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Below is a selection of seminal publications in the field of maternal health. Please send comments or suggestions to [email protected].

Strengthening the Profession of Midwifery


In all countries that have achieved a dramatic decrease in maternal and newborn death, well-trained health professionals have been a key to success. The returns on investing in human resources with midwifery skills are enormous.The State of the World's Midwifery (SoWMy) 2014, the second of its kind, will show what progress has been made since the launch of the first report in 2011 in increasing the number of skilled and competent midwives and others with midwifery skills; improving policies and regulations; and expanding the coverage of midwifery services and quality of care in 75 countries that carry more than 95 per cent of the global burden of maternal, newborn and child deaths. SoWMy 2014 will provide data on the availability, accessibility, acceptability and quality of midwifery services. It will also reveal service gaps and highlight the needs for future health workforce and health systems to ensure that all women and families have access to quality midwifery care.

In 2012-13, the Maternal Health Task Force (MHTF) and the PLOS Medicine Editors continue their collaboration to create a freely available, open access collection of outstanding research and commentary on maternal health, the MHTF-PLOS Collection on Maternal Health, to further our collective goal to improve women's and children's health worldwide through greater access to more comprehensive maternal health information and knowledge. Our continued commitment to highlighting and pressing for more evidence on maternal health reflects the persistence of this problem around the world: while the number of maternal deaths overall is declining, Millennium Development Goal 5 (to improve maternal health) is the goal most lagging behind due to a lack of progress in a critical number of countries.

The mission of the American College of Nurse-Midwives (ACNM) is to promote the health and well-being of women and newborns within their families and communities through development and support of the profession of midwifery. Over the last three decades, ACNM has mentored several generations of midwives in more than 30 countries who have contributed talent and commitment to making the world a safer place for women and children. We have developed invaluable institutional knowledge of the components required to build a profession of competent and qualified healthcare providers of maternal and infant care. ACNM's approach emphasizes partnership and capacity building with both individuals and organizations to strengthen the locus of control and ownership of projects within the host country, incorporating evidence-based best practices with flexibility and creativity. The future relies on upcoming generations to creatively work with multiple disciplines and across nations to solve the complex issues endangering women and families worldwide.

Perceived barriers and motivating factors influencing student midwives' acceptance of rural postings in Ghana

Research on the mal-distribution of health care workers has focused mainly on physicians and nurses. To meet the Millennium Development Goals Five and the reproductive needs of all women, it is predicted that an additional 334,000 midwives are needed. Despite the ongoing efforts to increase this cadre of health workers there are still glaring gaps and inequities in distribution. The objectives of this study are to determine the perceived barriers and motivators influencing final year midwifery students' acceptance of rural postings in Ghana, West Africa.

See the first comprehensive analysis of the midwifery profession around the world. This link will take you to the SOWMR website which Includes the full report, executive summary, background documents, resource kit, and more.

The global standards, competencies and tools for midwifery pre-service education are based on the three pillars of quality midwifery care: education, professional associations, and regulation.  The UN Population Fund, World Health Organization, and Federation of International Gynecologists and Obstetricians have all pledged support of the landmark ICM Global Standards.  

Created during Women Deliver 2010, this is the joint statement that spurred the creation of the first state of the world's midwifery report.  It calls on governments to address the following areas: education & training; legislation and regulation; recruitment, retention, and deployment; and professional association strengthening

Produced by the Dept. of Human Resources for Health of the World Health Organization (WHO).   The strategy revolves around 13 objectives in 5 inter-related key results areas

Missing Midwives: Save the Children, 2011
Report released on mothers day, 2011 outlining the need for additional well trained midwives worldwide

This toolkit includes 9 modules. It focuses specifically on strengthening the central role and function of the professional midwife in the provision of quality care during pregnancy and childbirth and in other reproductive and sexual health services.  The first module is a background paper.  Other topics include legislation & regulation, standards, competencies, curriculum guidelines, preperation of midwifery teachers, supervision, and continuing education.

