May 5 is International Day of the Midwife. With rising costs for the professionals who help women before, during and after childbirth, the job is becoming more and more difficult. But midwives are desperately needed.
Roughly 800 women and 8,000 newborns die every day due to preventable complications during pregnancy, childbirth and the immediate post-natal period. Those numbers come from the World Health Organization, which states in its #link:http://www.who.int/features/factfiles/midwifery/en/:10 Facts on Midwifery#: "Many of these lives could be saved if every birth were attended by a trained midwife."
These professionals are honored on May 5, the International Day of the Midwife (IDM). The #link:http://internationalmidwives.org/:International Confederation of Midwives# launched the initiative in 1992. This year, the IDM celebrates its 25th anniversary. The 2016 theme is "Women and Newborns: The Heart of Midwifery."
Soothing new mothers' fears
In Germany, a midwife must be present when a woman gives birth, be that at a hospital or at home, according to Paragraph 4 of the midwife law. There are around 21,000 to 21,500 midwives in the country and they are in high demand, Martina Klenk, the president of the #link:https://www.hebammenverband.de/startseite/:German Midwives Association# reports.
"Midwives are experts for pregnancy, birth and the postnatal period, and women want them by their sides," Klenk told DW. "After all, becoming a mother is an enormous change in a woman's life."
The women help first-time mothers-to-be by explaining what to expect and suggesting natural remedies for pregnancy ailments. They are present in the delivery room and they visit the new mother and baby at home several times after the birth to answer questions about caring for the newborn, if that is something the mother wants. Many new mothers do.
"A midwife is really good at taking away your fears and worries," Sarah Wohl, who gave birth to her first child in 2012, told DW. "She can show you how to bathe your child, how to make nursing more comfortable for you. These are among all the things a midwife does that a doctor simply cannot do because he only sees you in an artificial situation, not at home."
Linchpin liability insurance
Wohl, 31, lives in the German state of Hesse. She is currently expecting her second child and said she is very glad to have the same midwife around who helped her the first time.
That's not a given. Midwives face increasing difficulties in Germany because of the high cost they have to pay for their liability insurance, which has pushed some women out of the profession. In 2016, they had to pay more than 7,000 euros (about $8,040) a year and in 2017, the cost will go up again to more than 8,000 euros a year, Klenk said.
In 1981, liability insurance cost a midwife roughly 30 euros. The increase isn't so extreme because midwives are making more mistakes. Because of medical advances, many more babies survive today, even if something goes wrong during birth. But if the parents of a baby with a disability decide to sue, the midwife's insurance will have to cover the costs of treatment, damages for the mother if she can't go to work, and other costs that might arise.
The German Midwife Association calculated that an independent midwife makes about 8.5 euros an hour, the country's minimum wage. So 7,000 euros is a lot of money. In Austria, all midwives are registered with the Austrian Midwife Board, which offers a group liability insurance for 350 euros a year. Midwives also earn less in Germany's neighboring country, a spokeswoman for the Board told DW, but the difference is still significant.
Being there through the entire birth
Not all midwives in Germany are independent - hospitals employ them, too. But because of budget cuts, one midwife sometimes has to take care of three women in the delivery room at the same time. Klenk says that means a woman is left alone frequently in what amounts to a "crisis situation."
In other countries the treatment of women in delivery rooms is similar, with the doctor popping in only every now and then to make sure nothing is wrong. There's not a lot of personal care. That's why Teresa from Washington D.C. brought her doula, a birthing partner similar to a midwife, to the hospital with her when she gave birth in June 2015.
"She advocated for me and helped me through the birth," Teresa told DW, adding that while she had a good doctor, he was "only in the room to check on my progress and for the actual birth."
Yasmin also had her midwife along when she gave birth in Bonn, Germany, two years ago.
"She's like a mother, but not your own mother," the 30-year-old told DW, "which is good because you wouldn't want your own mother in the delivery room with you."
Yasmin was happy that her substitute mother stayed with her after she had witnessed the shift-system that the hospital midwives worked in. She said she would have worried about not liking a new midwife, who could have come in right in the middle of labor.
'A pillar of the maternal healthcare force'
Many women in developing nations aren't as lucky as this mother-to-be in Ethiopia, who has a midwife she can trust
In Pakistan, where Yasmin's father is from, midwifery has a long tradition. It is passed down from generation to generation, she said. Most births in rural regions of the country still happen at home with no doctors around, so the women are even more important than in an industrial country like Germany. Midwives, Yasmin said, are of very good standing in Pakistan.
Still, giving birth in Pakistan and other developing nations is not an easy thing. Approximately 287,000 women worldwide die every year due to complications related to pregnancy and childbirth, and 2.9 million newborns die in the first month of life. Most of these often preventable deaths occur in low-income countries and in rural areas, according to the WHO.
That's why the World Health Organization continues to support midwives.
"WHO works with countries to ensure that midwifery issues are addressed in national health strategies and plans," the organization says on its website. Midwives are "an essential pillar of the maternal and newborn healthcare workforce."