Midwives – delivering new life into the world

NICOLE REECE JAMES

The TT Association of Midwives (TTAM) was registered as a non-profit company in 1995. Its membership consists of 113 midwives and pupil midwives (in training).

A midwife is a person who has completed a midwifery education programme based on the ICM Essential Competencies for Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education.

In TT, midwives have been trained to the same standards. Our midwives have acquired the requisite qualifications and are registered and legally licenced to practise by the Nursing Council of TT.

They demonstrate competency in the scope of practice of the midwife and are the only people entitled to use the title "midwife."

The association’s mission is to advance and support the autonomous practice of midwives through education, advocacy, research and regulation for quality care of the childbearing family.

We embrace the values of professionalism, autonomy, accountability, integrity, respect and service.

TTAM is a member of the Caribbean Regional Midwives Association (CRMA) as well as the International Confederation of Midwives (ICM – the organisation that holds voting rights and decision-making interests as it pertains to our profession).

As part of the function of TTAM, we consider it necessary and have been offering critical training in the areas of childbirth education and breastfeeding support to the public.

We also provide continuous professional development opportunities to our members. This is imperative if midwives are to remain relevant and continuously upgraded in the field of midwifery.

There is a difference between midwifery and nursing. Midwifery is a separate profession and in TT midwives are granted a licence by the State to practise autonomously.

This allows midwives to practise in and outside hospital settings and work at private and public clinics, hospitals and within the home environment.

Midwives are trained to meet the sexual, maternal, newborn, child and adolescent health needs of the childbearing family.

They provide care during pregnancy (antenatal), labour and delivery (intranatal) and after delivery (postnatal), as well as care for the newborn.

They are considered the experts at normal vaginal delivery and are adequately trained to identify complications with the mother or newborn, provide emergency care and refer as needed.

From the perspective of the public hospital setting, the majority (99.6 per cent) of vaginal deliveries are attended to by midwives.

All mothers and infants are monitored and cared for by midwives during hospitalisation, even when they become obstetric deliveries.

Out of the hospital, home births are conducted by experienced midwives for normal pregnancies.

Home births are also a clinical requirement for pupil midwives. Hence this service is regulated by the training institution, supervised by experienced licenced midwives and offered free of charge to the low-risk client.

In private healthcare, the cost of midwifery services may vary based on the type of service requested and the practitioner providing the service.

Antenatal or postnatal visits may range from $350-$400, while delivery services range from $15,000 -$20,000 based on the services given. Midwifery care is covered by health insurance.

At present, there is a small number of practising independent midwives who belong to the association and one established midwife-led birthing and resource centre in TT.

These midwives usually offer services such as childbirth education sessions, antenatal visits, out-of-hospital births, postnatal visits, breastfeeding support, counselling and coping with infant loss.

According to the Pan American Health Organization, "Over the past two years, TT has met both the global and regional targets for maternal deaths."

TTAM's members have greatly contributed to this with their diligent midwifery services to the childbearing population.

According to the State of the World Midwifery Report 2021, "Midwifery interventions are known to be linked to lower mortality rates and care which can be delivered in their entirety by a midwife educated to global standards who is working within an enabling environment."

The demand for midwifery services has increased since the covid19 pandemic, when the population recognised the alternatives available to them for a safe childbirth.

There is no specific geographic area for our services, as we have midwives available throughout the country.

Childbirth education classes are the most popular of the midwifery services.

TTAM says, "It is found that women want to be seen as an individual, to have a trusting relationship and be supported and guided on one’s own terms. These four aspects are the basis of the midwifery profession – being with a woman."

The midwife is a professional whose expertise cannot be compared to other professionals, as each member of the team is an expert in their field. However, the remuneration of our local midwives is grossly inadequate for the services we provide, particularly in the public system of maternal and child health.

TTAM seeks to improve our midwives professionally by:

– Advancing education for its midwives with updates, seminars and webinars.

– Advocating with the Nursing Council to have mandatory and continuous professional development for re-licensure.

– Advocating for a chief midwifery officer at the level of the Ministry of Health.

– Providing an environment for midwives to share their professional insights both with their peers and with a wider global audience.

– Promoting the midwifery profession as a dynamic, versatile and deeply rewarding profession.

The work of the association is supported by the TTCSI as our umbrella association and we continue to embrace the opportunities for further advancement of the critical function of midwifery.

We may be classified at times as “angels” for delivering a new life into the world for the very first time. It is a job that midwives continue to value and cherish.

This column was submitted by the TT Coalition of Services Industries (TTCSI).

The coalition's weekly columns look at its operations, membership and overall contributions of the services sector to the socio-economic landscape of TT.