Maternal Health & Mortality Trends

Postpartum Family Planning: New Research Findings and Program Implications
: On July 19, 2012, at a meeting in Washington DC, the PROGRESS project presented findings from its research studies on topics related to postpartum family planning. The meeting offered an opportunity for partner agencies, including the U.S. Agency for International Development (USAID) and the World Health Organization (WHO), to discuss how these findings might contribute to expanding access to family planning information and services in the postpartum period. This is a short report from the meeting held on July 19, 2012, sponsored by FHI 360 and USAID. The slides presented at the meeting are available here.

Accountability for Maternal, Newborn & Child Health: WHO, 2012
In this publication, Countdown to 2015 provides profiles for the countries where more than 95% of all maternal and child deaths occur. The profiles highlight how well each country is doing in increasing coverage of high-impact interventions that can save the lives or millions of women and children.

Linking Family Planning and Community Health for Health Equity and Impact 2012 Report: Based on more than 125 references, the research presented in this paper provides compelling evidence that integration of family planning is a value-added strategy, saving lives, and spurring progress to prevent diseases, protect the environment, advance food security and nutrition, and improve the health of young people.

The Partnership for Maternal, Newborn and Child Health (PMNCH) 2011 Report
: Analysing Commitments to Advance the Global Strategy for Women's and Children's Health. This report seeks to further our collective understanding of the current Global Strategy commitments.

Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health
: The Partnership for Maternal, Newborn and Child Health, 2011.  A global review of the key interventions related to reproductive, maternal, newborn and child health.

Prevention and Management of Postpartum Hemorrhage and Pre-eclampsia
: USAID, MCHIP, 2011 

MCHIP, USAID's flagship maternal, newborn and child health program, has done a multi-country analysis in 31 USAID-supported countries on selected components of PPH and PE/E program readiness. Through the use of a detailed survey, country teams have assessed policy, practices, human resource and logistic issues for these programs. In addition, the country teams have mapped their achievements using a Key Interventions Scale Up Mapping Tool, developed by MCHIP and applied in these countries. 

In this statement, WHO, the International Confederation of Midwives (ICM) and the International Federation of Gynaecology and Obstetrics (FIGO) advocate for skilled care for all women during pregnancy, childbirth and the immediate postnatal period. This document is especially aimed at countries in which the coverage of skilled attendance at birth is below 85%. It defines clearly who is a skilled attendant, what skills she/he should have and how she/he should be trained and supported.

Atlas of Birth: White Ribbon Alliance, 2010
The Atlas of Birth is a clear, accessible guide to the global picture of maternal health, told with maps, graphics and stories from many countries. It documents the biggest killer of young women in developing countries, and reveals one of the greatest opportunities of our time -- to prevent the preventable -- those maternal deaths that happen every single minute of every single day.  This project includes the book, an interactive website, and the acclaimed short film, Birth and Death.

Trends in Maternal Mortality: 1990-2008
: WHO, 2010

Estimates developed by the WHO, UNICEF, UNFPA, and the World Bank

Mortality Estimates developed by IHME.  This link will take you to the IHME website to download.  Other resources on the site include multiple presentations on maternal mortality, interactive data sets, and visualizations. 

Includes executive summary, series comments, series papers, and a podcast



Neonatal Health

The equity impact of participatory women's groups to reduce neonatal mortality in India: Secondary analysis of a cluster-randomised trial: Int. J. Epidemiol. Advance Access published March 18, 2013 - - - We describe and explain the equity impact of a women's group intervention in India that strongly reduced the neonatal mortality rate (NMR) in a cluster-randomised trial. The study concludes that  participatory community interventions can substantially reduce socio-economic inequalities in neonatal mortality and contribute to an equitable achievement of the unfinished MDG agenda.

Born too soon: the global action report on preterm birth
: WHO, Save the Children, March of Dimes, PMNCH, 2012
The report shows the extent to which pre-term birth is on the rise in most countries, and is now the second leading cause of death globally for children under five, after pneumonia. 

