Midwives are primary carers in our health system providing primary maternity care which is grounded in evidence-based maternal health care and is centred around the woman [1]. This essay will discuss how primary care and primary health care differ and how primary health care provided by midwives contributes to healthy outcomes for women and their babies. Firstly, it will define and address the differences between primary care and primary health care. Next, it will explain how midwives work as primary health care providers and finally it will present how midwifery-led primary health care contributes to healthy maternal and neonate outcomes. It is incorrect to use the terms ‘primary care’ and ‘primary health care’ as if they are interchangeable and this is why clear definitions are important [2]. Primary care is a therapeutic service delivered in the community that is often a person’s entry point into a medical system focussed on illness diagnosis, treatment and/or referral [3]. The primary carer is the initial practitioner and has the greatest responsibility and can include general practitioners, pharmacies, allied and community health providers and midwives [4]. The term ‘primary health care’ is predominantly used to refer to a public health philosophy that provides essential, consumer acceptable healthcare services to the greater population that are equitably accessible to individuals, families and the community [3]. Primary health care is committed to addressing dominant health problems at a society level, promoting individual and community self-reliance and participation, ensuring suitable health education is delivered and is connected to all other sectors in relation to community development [5]. Examples would be vaccinations or hand-sanitation in a viral pandemic. Primary health care focusses on the broader community’s health as a whole, ensuring social and economic development that is affordable and logistically attainable to all in the community in need and involves interdisciplinary collaboration. Primary care, on the other hand, focusses on sustaining individual health and maintaining relationships over time. Midwives, although not generally diagnosing and treating illness, are seen as primary carers as they are often the entry point into the maternity health system. Their scope of practice closely aligns with primary health care in providing antenatal, labour and birth and postnatal care that is woman-centred, geographically accessible, holistic and supports the woman’s full participation in taking ownership of her health and wellbeing [1]. Midwives work as part of a team, often referring to secondary and tertiary health services. Many of these values and principles are reflected in the International Confederation of Midwives’ Codes of Ethics [6] and the Nursing and Midwifery Board of Australia’s Code of Conduct for Midwives [7]. These documents also emphasise the point that maternal health is not just about the access to pregnancy, birth and newborn care, but is a greater public health issue. Important in this greater issue is the integration of referral pathways. This is usually for a particular purpose and for care that is outside the midwife’s expertise or scope of practice [7]. Eddy [3] mentions that midwives are also mindful of power and service access inequality and are often involved in political activism to ensure that women receive the care that they need and are entitled to. This involves the human right to engage with services that incorporate ‘body, mind, spirit, land, environment, culture, custom and the social determinants of health’ [3]. The social determinants of health that may affect midwifery healthcare include and are not limited to, genetics, healthy child development, social support networks, education, social and physical environments, health practices and services and culture. [8]. Health is a multi-faceted state of being that includes biological, social and ecological factors within the societal environment [8]. Midwives offer care with the belief that most women are healthy, and childbearing is a normal physiological process. Midwives are looked at as ‘guardians of the normal’ [9] and are not illness focussed. Healthy outcomes for women and children are expected and these results are being reflected within primary maternity care settings. Sandall’s [10] Cochrane review suggests that midwife-led continuity of care increases a women’s likelihood of, being more satisfied with her birth, having fewer interventions and analgesia and being with a midwife she knows for the process. Babies are also less likely to be born early and are at a lower risk of mortality [10]. A more recent Australian study evaluating a caseload midwifery program revealed similar favourable findings [11]. This further supports how primary health care provided by midwives contributes to healthy outcomes for women and their babies, maximising the gains that can be achieved during maternity care [3]. Healthy outcomes also rely on the aforementioned collaborative and supportive infrastructure being in place to assist midwives to provide comprehensive primary health care to cover any of these facets outside of their scope [3]. In summary, the difference between primary care and primary health care is one of scope. Primary care is concerned with meeting individual clients’ needs, while primary health care considers outcomes for the entire community.Working as primary carers, midwives also perform a broader function in the primary health care system by supporting and educating the woman and families in their care, and advocating for holistic equality to access basic health services leading to better health outcomes for society. References 1. Nursing and Midwifery Board of Australia, Midwife standards for practice. 2018. 2. Muldoon, L.K., W.E. Hogg, and M. Levitt, Primary care (PC) and primary health care (PHC). What is the difference? Canadian Journal Of Public Health = Revue Canadienne De Sante Publique, 2006. 97(5): p. 409-411. 3. Eddy, A., Midwifery as primary healthcare, in Midwifery Preparation for Practice, S. Pairman, et al., Editors. 2019. p. 79-88. 4. The Australian Government Department of Health. Primary care. 2020 [cited 2020 April 05, 2020]; Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/primarycare. 5. World Health Organisation. Declaration of Alma-Ata. 1978 [cited 2020 6/8/2020]; Declaration of Alma-Ata]. Available from: https://www.who.int/publications/almaata_declaration_en.pdf. 6. International Confederation of Midwives. International Code of Ethics for Midwives. 2008 2014. 7. Nursing and Midwifery Board of Australia, Code of conduct for midwives. 2018, Nursing and Midwifery Board of Australia.: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx. 8. McMurray, A. and J. Clendon, Community Health and Wellness - E-Book : Primary Health Care in Practice. 2014, Chatswood, AUSTRALIA: Elsevier Health Sciences. 9. Leap, N., Promoting physiological birth, in Midwifery Preparation for Practice, S. Pairman, et al., Editors. 2019. p. 347-361. 10. Sandall, J., Midwife-led continuity models versus other models of care for childbearing women (Review) Midwife-led continuity models versus other models of care for childbearing women (Review). Cochrane database of systematic reviews (Online), 2013: p. Art. No.: CD004667. 11. Gidaszewski, B., et al., Comparison of the effect of caseload midwifery program and standard midwifery-led care on primiparous birth outcomes: A retrospective cohort matching study. Midwifery, 2019. 69: p. 10-16. mark 75/100
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