The Impact of Nursing and Midwifery Interventions on Reducing Maternal Mortality A Narrative Revi
DOI:
https://doi.org/10.22399/ijcesen.3909Keywords:
Maternal mortality, Nursing interventions, Midwifery care, Intrapartum management, Postnatal care, Skilled birth attendanceAbstract
Nursing and midwifery interventions play a pivotal role in reducing maternal mortality by delivering timely, evidence-based care across the continuum of pregnancy, childbirth, and the postpartum period. This narrative review synthesizes literature on antenatal risk screening, skilled intrapartum attendance, active management of the third stage of labor, immediate newborn care, and postpartum surveillance—interventions that directly reduce causes of maternal death such as hemorrhage, hypertensive disorders, sepsis, and obstructed labor. Emphasis is placed on how midwives and nurses implement clinical protocols, perform early recognition and referral for complications, and provide life-saving measures in low-resource settings. The review also considers the contribution of community-based midwifery, task-shifting strategies, and the use of standardized checklists and simulation training to improve clinical competence and response times.Beyond clinical procedures, the review highlights system-level and socio-cultural factors that modulate the effectiveness of nursing and midwifery interventions. Workforce capacity—education, continuous professional development, and supportive supervision—emerges as a critical determinant of outcomes, as does health system integration that ensures referral pathways, supply chain reliability, and data-driven quality improvement. Cultural competence, respectful maternity care, and community engagement are discussed as essential components for improving utilization of skilled care and timely help-seeking. Finally, the narrative identifies gaps in high-quality outcome data, calls for rigorous implementation research, and offers recommendations for policy and practice to strengthen nurse-midwife-led models as a central strategy for accelerating reductions in maternal mortality.
References
[1] Anderson R, Williams A, Hoque DME, Jess N, Shahjahan F, Hossain A, et al., (2023). Implementing midwifery services in public tertiary medical college hospitals in Bangladesh: a longitudinal study. Women Birth. 36:299–304. 10.1016/j.wombi.2022.09.006
[2] World Health Organization. (2019). Strengthening quality midwifery education for Universal Health Coverage 2030: Framework for action. Geneva, Switzerland: World Health Organization.
[3] Fikre R, Gubbels J, Teklesilasie W, Gerards S, (2023). Effectiveness of midwifery-led care on pregnancy outcomes in low-and middle-income countries: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 23:386. 10.1186/s12884-023-05664-9
[4] Bogren M, Begum F, Erlandsson K., (2017). The historical development of the midwifery profession in Bangladesh. Journal of Asian Midwives. 4:65–74.
[5] World Health Organization. (2023). WHO recommendations on antenatal care for a positive pregnancy experience: screening, diagnosis and treatment of tuberculosis disease in pregnant women.
[6] ALReshan MSM, MoammedAlreshan HS, Al Rashan SSM, Alhozobar MN, Al Mahri MFM, Alsqoor SRA, et al., (2022). Critical analysis of midwifery care models in evaluating continuity of care, patient satisfaction, and maternal-infant health outcomes. Chelonian Research Foundation. 17:850–65.
[7] Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, et al., (2021). Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. Lancet Glob Health. 9:e24–32. 10.1016/S2214-109X(20)30397-1
[8] Saha M, Odjidja EN., (2017). Access to a skilled birth attendant in Bangladesh: what we know and what health system framework can teach us. Health Syst Policy Res. 4:66. 10.21767/2254-9137.100085
[9] Rosa-Mangeret F, Benski AC, Golaz A, Zala PZ, Kyokan M, Wagner N, et al., (2022). 2.5 Million Annual Deaths—Are Neonates in Low- and Middle-Income Countries Too Small to Be Seen? A Bottom-Up Overview on Neonatal Morbi-Mortality. Trop Med Infect Dis. 7:64. 10.3390/tropicalmed7050064
[10] World Health Organization. (2023). Maternal mortality. Fact sheets 2019.
[11] Byrskog U, Akther HA, Khatoon Z, Bogren M, Erlandsson K., (2019). Social, economic and professional barriers influencing midwives’ realities in Bangladesh: a qualitative study of midwifery educators preparing midwifery students for clinical reality. Evid Based Midwifery. 17:19–26.
[12] Graham WJ, Varghese B., (2012). Quality, quality, quality: gaps in the continuum of care. Lancet. 379:e5–6. 10.1016/S0140-6736(10)62267-2
[13] World Health Organization, (2004). International Confederation of Midwives, International Federation of Gynecology and Obstetrics. Making pregnancy safer: the critical role of the skilled attendant: a joint statement by WHO, ICM and FIGO.
[14] Islam F, Rahman A, Halim A, Eriksson C, Rahman F, Dalal K., (2015). Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study. BMC Health Serv Res. 15:237. 10.1186/s12913-015-0918-9
[15] Nyfløt L, Sitras V., (2018). Strategies to reduce global maternal mortality. Acta Obstet Gynecol Scand. 97:639–40. 10.1111/aogs.13356
[16] World Health Organization. (2024). Newborn mortality.
[17] Nedvědová D, Dušová B, Jarošová D., (2017). Job satisfaction of midwives: a literature review. Central European Journal of Nursing and Midwifery. 8:650–6. 10.15452/CEJNM.2017.08.0014
[18] Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al., (2013). Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 381:1747–55. 10.1016/S0140-6736(13)60686-8
[19] International Confederation of Midwives. (2017). Midwifery Led Care, the First Choice for All Women.
[20] Bagheri A, Simbar M, Samimi M, Nahidi F, Alavimajd H, Sadat Z., (2021). Comparing the Implications of Midwifery-Led Care and Standard Model on Maternal and Neonatal Outcomes during Pregnancy, Childbirth and Postpartum. Journal of Midwifery and Reproductive Health. 9:2863–72.
[21] Wichaidit W, Alam MU, Halder AK, Unicomb L, Hamer DH, Ram PK., (2016). Availability and quality of emergency obstetric and newborn care in Bangladesh. Am J Trop Med Hyg. 95:298–306. 10.4269/ajtmh.15-0350
[22] International Centre for Diarrhoeal Disease Research. (2024). Bangladesh. Maternal, Neonatal and Child Health.
[23] Ferreira, M. B., Silveira C. F., Silva S. R., Souza D. J., and Ruiz M. T. (2016). Nursing Care for Women With Pre‐Eclampsia and/or Eclampsia: Integrative Review. Revista da Escola de Enfermagem da USP 50(2): 324–334. 10.1590/S0080-623420160000200020.
[24] Borenstein, M., Hedges L., Higgins J., and Rothstein H. R. (2010). Comprehensive Meta‐Analysis CMA (Version 2.2. 057). Biostat.
[25] Goldsmith, M. R., Bankhead C. R., and Austoker J. (2007). Synthesising Quantitative and Qualitative Research in Evidence‐Based Patient Information. Journal of Epidemiology and Community Health 61(3): 262–270. 10.1136/jech.2006.046110.
[26] Ibrahim, A. M., and Jahanfar S. (2024). Effectiveness and Equity of mHealth Apps for Preeclampsia Management in LMICs: A Rapid Review Protocol. PLoS One 19(11): e0313655. 10.1371/journal.pone.0313655.
[27] Digenis, C., Salter A., Cusack L., Koch A., and Turnbull D. (2020). Reduced Length of Hospital Stay After Caesarean Section: A Systematic Review Examining Women's Experiences and Psychosocial Outcomes. Midwifery 91: 102855. 10.1016/j.midw.2020.102855.
[28] Benligül, E. M., Bektaş M., and Arslan G. (2022). Understanding and Interpreting Meta‐Analysis: Recommendations for Nurses. E‐Journal of Dokuz Eylul University Nursing Faculty 15(1): 86–98. 10.46483/deuhfed.872337.
[29] Chou, C. C., Liaw J. J., Chen C. C., Liou Y. M., and Wang C. J. (2021). Effects of a Case Management Program for Women With Pregnancy‐Induced Hypertension. Journal of Nursing Research 29(5): e169. 10.1097/jnr.0000000000000450.
