An effective strategy for maternity services in Greece needs to address the following issues:
• The high number of caesarean sections
• The absence of midwives as leaders in the management of maternity care
• The inadequate use of evidence based protocols or of general action guidelines, especially in the private sector, which facilitates clear differences in practice and questions clinical effectiveness
• The difficulty of evaluation of the provided services due to the almost non-existence of organised data and the lack of computerisation in the public mater-nity hospitals
First steps in evidence based midwifery
The efforts of the midwives in the past 5 years have particularly focused on sup-porting normal birth in the public hospitals. They now have overall responsibility for 30% of the deliveries and have been successful in avoiding complications and providing greater satisfaction for women. They have been working to develop and implement evidence based midwifery guidelines. They have given great emphasis to parenthood preparation through pre-conceptual and antenatal care.
Their significant agenda has been to collaborate effectively with women both individually and through women’s organisations.
3. Clear distinction between normal physiological and high-risk pregnancies and appropriate consequent management
4. Introduction of evidence based care
5. Use of evidence based criteria for induction of labour
6. Commitment to a reduction of the number of caesarean sections
7. Accurate recording of all the relevant perinatal health-care data by the National Statistical Service of Greece, especially in the private sector
8. Ongoing evaluation of midwives’ practice to provide evidence of their role in supporting the physiological process of pregnancy and labour and thus reduce cost in a safe environment for the mother and newborn
It is clear that the most appropriate setting for and future development of midwifery in Greece is closely allied to the public national health system and not to the private sector.
The midwives have also put forward a proposal for the creation of a directorate of perinatal health care in the framework of public health. The co-existence of obstetricians, midwives and paediatricians within this directorate and the conse-quent exchange of views would contribute, in our opinion, to the improvement of maternity services.
Conclusion
As discussed in this chapter, the practice of midwifery in Greece has many problems and contradictions that need confronting on a daily basis. The basic pro-fessional status of the midwife has remained unchanged in the past three decades.
I would therefore suggest that midwives have to try very hard to be ‘active mid-wives’ in Greece today and to practise according to the international definition of the midwife and the European directive, even though they have high levels of edu-cation and the directive is instilled in national legislation. This situation in Greece is an example of how the system, its structure, direction and economic transactions have a huge influence on midwifery, despite midwives’ increased knowledge and expertise. Midwives in Greece have the potential to provide invaluable services by holding on to and expanding their professional domain. Their efforts are now being recognised by the women they care for, whose requests for physiological childbirth and greater support with breastfeeding are increasing all the time.
This chapter has described many of the difficulties in Greek midwifery, which work as barriers to evidence based practice, and has explored some of the strategies that are currently being used to re-engage with normal birth and professional autonomy.
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5. Reflections on Running an Evidence Course
Denis Walsh
Introduction
In 1998, I was working as a research and development midwife at a large consultant unit in England and had led the development of midwifery-led guidelines for intrapartum care locally. We produced a little booklet that we gave to every midwife. It consisted of ten areas of labour care where we had distilled practice recommendations from the research literature. We sold the booklet at one of our national study days and subsequently were inundated with requests to purchase it. In the next 12 months, over 2000 copies were sold to midwives within the United Kingdom and abroad.
The exercise of developing the guidelines had made me become well aware of how much evidence existed, which was supportive of normal labour and birth.
In the late 1990s, the medicalisation of childbirth was a central agenda item for midwives and so much of what midwives saw in practice seemed based on obstetric research around birth interventions. I began to consider disseminating this largely unacknowledged and apparently hidden body of evidence so that midwives would feel supported in their practices around physiological birth.