Midwives face responsibility gap in healthcare system

Midwives provide care during pregnancy, childbirth and the postpartum period, but still need a doctor’s number or signature for tasks they carry out themselves, mbl.is reports. The Icelandic Midwives Association says the arrangement creates unnecessary duplication and may increase the risk that results are missed.

For example, a doctor’s number must be entered on laboratory requests in antenatal care, even when the doctor has never met the woman receiving the service. The request instead carries the number of a doctor, rather than the midwife responsible for her care and follow-up.

Unnur Berglind Friðriksdóttir, chair of the Icelandic Midwives Association, says midwives must then monitor the tests separately and search for the results themselves because they are not sent to them automatically. The results appear with the doctor listed on the request.

“This is a safety issue,” Unnur told mbl.is. She said the extra steps amount to a form of double bookkeeping and increase the risk that something will be lost in the process.

Midwives are specialists in normal pregnancy, childbirth and the postpartum period, and routine tests are part of the service they provide. Although they have their own professional identification numbers, they cannot use them on these laboratory requests.

Unnur said the issue was not only about expanding the scope of midwives’ work, but also about updating the systems to reflect the responsibilities they already have. In some cases, she said, the solution would be a simple technical change, such as adding one option to a computer system.

Midwives also prepare and complete certificates but must obtain a doctor’s signature. The doctor may not be involved in the woman’s care and must either review her medical history and the assessment behind the certificate or trust the midwife’s work and sign it.

“This should not be the case. The midwife should be responsible for her own work,” Unnur said.

She also referred to women with gestational diabetes who need blood glucose monitoring equipment. Midwives complete the paperwork, but a doctor must still approve it. Unnur questioned why a midwife could not apply for the equipment after the diagnosis had already been made.

She said similar issues affected various referrals and other tasks, and that changing the systems would both improve patient safety and create significant efficiencies.