title: Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.
abstract: In this first paper in a series of four papers on midwifery, we aimed to examine, comprehensively and systematically, the contribution midwifery can make to the quality of care of women and infants globally, and the role of midwives and others in providing midwifery care. Drawing on international definitions and current practice, we mapped the scope of midwifery. We then developed a framework for quality maternal and newborn care using a mixed-methods approach including synthesis of findings from systematic reviews of women's views and experiences, effective practices, and maternal and newborn care providers. The framework differentiates between what care is provided and how and by whom it is provided, and describes the care and services that childbearing women and newborn infants need in all settings. We identified more than 50 short-term, medium-term, and long-term outcomes that could be improved by care within the scope of midwifery; reduced maternal and neonatal mortality and morbidity, reduced stillbirth and preterm birth, decreased number of unnecessary interventions, and improved psychosocial and public health outcomes. Midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed, and regulated. Our findings support a system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all. This change includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships, is tailored to their needs, focuses on promotion of normal reproductive processes, and in which first-line management of complications and accessible emergency treatment are provided when needed. Midwifery is pivotal to this approach, which requires effective interdisciplinary teamwork and integration across facility and community settings. Future planning for maternal and newborn care systems can benefit from using the quality framework in planning workforce development and resource allocation.
authors: Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK. Electronic address: m.renfrew@dundee.ac.uk.
authors: Mary J
authors: MJ
authors: Renfrew
authors: Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK.
authors: Alison
authors: A
authors: McFadden
authors: Pan American Health Organisation, Brasilia, Brazil.
authors: Maria Helena
authors: MH
authors: Bastos
authors: Instituto de Cooperación Social Integrare, Barcelona, Spain.
authors: James
authors: J
authors: Campbell
authors: Division of Social Statistics and Demography, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK.
authors: Andrew Amos
authors: AA
authors: Channon
authors: Midwifery Expert Committee of the Maternal and Child Health Association of China, Beijing, China.
authors: Ngai Fen
authors: NF
authors: Cheung
authors: Parto do Princípio-Mulheres em Rede pela Maternidade Ativa, São Caetano do Sul, Brazil.
authors: Deborah Rachel Audebert Delage
authors: DR
authors: Silva
authors: School of Health, University of Central Lancashire, Preston, Lancashire, UK.
authors: Soo
authors: S
authors: Downe
authors: Yale School of Nursing, New Haven, CT, USA.
authors: Holly Powell
authors: HP
authors: Kennedy
authors: Kamuzu College of Nursing University of Malawi, Lilongwe, Malawi.
authors: Address
authors: A
authors: Malata
authors: Department of Health Sciences, University of York, Heslington West, York, UK.
authors: Felicia
authors: F
authors: McCormick
authors: Institute of Community and Public Health, Birzeit University, Birzeit, Palestine.
authors: Laura
authors: L
authors: Wick
authors: Community Health Sciences, Boston University School of Public Health, Boston, MD, USA.
authors: Eugene
authors: E
authors: Declercq
mesh_terms: D001938:Brazil; D002681:China; D002983:Clinical Competence / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D006293:Health Promotion / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007194:India; D007231:Infant, Newborn; D008880:Midwifery / Q000458:organization & administration / Q000592:standards*; D017060:Patient Satisfaction; D018743:Perinatal Care / Q000458:organization & administration / Q000592:standards*; D011247:Pregnancy; D011256:Pregnancy Outcome; D037841:Pregnant People / Q000523:psychology; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards