The Lancet series on Midwifery: my favourite quotes so far…

lancet_logoThis week saw the publication (online ahead of print) of the much-anticipated Lancet series on midwifery. and today I’m simply sharing some of the quotes and paragraphs that have particularly struck me as I read these papers…

  • “One important conclusion is that application of the evidence presented in this Series could avert more than 80% of maternal and newborn deaths,1 including stillbirths. Midwifery therefore has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children.” (Horton and Astudillo 2014)
  • “A frequent view is that midwifery is about assisting childbirth. It is, but it is also much more than that. As defined in this Series,2 midwifery is “skilled, knowledgeable, and compassionate care for childbearing women, newborn infants, and families across the continuum throughout pre-pregnancy, pregnancy, birth, post partum, and the early weeks of life”. Midwifery includes family planning and the provision of reproductive health services. The services provided by midwives are best delivered not only in hospital settings but also in communities—midwifery is not a vertical service offered as a narrow segment of the health system. Midwifery services are a core part of universal health coverage.” (Horton and Astudillo 2014)
  • “Research on the prevalence and nature of D&A [disrespectful and abusive care] reveals that this is not the phenomenon of a few bad apples. Rather, it runs wide and deep within the maternity services of many countries. And the spectrum of D&A is broad too: from shouting and scolding, to slapping and pinching, to abandonment of patients, discrimination, and non-consented interventions.8 D&A is inflicted not only by individual providers, but also by health systems as a whole when the conditions in facilities deviate greatly from accepted standards of care and of infrastructure, staff, equipment, and supplies needed to deliver that care … when D&A is called out for what it is—the symptom of fractured health systems and locally expressed power dynamics that conspire against both patients and providers—then the real work of improving quality and creating accountability can begin.” (Freedman and Kruk 2014)
  • “Women reported that information and education were essential to allow them to learn for themselves, that they needed to know and understand the organisation of services so they could access them in a timely way, that services needed to be provided in a respectful way by staff who engendered trust and who were not abusive or cruel, and that care should be personalised to their individual needs, and offered by care providers who were empathic and kind. Particularly, women wanted health professionals who combined clinical knowledge and skills with interpersonal and cultural competence. These findings were of crucial importance in identification of components of quality maternal and newborn care.” (Renfrew et al 2014)
  • “These findings support a system-level shift from fragmented maternal and newborn care focused on identification and treatment of pathology for the minority, to skilled care for all. Midwifery is pivotal to this approach. Future planning for maternal and newborn care systems can benefit from incorporating the quality framework into workforce development and resource allocation.” (Renfrew et al 2014)
  • “Two “blind-spots” were identified in the Lancet Midwifery Series: respectful care and overmedicalisation. 3” (Stones and Arulkumaran 2014)
  • “Women’s use of midwifery services should be supported, more should be done to meet women’s needs, and improvements should be made in the quality of care received by women and newborn infants. Progress in all three areas is needed to obtain a comprehensive health gain.5 (Hoope-Bender et al 2014).


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LP Freedman, ME Kruk. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas.  Lancet (2014) published online June 23. doi:10.1016/S0140-6736(14)60859-X

CSE Homer, IK Friberg, MA Bastos Dias et al. The projected effect of scaling up midwifery. Lancet (2014) published online June 23.

P ten Hoope-Bender, L de Bernis, J Campbell et al.  Improvement of maternal and newborn health through midwifery. Lancet (2014) published online June 23.

R Horton, O Astudillo. The power of midwifery.  Lancet (2014) published online June 23.

W Van Lerberghe, Z Matthews, E Achadi et al. Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. Lancet (2014) published online June 23.

MJ Renfrew, A McFadden, MH Bastos et al.  Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet (2014) published online June 23.

W Stones, A Arulkumaran.  Health-care professionals in midwifery care.  Lancet (2014). published online June 23.