Photo by Diana Polekhina

Midwifery Today, Issue 149, Spring 2024
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There are two sides to the discussion about the strength of midwifery—safety and satisfaction. Mercy In Action has the evidence to prove both!

Global recognition of the importance of midwifery is growing. Recently, I was asked to contribute to a presentation that was being prepared for a large foundation seeking evidence that midwifery works. Due to time constraints, I was informed that we could have exactly two slides in the final PowerPoint presentation, which seemed not enough to make even a brief report on our Mercy In Action birth center outcomes in the Philippines. However, we were honored to be asked to participate in this international powerhouse meeting and thrilled that this foundation is considering funding midwifery in low and middle-income countries. We quickly gathered resources and tapped our volunteer statistician, a fellow midwife with her PhD who is a graduate of Mercy In Action College of Midwifery, for help in preparing two very important slides. These two slides ended up showing two sides of our good outcomes over the decades.

Mercy In Action Vineyard, Inc. (also doing business as Mercy In Action College of Midwifery) is a United States-based 501(c)(3) nonprofit I founded and have spent my adult life on. Together with a devoted team of international and multicultural staff, volunteers, and donors, we have built and supported birth centers in the Philippines since 1991 and now support midwives in dozens of countries with our programs. Our model is to build, support, and fund midwife-led birth centers that use the “Midwives Model of Care”© and follow the International Childbirth Initiative (ICI) 12 Steps to Safe and Respectful MotherBaby-Family Maternity Care. In our time working in the Philippines so far, Mercy In Action’s midwife-led birth centers have seen more than 17,000 babies born while keeping detailed statistics on birth outcomes and patient satisfaction.

By applying evidence-based practices, we have demonstrated that all complications are low, and maternal and neonatal deaths remain well below national rates. Our statistics have shown consistently over 30 years that four times as many babies and mothers survive in our facilities than in the nation as a whole. This is true even in the face of numerous systemic risk factors in our served population, such as chronic malnutrition, under-employment, substandard housing, and generally low socioeconomic standing on the part of the parents. We have also achieved these results in a system where there is a serious lack of medical backup support; tragically, it is all too common for hospitals to turn people away even with a life-threatening birth emergency. Finally, there is the continuous threat of natural disasters; earthquakes, floods, typhoons, and fires have all disrupted our clinics at one time or another and temporarily hindered our ability to provide care. Despite the myriad of challenges, Mercy In Action-supported birth centers have continually shown, with statistical analysis, a newborn and maternal mortality rate that is significantly lower than that of the country we are in.

When considering the 17,381 babies born in our centers so far, this represents many lives saved and untold suffering averted. This is something to be proud of, and we desire to share our model with everyone who wants to improve health and health care for the underserved anywhere in the world.

But there is more to the story, and that concerns the other side of the coin: patient satisfaction. In addition to keeping detailed statistics on the events of labor, birth, newborn, and postpartum, Mercy In Action has also been proactive about gathering satisfaction surveys in the form of women’s and families’ questionnaires. After giving birth in our clinics, families answer questions that are matched to the 12 Steps of the International Childbirth Initiative (ICI) so we can track how well we are doing (in the patient/client’s eyes) in delivering both safe and respectful care. In thousands of surveys, patient satisfaction has always been and remains consistently high over time. This shows the strength of midwifery care that is grounded in compassion and empathy.

It seems there is a global conversation going on about the strength of midwifery, and it is mostly positive and affirming. A webinar series called “Midwife-Led Birth Centers,” which was recently held online and focused on midwife-led birth centers in low and middle-income countries, was hosted by the International Confederation of Midwives (1). The research team for this project included universities, government and non-government organizations, and midwife organizations in several countries.

Also this year, to the delight of birth advocates everywhere, it was revealed that UNESCO has included midwifery on their year 2023 “Representative List of the Intangible Cultural Heritage of Humanity (2).” This recognition of the cultural contribution of the “knowledge, skills and practices” of midwifery will no doubt help strengthen the respect and appreciation the time-honored and invaluable profession of midwifery deserves.

In conclusion, when considering the strengths of midwifery, we do well to remember that parents who enlist midwives to help them deliver a baby depend on our ability to provide both safety and satisfaction in the birth process. One is not more important than the other, and both sides work together in the ideal mix of midwifery strength. As I learned from a favorite saying of the Dutch midwives I studied with in Amsterdam back in the 1980s, “A good birth is a safe birth.” I had just two slides to demonstrate high patient satisfaction and impressive outcomes based on the inherent strength of the midwifery model. It is a model worth being scaled up everywhere!

Note: To view more of Mercy In Action’s outcome statistics over the years, we refer you to the book Birth Models That Work (3), edited by Robbie Davis-Floyd, where our statistics were published in detail on almost 10,000 births (in the most recent configuring of our statistics a decade later, the percentages in all areas remain similar to those published in 2009). Also of interest may be Mercy In Action’s online CEU course called “Statistics for Midwives,” written by our graduate Nicole Werner, Ph.D., using many of Mercy In Action’s birth statistics as examples throughout the course (4). Watch for the results of Mercy In Action’s patient satisfaction surveys – statistics we are compiling now will be published in the future.

Vicki Penwell, a midwife for more than 40 years, has attended births and taught midwives on four continents and created educational opportunities for thousands of maternity care providers, in both pre-service and in-service settings. She has a master’s degree in Midwifery and another master’s degree in Intercultural Studies and is currently working on a doctorate in Creative Leadership, writing her dissertation on Mercy In Action’s First 1000 Days pilot project. Splitting her time living between the Philippines and the USA, Vicki teaches regularly in seminars and workshops around the world.

Notes:

1. https://vimeo.com/890853930/81167a6669.
2. https://ich.unesco.org/en/RL/midwifery-knowledge-skills-and-practices-01968.
3. Robbie Davis-Floyd. 2009. Birth Models That Work (University of California Press)
4. www.mercycollegeofmidwifery.edu/online-statistics-for-midwives.