Study results showing effectiveness of integrated perinatal interventions including ACNM's Home Based Life Saving Skills program in reducing perinatal mortality in Matlab, Bangladesh. 

Clinical & Teaching Resources

Pre-Eclampsia & Eclampsia:  WHO's latest recommendations for prevention and treatment of pre-eclampsia and eclampsia.

Prevention PPH: WHO's latest recommendations for the prevention and treatment of postpartum hemorrhage

NB Resuscitation: WHO's latest guidelines on basic newborn resuscitation

mHealth for Midwives: A Call to Action: Anna Maria Speciale and Maria Freytsis Journal of Midwifery & Women's Health, Vol. 58, Issue 1, pp. 76-82, January/February 2013.  The exponential growth of mobile communications is connecting people in a way previously not imagined and creating opportunities to make unique health impacts. Integrating the strengths of midwifery care and mHealth technology into the strategy for achieving the critical Millennium Development Goals related to maternal and child health is a powerful way forward. Midwifery involvement in the mHealth revolution, particularly at this critical point in its development, could benefit midwifery education and access to midwifery care, creating the shift needed to make real strides in decreasing maternal mortality globally.

Innovative Financing Options for the Preservice Education of Health Professionals: CapacityPlus announces a new technical brief which suggests 19 ways to pay for a health professional education. Many developing countries are making significant investments to increase the number of health workers available to provide care to growing populations. However, the available funding is far short of what is required. For these countries to train and produce a health workforce sufficient to meet the population's needs, new sources of funding for health worker education need to be found. To address this problem, CapacityPlus partnered with the International Finance Corporation, the World Bank, and the Global Health Workforce Alliance to explore innovative solutions for the financing of health worker education.

Model Curriculum Outlines for Professional Midwifery Education:
ICM, 2012.  This set of four resource packets is based on the updated competencies and global education standards, andis provided to the global community to enhance understanding and use of the documents. They are currently available on the ICM Website in English and Spanish. A French version will be available by the end of September 2012.

FIGO Guidelines on the Prevention and Treatment of PPH with Misoprostol: These Guidelines, published by FIGO in 2012, reflect the latest best available research on the use of misoprostol for PPH prevention and treatment (including evidence-based recommendations for dosages and routes of administration, and the side effects and precautions associated with its use) and are aimed at healthcare providers and clinical policy makers worldwide.

WHO Midwifery Education Modules: WHO, 2006

Six modules for midwifery educators.  Includes modules on managing PPH, prolonged & obstructed labor, eclampsia, incomplete abortion, and sepsis.
Hesperian's comprehensive app on pregnancy and birth contains a wealth of information on how to stay healthy during pregnancy
. This easy-to-use manual is arranged by symptoms (e.g. vaginal bleeding in early pregnancy). Because this symptom-based approach is different from most.  Topics include:  how to recognize danger signs during pregnancy, birth, and after birth
what to do when a danger sign arises
when to refer a woman to emergency care
instructions for community health workers with step-by-step explanations such as "How to take blood pressure", "How to treat someone in shock", "How to stop bleeding".  

Managing Complications in pregnancy and childbirth: a guide for midwives and doctors: WHO, 2003 
medical texts, which are arranged by disease, a corresponding diagnosis table is provided. Links have been used extensively to facilitate navigation between symptoms and diagnoses. The clinical action steps are based on clinical assessment with limited reliance on laboratory or other tests and most can be performed in a variety of clinical settings (e.g. district hospital or health centre).

Managing Newborn Problems: a guide for midwives and doctors: WHO, 2003

This guide is designed to assist countries with limited resources in their efforts to reduce neonatal mortality and to ensure care for newborn babies with problems due to complications of pregnancy and childbirth, such as asphyxia, sepsis, and low birth weight or preterm birth. The main section of this guide is arranged by clinical signs or findings, which facilitates early identification of illness, and provides up-to-date guidelines for clinical management.

American College of Nurse-Midwives
409 12th St SW, Suite 600, Washington, DC 20024-2188
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