[30] Gholami, K., Norouzkhani N., Kargar M., et al. (2022). Impact of Educational Interventions on Knowledge About Hypertensive Disorders of Pregnancy Among Pregnant Women: A Systematic Review. Frontiers in Cardiovascular Medicine 9: 886679. 10.3389/fcvm.2022.886679.
[31] Alnuaimi, K., Abuidhail J., and Abuzaid H. (2020). The Effects of an Educational Programme About Preeclampsia on Women's Awareness: A Randomised Controlled Trial. International Nursing Review 67(4): 501–511. 10.1111/inr.12626.
[32] Egger, M., Davey Smith G., Schneider M., and Minder C. (1997). Bias in Meta‐Analysis Detected by a Simple, Graphical Test. BMJ (Clinical Research Ed.) 315(7109): 629–634. 10.1136/bmj.315.7109.629.
[33] Begg, C. B., and Mazumdar M. (1994). Operating Characteristics of a Rank Correlation Test for Publication Bias. Biometrics 50(4): 1088–1101. 10.2307/2533446.
[34] Altman, M. R., Murphy S. M., Fitzgerald C. E., Andersen H. F., and Daratha K. B. (2017). The Cost of Nurse‐Midwifery Care: Use of Interventions, Resources, and Associated Costs in the Hospital Setting. Women's Health Issues 27(4): 434–440. 10.1016/j.whi.2017.01.002.
[35] Amanak, K., Sevil U., and Karacam Z. (2019). The Impact of Prenatal Education Based on the Roy Adaptation Model on Gestational Hypertension, Adaptation to Pregnancy, and Pregnancy Outcomes. Journal of the Pakistan Medical Association 69(1): 11–17.
[36] Centre for Reviews and Dissemination. (2009). Systematic Reviews: CRD's Guidance for Undertaking Systematic Reviews in Healthcare, New York.
[37] Deliktas, A., Kabukcuoğlu K., and Kış A. (2016). Meta‐Analysis Application Process in Nursing: A Guide Intended for Methodology. Journal of Human Sciences 13(1): 1906–1925.
[38] Caropreso, L., de Azevedo Cardoso T., Eltayebani M., and Frey B. N. (2020). Preeclampsia as a Risk Factor for Postpartum Depression and Psychosis: A Systematic Review and Meta‐Analysis. Archives of Women's Mental Health 23(4): 493–505. 10.1007/s00737-019-01010-1.
[39] Gomathi, B., Anuchitra R., and Nautiyal R. (2020). Effectiveness of Vascular Symptom Management Package (Vsmp) on Quality of Life (Qol) Among Pregnant Women With PIH in Hilly Areas of Uttarakhand. International Journal of Research in Pharmaceutical Sciences 11(2): 1288–1293.
[40] Degu, A. B., Yilma T. M., Beshir M. A., and Inthiran A. (2022). Evidence‐Based Practice and Its Associated Factors Among Point‐Of‐Care Nurses Working at the Teaching and Specialized Hospitals of Northwest Ethiopia: A Concurrent Study. PLoS One 17(5): e0267347. 10.1371/journal.pone.0267347.
[41] Bown, M. J., and Sutton A. J. (2010). Quality Control in Systematic Reviews and Meta‐Analyses. Europian Journal of Vascular Endovascular Surgery 40(5): 669–677. 10.1016/j.ejvs.2010.07.011.
[42] Gholami, K., Norouzkhani N., Kargar M., et al. (2022). Impact of Educational Interventions on Knowledge About Hypertensive Disorders of Pregnancy Among Pregnant Women: A Systematic Review. Frontiers in Cardiovascular Medicine 9: 886679. 10.3389/fcvm.2022.886679.
[43] Abazarnejad, T., Ahmadi A., Nouhi E., Mirzaee M., and Atghai M. (2019). Effectiveness of Psycho‐Educational Counseling on Anxiety in Preeclampsia. Trends in Psychiatry and Psychotherapy 41(3): 276–282. 10.1590/2237-6089-2017-0134.
[44] Higgins, J. P., Altman D. G., Gøtzsche P. C., et al. (2011). The Cochrane Collaboration's Tool for Assessing Risk of Bias in Randomised Trials. BMJ (Clinical Research Ed.) 343: d5928. 10.1136/bmj.d5928.
