On the occasion of International Midwives' Day, which is commemorated every year on May 5th, the Slovak Chamber of Nurses and Midwives (SK SaPA) draws attention to the still unresolved problem of applying the legal competencies of midwives, whose care is needed by our women and their children. International Midwives' Day has been celebrated on May 5th since 1992 under the auspices of the International Confederation of Midwives (ICM), which supports, represents, and works to strengthen the professional association of midwives on a global scale. The aim of this day is to celebrate and raise awareness of the importance of the work of midwives and to emphasize women's rights and their access to maternity care before, during, and after childbirth.
SK SaPA organizes meetings for midwives every year during this period, where they exchange experiences and discuss issues related to the performance of their profession. It is necessary to support midwives, as well as the development of maternal competencies, and to turn the idea that a midwife becomes an independent healthcare provider with appropriate competencies into actual practice. Despite the fact that women are calling for the restoration of the activities of midwives, we cannot ensure a sufficient number of midwives working outside of hospitals or clinics. Barriers stand in the way, which we need to address by changing the system of care for women, bringing it closer to the system of care in EU countries. Therefore, SK SaPA has prepared the Independent Midwifery Practice Project, where we define the basic areas for implementing the necessary changes that can help eliminate these shortcomings, but neither the ministry nor the health insurance companies have a real interest in solving this area systematically and comprehensively.
"In recent times, we have seen genuine efforts on the part of the Union health insurance company, as well as the General Health Insurance Company, where we have achieved certain progress after mutual negotiations, which we are very pleased with, but it is going very slowly, we have no support from the Ministry of Health or politicians," says the Vice-President of SK SaPA for midwifery, Adriana Nemčoková. With the General Health Insurance Company, we have launched a telephone support project for breastfeeding women - policyholders of the General Health Insurance Company, where experienced midwives are available in case of any breastfeeding problems for women. We have been cooperating with the Union insurance company for a longer time on supporting contracts for midwives who are interested in working in independent practice so that this care is also paid for. The Union insurance company also helped us organize a meeting this year with foreign midwives with experience in independent practice from the Czech Republic and the Netherlands, which is of great benefit to midwives who are interested in performing independent practice in midwifery.
"Midwives are educated, utilizing their acquired knowledge and practical skills with a sensitive individual approach, maximum respect and esteem for every woman, with recognition and support for their rights and the satisfaction of their specific needs. They have the appropriate competencies for all activities stemming from their education and at the same time bear full responsibility for their decisions and activities," stated the Vice-President for midwifery of SK SaPA, Adriana Nemčoková. "Despite the fact that the preparation for the profession of midwife is at a very high level in our country and the conditions for obtaining professional qualification are uniform within the European Union, the application of the competencies of Slovak midwives in practice is incomparable with their foreign colleagues," states the President of SK SaPA, Iveta Lazorová. "Midwives perform their profession predominantly only in hospitals and in gynecologists' clinics, where their independence in decision-making and application of competencies based on their professional knowledge is limited, which results in a decline in interest in studying midwifery, as well as a decline in interest in performing the profession. Factors contributing to this phenomenon include the low autonomy of the profession, high psychological and physical strain during the performance of the profession, and the position in society among both the lay and the professional public."
Slovak midwives face many problems in practice, among which are primarily the dominance of doctors in normal, uncomplicated conditions, disrespect for their status, the impossibility of taking over care for physiological childbirth to the extent allowed by legislation, and, of course, insufficient financial remuneration in view of the responsibility of their profession. They are often perceived more as nurses or doctor's assistants, and the public is often unaware of their existence.
"A midwife considers the miracle of childbirth to be normal and leaves it without intervention unless problems arise. An obstetrician normally perceives childbirth as a problem; if left alone, it is a miracle," this statement probably best captures the essence of the difference in approach to childbirth between a doctor and a midwife, states President Lazorová.
In Slovakia, there are several initiatives and civic associations that draw attention to the insufficient provision of quality care in midwifery, based on evidence-based practice, as well as on the recommendations of international organizations, led by the World Health Organization. However, increasingly, there is a demand from women themselves for the provision of care in a natural environment. Mothers are uncertain, they need someone to take care of them and advise them on the problems that motherhood, breastfeeding, and caring for a newborn bring. An important area to which midwives should pay due attention is also the preparation of pregnant women for childbirth in so-called prenatal courses.
The Public Defender of Rights of the Slovak Republic also points out the shortcomings in providing care to women. Based on her findings, she states that there is a lack of respect for the privacy and dignity of birthing women, procedures are performed without consent, and informed consent is not sufficiently explained. The Public Defender of Rights proposes the introduction of uniformly applied standards that will take into account scientific and medical development while fully respecting women's rights, further ensuring adequate financial resources for healthcare facilities, and the right to the presence of a close person or a person designated by the patient. She also calls for the implementation of training for healthcare personnel.
SK SaPA explains that these shortcomings are systemic, therefore a fundamental change is needed, not just minor adjustments that will not solve these problems. "It is essential that the care provided by midwives during a normal, uncomplicated pregnancy and postpartum period be fully covered by public health insurance. Midwives have their competencies, which they are capable of performing in practice, thereby helping and guiding women in the prenatal period, during childbirth, and in the postpartum period. Their contribution to the system and to the health of women and their children is undeniable and has been verified in many countries around the world. It is incomprehensible to us that we have to fight for years, negotiate, and justify the need for changes in order to bring midwifery care to the level it deserves," stated President Iveta Lazorová.
The Slovak Chamber of Nurses and Midwives reminds that care for low-risk pregnant women, mothers, and their newborns needs to be supported through the activities of midwives. This will bring financial savings to the system and reduce the costs of managing complications. Midwives are sufficiently educated and experienced to be able to provide pregnant women, women in labor, and newborns with quality and safe care before, during, and after childbirth.
Source: Slovak Chamber of Nurses and Midwives The Slovak Chamber of Nurses and Midwives (SK SaPA) is a self-governing professional organization with nationwide jurisdiction, headquartered in Bratislava, bringing together 38,000 nurses and midwives. The main task of SK SaPA is to defend the professional, economic, and social interests of the chamber's members in healthcare, social, educational, and other facilities.