WHO declares 2020 as international year of nurses and midwives
Making up more than half of the health workforce in many countries, including South Africa, nurses and midwives are essential to achieving universal health coverage.
The World Health Organisation has declared 2020 as the International Year of the Nurse and Midwife, honouring the 200th anniversary of Florence Nightingale’s birth.
“Mothers and babies could see better outcomes and greater affordability of care, if our health-care system was structured to give midwives a greater role in pregnancy management and birth,” said Dr Howard Manyonga, obstetrician and head of The Birthing Team, an affordable maternity programme available in Pretoria, Durban, Polokwane and Johannesburg.
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“Midwives must be better integrated into our health system, particularly in the private sector where currently they are positioned as assistants to obstetricians,” he said.
“Making midwives the primary practitioners in non-complex pregnancies will increase access and make private care more affordable for more women, including those not on medical schemes.”
The Birthing Team programme is restructuring how South African midwives and obstetricians interact.
It applies an integrated care model to maternity care, which emphasises collaboration, team fees, rigorous prenatal care and a community-based approach.
“Our midwives work to the top of their professional scope of practice in a collaborative manner with allied health professionals.
“They rotate through the antenatal clinic, labour ward, postnatal ward and postnatal clinic, additionally becoming proficient in providing breastfeeding support, baby immunisations and contraceptive services,” said Manyonga.
Better integration of midwives also incentivises prenatal care by making it more affordable.
“Quality prenatal care is the best determinant of a healthy delivery – with this in mind, we created a set fee for complete care by a team of midwives and obstetricians, allowing women to access all necessary prenatal care at no risk of a co-payment,” said Manyonga.
The high costs in the private sector are partly driven by high caesarean rates, which are often due to poorly managed patients as well as the fact that obstetricians are working on their own and have to schedule elective births as they cannot be available all the time.
“While caesareans allow for predictable scheduling and are often requested, they do pose a higher risk for both mother and baby.
“A caesarean is major a surgery which exposes the patient to anaesthetic risks, surgical complications and infection,” said Manyonga.
Since midwives and obstetricians are paid separately in South Africa, they are often in direct competition for patients.
This means that if a complication presents during birth, there is a financial disincentive for midwives to refer the patient on to a specialist, which can compromise patient care and experience.
“The Birthing Team model addresses this through collaborative teamwork between both parties,” Manyonga explained.
