Human Resources for Health in Maternal, Neonatal and - HRH ...

settings‖(ICN 2009). They may be involved in the provision of MNRH care and services, but
are not necessarily in attendance at births. Midwives are engaged in the provision of support,
care and advice during the pre-pregnancy period, as well as during pregnancy, labour and the
postpartum period. This includes attending births in normal and complicated situations and
providing counselling, education and family planning services. A midwife is someone who
has successfully completed a course in midwifery and who is legally licensed to practice
(ICM 2005). Auxiliary or assistant midwives provide more ―indirect patient care activities‖
(Hasson 2005). They are often the first formally trained midwife cadre that women see at
community level and can provide a bridge between traditional and biomedical models of care
(Warren 2007).
Midwifery practitioners are skilled birth attendants (SBAs), however, not all nurses have
midwifery skills and are therefore not automatically classified as SBAs. The term SBA is
defined as:
an accredited health professional — such as a midwife, doctor or nurse — who has
been educated and trained to proficiency in the skills needed to manage normal
(uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the
identification, management and referral of complications in women and newborns
(WHO ICM FIGO 2004)
Traditional birth attendants (TBAs) (described in more detail below), whether trained or not,
are excluded from the category of skilled health workers (World Health Organization, 2004).
Minimum and additional skills have been specified for SBAs which have improved
understanding of training requirements and the broader context required for skilled attendants
to function effectively (Safe Motherhood Inter-Agency Group 2000; WHO ICM FIGO 2004).
Contribution of SBAs to improving MNRH
SBAs have been shown to be critical to improving maternal health outcomes. A systematic
review conducted in developed countries found that, compared to other models of care,
midwife-led care:
Leads to fewer antenatal hospitalisations and instrumental vaginal deliveries
Decreases the use of pain killers during labour
Leads to more spontaneous vaginal births, and
Probably has little or no effect on foetal and neonatal deaths, augmentation or
induction of labour, Caesarean sections, and postpartum haemorrhage (Hatem 2008).
However this review was undertaken in HIC and availability and quality training needs to be
taken in consideration when understanding this in the context of LMIC.For example where
EmOC is not accessible for women who birth at home in a LMIC context, antenatal
hospitalisations for high risk women may be a useful step.
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