services”
(Ban
Ki
Moon
2011)
• Saving
newborn
lives
starts
in
pre-­‐pregnancy
and
goes
across
the
con9nuum
• Strengthening
the
midwifery
workforce
is
a
key
to
saving
newborn
lives