[45] Amoakoh‐Coleman, M., Borgstein A. B. J., Sondaal S. F., et al. (2016). Effectiveness of Mhealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low‐ and Middle‐Income Countries: A Systematic Review. Journal of Medical Internet Research 18(8): e226. 10.2196/jmir.5533.
[46] Marufu TC, Collins A, Vargas L, et al., (2021). Factors influencing retention among hospital nurses: Systematic review. Br J Nurs. 30:302–308. doi: 10.12968/bjon.2021.30.5.302.
[47] WHO. (2015). Trends in maternal mortality: 1990–2015: Estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization.
[48] Li LZ, Yang P, Singer SJ, et al., (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis. JAMA Netw Open. 7:e2443059–e2443059. doi: 10.1001/jamanetworkopen.2024.43059.
[49] Mattison C, Bourret K, Hebert E, et al., (2021). Health systems factors impacting the integration of midwifery: An evidence informed framework on strengthening midwifery associations. BMJ Global Health. 6:e004850. doi: 10.1136/bmjgh-2020-004850.
[50] WHO. (2014). WHO recommendations on postnatal care of the mother and newborn. World Health Organization.
[51] Gillen P, Neill RD, Mallett J, et al., (2022). Wellbeing and coping of UK nurses, midwives and allied health professionals during COVID-19 — a cross-sectional study. PLoS One. 17:e0274036. doi: 10.1371/journal.pone.0274036.
[52] Renfrew MJ, McFadden A, Bastos MH, et al., (2014). Midwifery and quality care: Findings from a new evidence informed framework for maternal and newborn care. Lancet. 384:1129–1145. doi: 10.1016/S0140-6736(14)60789-3.
[53] Bishai DM, Cohen R, Alfonso YN, et al., (2016) Factors contributing to maternal and child mortality reductions in 146 low and middle income countries between 1990 and 2010. PLoS One. 11:e0144908. doi: 10.1371/journal.pone.0144908.
[54] Truth AU. (2013). A universal truth: No health without a workforce. Vol. 2013. World Health Organization (WHO) report; 1–104.
[55] Boukhalfa C, Ouakhzan B, Masbah H, et al., (2024). Investing in midwifery for sustainable development goals in low and middle income countries: A cost benefit analysis. Cost Eff Resour Alloc. 22:1. doi: 10.1186/s12962-023-00507-y.
[56] WHO. (2024). SDG Target 3.1. Maternal mortality: By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births.
[57] Campbell OMR, Amouzou A, Blumenberg C, et al., (2024). Learning from success: The main drivers of the maternal and newborn health transition in seven positive outlier countries and implications for future policies and programmes. BMJ Glob Health. 9:e012126. doi: 10.1136/bmjgh-2023-012126.
[58] Petrella AR, Hughes L, Fern LA, et al., (2021). Healthcare staff well being and use of support services during COVID 19: A UK perspective. Gen Psychiatr. 34:e100458. doi: 10.1136/gpsych-2020-100458.
[59] WHO. (2019). Maternal mortality.
[60] Fikre R, Gubbels J, Teklesilasie W, et al., (2023). Effectiveness of midwifery led care on pregnancy outcomes in low and middle income countries: A systematic review and meta analysis. BMC Pregnancy Childbirth. 23:386. doi: 10.1186/s12884-023-05664-9.
[61] Walker SB, Rossi DM, Sander TM. (2019). Women’s successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature. Midwifery. 79:102552. 10.1016/j.midw.2019.102552.
[62] Cronie D, Perdok H, Verhoeven C, Jans S, Hermus M, De Vries R, et al. (2019). Are midwives in the Netherlands satisfied with their jobs? A systematic examination of satisfaction levels among hospital and primary-care midwives in the Netherlands. BMC Health Serv Res. 19:832. 10.1186/s12913-019-4454-x.
[63] Forster DA, McLachlan HL, Davey MA, Biro MA, Farrell T, Gold L, et al. (2016). Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth. 16:28. 10.1186/s12884-016-0798-y.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 International Journal of Computational and Experimental Science and Engineering

This work is licensed under a Creative Commons Attribution 4.0 International License.