The Role and Importance of the Midwife Before, During and After Birth and their Status in the Health System

Background: Midwives are globally recognized as health professionals who specialize in the care of women in labor with a vital role in maternal and newborn health care. Midwives specialize in the care of women in labor and play a key role globally in managing normal vaginal birth, caring for pregnant women including supporting women and their families, providing consultations, managing normal birth for low-risk pregnant women and helping them maintain a healthy pregnancy. Despite the fact that the midwifery profession is an autonomous profession, in some countries there are many struggles to achieve recognition within its formal scope of work. The role of the midwife/midwife remains unclear in many countries due to poorly articulated policies and a lack of regulatory frameworks, which results in a lack of public clarity regarding the role of the midwife. Objective: The purpose of this expert report is to present the role of the midwife in protecting the health of mothers before, during and after childbirth, to clearly define their role and importance, and the need to improve midwifery as a profession in order to reduce the number of caesarean sections. Methods: This systematic review includes a comprehensive literature search of published scientific articles, in English, from 2020 to 2024, using electronic databases considered most relevant to the topics; CINAHL, EMBASE and PubMed. In this systematic review and meta-analysis, we included studies on the role of midwives in different countries, including Thailand, the United States, Australia, Canada, the UK, the Netherlands, Bosnia and Herzegovina, Slovenia, Croatia and Serbia, to arrive at results on what the role of midwives is in these countries. Citations without abstracts and/or full text, anonymous reports, editorials, case reports, case series and qualitative studies were excluded. Results: In the Law on Health Care of the FBiH, and the Law on Nursing and Midwifery of the FBiH, the role of the midwife is insufficiently defined and she is not given sufficient authority to work. For childbirth in BiH, in addition to midwives, a doctor must always be present. In European and foreign countries, the role of the midwife is put in the foreground during childbirth, so there are also hospitals where women give birth and are cared for by midwives. Midwife-led care, an approach that is already widely practiced in developed countries; however, it is a relatively new approach in lower-income countries. In midwife-led care, a midwife who is well known to the mother provides care for the low-risk pregnant woman during antenatal care, delivery and the postnatal period, rather than being cared for by different medical staff led by an obstetrician. The primary focus of care led by midwives is to support a healthy physiological pregnancy and birth and to empower women to give birth naturally with little or no regular intervention. Conclusion: It is very worrying for midwifery as a profession that there is currently a lack of visibility of midwives in practice within their scope of practice in Bosnia and Herzegovina. More research is needed on demonstrating the value of midwives as a primary role in the context of midwifery practice in Bosnia and Herzegovina.