Have you heard of the term doula before, but are unsure of what it means? Do you know the difference between obstetrics and gynaecology? Are you interested in receiving care from a midwife but are unsure of what this care would look like?
PUSH is determined to be a resource for increasing awareness on sexual and reproductive health, ensuring women and all people giving birth are empowered to make informed decisions about their bodies.
Below are recognised definitions of key terms in the women’s and maternal health space which we hope can provide our community with clarity and improve literacy on issues affecting women.
A midwife is a person who has successfully completed a midwifery education programme that is based on the ICM Essential Competencies for Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education and is recognised in the country where it is located; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour, and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance, and the carrying out of emergency measures.
The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care.
A midwife may practise in any setting including the home, community, hospitals, clinics, or health units.
Source: International Confederation of Midwives (ICM)
Importantly, midwives educated and regulated to ICM’s global standards can meet about 90% of the need for essential sexual, reproductive, maternal, newborn and adolescent health interventions. A growing body of evidence also demonstrates that when midwives are adequately educated and regulated, they are the best possible care providers for women and newborns.
Source: State of the World’s Midwifery 2021
“It’s not just the making of babies, but the making of mothers that midwives see as the miracle of birth.” - Barbara Katz Rothman
The nurse is a person who has completed a programme of basic, generalised nursing education and is authorised by the appropriate regulatory authority to practise nursing in his/her country. Basic nursing education is a formally recognised programme of study providing a broad and sound foundation in the behavioural, life, and nursing sciences for the general practice of nursing, for a leadership role, and for post-basic education for specialty or advanced nursing practice.
The nurse is prepared and authorised (1) to engage in the general scope of nursing practice, including the promotion of health, prevention of illness, and care of physically ill, mentally ill, and disabled people of all ages and in all healthcare and other community settings; (2) to carry out healthcare teaching; (3) to participate fully as a member of the healthcare team; (4) to supervise and train nursing and healthcare auxiliaries; and (5) to be involved in research.
Source: International Council of Nurses (ICN)
It is worth noting that midwives practise a psychosocial model of childbirth rather than the biomedical nursing model. In other words, nurses focus on the treatment of the sick and injured, whereas the midwifery profession is grounded in the notion that pregnancy and birth are normal life events that necessarily don’t require medical interventions. While many nurses specialise in maternity and/or neonatal care, people working as trained midwives are the only health profession specifically devoted to the care of birthing people and newborns.
Conflating the two professions creates confusion for birthing people and families who may be interested in receiving the services provided by a midwife but are unaware this option exists as a result of pervasive narratives that medicalise childbirth and leave midwives out of mainstream health culture.
“Nurses are the heart of healthcare." - Donna Wilk Cardillo
A doula is a trained professional who provides continuous physical, emotional, and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.
Doulas provide position ideas for comfort and labour progression which cross over with hands-on comfort measures like comforting touch, counter pressure, breathing techniques, and other “doula magic” for families. A doula’s skilled hands and positioning tools can often help a malpositioned baby find its way through the pelvis and into the birthing parent’s arms. Doulas help families to feel supported, easing the emotional experience of birth and also helping to create a space where the hormones of labour can work at their best. Whether a birth is completely unmedicated or medically very complex, every family can benefit from nurturing and connection at this tender, incredible time in their lives.
It’s important to note that a doula is not an appropriate substitute for a midwife or a doctor as they don’t have medical training.
Source: DONA International
“I believe that birth is a sacred and powerful rite of passage that can be positive and empowering. Having a doula ensures that you have continuity of care, access to accurate information, and an experienced guide along this journey who can hold and protect the space for you.” - Thando Zwane
The traditional birth attendant (TBA) has been defined as a person (usually a woman) who assists the mother at childbirth and who initially acquired her skills delivering babies by herself or by working with other traditional birth attendants. In the light of evidence from various countries, it would appear that this definition of the TBA is rather narrow in the sense that, in many cases, the TBA's work includes not only her attendance at childbirth but the provision of basic care to women throughout the normal maternity cycle, the provision of care to the normal newborn, participation in the promotion of modern methods of family planning, and participation in other primary health-care activities, including the identification and referral of high-risk patients. Such referral is being increasingly assumed by TBAs in many countries.
Source: World Health Organisation (WHO)
“I couldn’t imagine that without any formal training and proper equipment I had helped a mother deliver a baby. I solely relied on traditional techniques that I had observed my auntie apply, and they worked miracles.” - Florence Auma Agoola
Ob-Gyns are doctors who have special training and education in women’s health care. They are dedicated to the medical and surgical care of women’s health throughout the lifespan. Obstetricians focus on pregnancy and related health issues, while gynaecologists focus on general reproductive health.
Some Ob-Gyns have extra training in a focused area of women’s health care. These areas include:
Source: American College of Obstetricians and Gynaecologists (ACOG)
“Safety during labour is the floor of what people deserve. What we should all really be aiming for is the ceiling: care that is not just safe, but also supportive and empowering.” - Dr. Neel Shah
When selecting a care provider, every birthing person and their family should be supported to access the care model that best suits their medical, emotional, and cultural needs. This ability to empower community members to make informed decisions with respect to their reproductive health decision-making is a fundamental component of the PUSH Campaign. We centre midwives in this work because we know from mounting global evidence that increased investment in the midwifery workforce is key to reducing maternal and neonatal death, and providing women and all people with access to quality sexual and reproductive health services.
Let us know how else we can support your learning! We look forward to sharing more resources like this one to contribute to the collective understanding of the maternal health space and the key professions within it.