The
definition of the word midwife is widely recognised as ‘with the woman’, the
person working alongside women and understanding their environment (Page,
2003). With a more detailed description, The International Confederation of
Midwives defines the midwife as a person who has acquired the necessary
qualifications to be licensed and registered to practise the profession of
midwifery (2017). Locally, the Healthcare Act of Malta states that no
qualification for licence is given unless the person is legally allowed to
practice in Malta, is of good conduct and is part of the Register of Midwives
(2017). The midwife is also a responsible advocate for women, giving them the
required support and advice throughout the gestational, labour and postnatal
period (ICM, 2017).

Savona-Ventura
states that midwifery practice in Europe started in the sixteenth century where
female midwives decreased the need for physicians who were only called in
during the worst cases. During the following century, there was an advancement
in instrumental deliveries due to further studies. The eighteenth century is
known as the century of the forceps, marking the time of the first embryotomy
in Malta. In Europe, until the twentieth century, the majority of births were
carried out at home under the supervision of a midwife or a health attendant
(1995). In addition to Savona-Ventura’s findings, Dr Paul Cassar states that
the first initiative in
introducing formal teaching of midwifery was proposed in the late 18th century
by Dr Giuseppe Antonio Creni but not materialised before March 1802 by Dr
Francesco Buttigieg. Also, Dr Paul Cassar reveals that in the 18th
century, women used to deliver on a birthing chair, a wooden chair with a horse
shoe shaped aperture cut into. This was later condemned by Dr. Salvatore Luigi
Pisani, due to its restriction of the widening of the birth canal and putting
pressure on the infant’s skull (1970).

Midwives
and nurses follow a Code, published by The Nursing and Midwifery Council,
including the professional standards which gives importance to four factors.
The first factor is to prioritise people, that is, to stand up for their human
rights, to gain full consent and to inform the patient fully of their situation.
The second point is to practice effectively, meaning that one needs to use
terms that are fully understood by the patient as well as collect and store all
data findings appropriately. The third factor given importance is to preserve
safety by taking all the necessary precautions, taking accurate assessments and
making reasonable referrals to other professional. Lastly, it is also vital to
promote professionalism and trust. One must act with honesty and integrity,
stay objective and present people with appropriate behaviour (2011).

In
2016, The International Confederation of Midwives listed the essential
competencies for midwifery including various skills and that need to be applied
in practice depending on patient’s condition. Together with the Health Care Act
(2017), it states that these skills start from an early stage of the woman’s
reproductive health, focusing on family planning and contraception. During this
time, the midwife should be able to take a complete health history, engage the
patient and her family in pre-conception counselling, perform physical
examinations and refer to treatments based on the individual needs. According
to Vlemmix et al., it is imperative that the woman is provided with all the
relevant information in order to be able to make decisions herself. As an
advocate, the midwife is accountable for looking in the best interest of her
patients (2013).

Prenatal
care is defined as a mechanism for detecting risk factors which may lead to an
undesirable pregnancy outcome (Taylor, Alexander and Hepworth, 2005). The work
of a midwife is crucial during the gestational period. This is shown in
Goldberg’s and McClure’s study, where it is found that where more importance
was given to prenatal care, various obstetric problems such as foetal growth, heart
rate abnormalities and ultimately fewer stillbirths, decreased (2017). In a
similar study, Beeckman, Louckx, Downe, and Putman, also found that women that
started maternity care before the 14th week had a lower risk for a preterm
birth and birth problems (2012). Correspondingly, Taylor et al. found that
timely and accurate prenatal assessments have a positive effect in identifying
gestational complications which can offer perinatal treatment to enhance the
outcome for preterm infants (2005). According to Vlemmix et al., public health
advice related to diet, exercise and lifestyle choices is also fundamental.
This is the midwife’s responsibility since it is vital for a woman to be aware
of the importance of not only her own health but also that of the foetus
(2013).

When
it comes to the moment of birth, the midwife’s help and support is one of the
most pivotal factors for a positive birth outcome (Lavender, Walkinshaw,
Walton, 1999). Shahhosseini, Gardeshi, Valukolaee and Khermandichali, equally
showed that for the best possible outcome on the experience of labour and
childbirth, the focus should be more on midwifery led care (2017).  The ICM includes various necessary abilities
including; taking maternal vital signs during labour, monitoring its progress
and facilitating it with support. Other skills include performing pelvic
examinations for dilation, effacement, position and adequacy of the pelvis,
providing pain relief therapies and carrying out a normal and safe vaginal
delivery in low risk cases (2016). According to Bäckström and Hertfelt Wahn, during
this life-changing moment, the father (or partner) also needs to also be
reassured of his importance as part of the birthing couple and told of ways of
how he can help (2011). A study by Tarkka, Paunonen and Laippala, shows that
general positive childbirth experiences are carried out by positive
professional skills of the midwife and by the positive attitude of the baby’s
father (2000).

The
postnatal and neonatal periods of a woman’s journey are as important as pregnancy
and birth itself. Sellwood and Huertas-Ceballos state that postnatal
examinations of the mother and baby should be included in the core of
midwifery. Their study questions the effiency of this care when one considers
the high number of women who have problems on this new lifestyle change. Common
postnatal problems include those of breastfeeding, rising health problems
following the birth, postnatal stress and depression and difficulty in providing
the optimum infant care. Their review on the NICE guidelines in their study
proposed that the wellbeing of the mother is linked to that if the infant and
vice versa. This importance given could decrease the global neonatal mortality
rate of about 4 million infants a year (2008).

The
relationship between the midwife and the woman could be an emotional challenge
for the midwife (Hunter, 2006). Emotional Intelligence i.e. the ability to
identify emotions and manage them in patients, is crucial in a midwife for her
to be able to bring up sensitive and emotional issues in practice. (The Royal
College of Midwives, 2011). In addition to this, Jonathan Cliff came to a
conclusion that the essentiality of listening should never be undervalued and
that every midwife’s philosophy should always be woman-centred. He insists that
the profession of midwifery has the privilege of being present with the mother providing
her with support, stand up for and empower women during this life-changing
moment (2015).