Mothers could receive better support before, during and after pregnancy if midwives were given the opportunity to be more present in the community, according to midwifery professor Rita Borg Xuereb.

Photo: Matthew Mirabelli

“Midwives have the potential to offer much more. Many maternal services that are currently centralised at Mater Dei Hospital can be extended into health centres or local councils to better support and educate mothers, many of whom work, and to alleviate the demands on the hospital,” she said.

Prof. Borg Xuereb, a university lecturer and midwife, will be participating in a roundtable discussion on maternal health organised by the Malta Trust Foundation in collaboration with Humanity 2.0 Lab, a pioneering foundation based in Rome that is supported by the Vatican’s Dicastery for Promoting Integral Human Development.

Some 30 healthcare professionals will come together to identify the best strategies to accelerate enhanced outcomes in global maternal and infant health, in line with the United Nations sustainable development goals.

The discussion, led by President Emeritus Marie-Louise Colerio Preca, will end with the signing of a memorandum of understanding between the Malta Trust Foundation and Humanity 2.0 Lab – to provide a framework of cooperation and collaboration between the two sides with special focus on maternal health.

Prof. Borg Xuereb believes the key to addressing maternal health is investing in a person and family-centred approach that ensures continuity of care.

“I don’t hesitate to say we are leaders in Europe and the Mediterranean with regard to maternal care. But, of course, there is room for improvement,” Prof. Borg Xuereb said.

There is more we can do. We can make a difference

“Midwives in Malta are mainly focused in hospital. I think they should come out more into the community. We already offer successful community services, such as the discharge liaison midwife (who visits women at home after birth), but there is more we can do. We can make a difference,” she said adding that, all too often, midwives end up not practising the range of skills they were trained in.

How can midwives help in the community?

Prof. Borg Xuereb went on to give examples. Moving booking clinics into the community will reduce the load at Mater Dei and allow midwives more time to talk and listen to mothers who are booking the midwifery service.

Medical investigations could be done at health centres, freeing up the hospital for high-risk cases. Opening breastfeeding clinics in the community would offer accessible support to struggling mothers and improved follow-ups would increase the breastfeeding rate.

Other services that would work well in the community include: parentcraft classes, sexual health, reproductive health and family planning and antenatal care. By fulfilling an educational role, midwives would also help address nutrition and obesity that often lead to gestational diabetes, as well as other health issues such as smoking cessation.

They would also offer more support to migrant women who are often unaware of the services they are entitled to. 

Maternal mental health

Midwives could also support more on a mental health level. “Our midwives are trained in perinatal (during and after pregnancy) mental health and we have a perinatal mental health clinic at the hospital. We now need to start an outreach service. International statistics show that antenatal depression (during pregnancy) is as high as postnatal depression. Then there are the women who experienced previous mental health issues,” she said.

All these services, she said, would also need to be offered during hours that make sense for working women. Prof. Borg Xuereb believes this is achievable with long-term planning: “If we don’t have the resources today, we will within a few years. At present, the midwifery course has an intake of 15 students per year, but we have many more applicants each year, so we can increase the intake of students given that we will have more services,” she said.

She added that having children was important for the country. Malta’s fertility rate stands at 1.42 and needs to increase to at least 2.1 to be sustainable.

“The State needs to take care of the health of mothers and of their families, this is essential for the country. Investing in issues of community-based maternal healthcare and focusing on prevention also makes economic sense, apart from benefiting the wellbeing of the mother and the baby,” she concluded.