The first steps in Germany – workshops
In German speaking countries, interest in evidence based care was intensified after a scientific workshop was held by the International Association of Midwives in Tübingen, Germany, in September, 1989 (1, 2). Since then, an annual scientific workshop for midwives has been offered by the Association of German Midwives (deutscher Hebammenverband). This workshop gives midwives, who are interested in research, the opportunity to cooperate and discuss current issues with colleagues, in addition to providing information about evidence based care practices (3 -14). Prof. Dr. Mechthild Gross has moderated it since its inception. In 2010, the workshop was included in the preparation phase of the 13th annual Congress of German Midwives in Düsseldorf. Several bachelor and master theses were presented. Additionally, there were practical projects presented by dedicated midwives that were later transformed into bachelor theses (15).
Evidence based care in pregnancy and childbirth
Prof. Marc Keirse’s speech at the fifth workshop in 1994 (16) lead to midwives taking charge of translating the major standard reference, A Guide to Effective Care in Pregnancy and Childbirth (17) into German. The first German edition was published in 1994, and in 2006 the second German edition, of the third English edition, was published (18, 19). This guide is based on two extensive volumes on evidence based care throughout pregnancy and childbirth (20) which represent the cradle of evidence based health care. They are also the predecessors of the multidisciplinary Cochrane Collaboration and Cochrane Library (21). Based on this outcome oriented approach to clinical studies, new approaches to effective care during childbirth were developed at the Hanover Medical School (22).
In hindsight, the 1990s may be regarded as a decade of fostering awareness among midwives of scientific approaches. Midwives connected to university hospitals, whether through education or through work, generally came into contact more regularly than colleagues practising outside of the academic setting.
In eastern Germany, midwives who were also medical educators were more familiar, and thus more proficient, with the scientific setting. As a doctoral candidate at the University of Bremen, I (MG) had to prove my knowledge of Latin to the head midwife in the delivery room, who originally came from Rostock (eastern Germany). In response to her statement that the foetus’ head was “ante portas”, I remarked that it would not be long until the birth. This was apparently a test of compatability between my academic abilities, and my competency in midwifery. Upon passing this “test”, that the following clinical cooperation was off to a good start.
In the new millennium, several universities and colleges have developed focuses in midwifery trying to establish a long lasting infrastructure. In addition to the Department of Obstetrics, Gynaecology and Reproductive Medicine at The Hanover Medical School, the Department for Health Care Sciences at the Medical Faculty of the Martin Luther University in Halle-Wittenberg must be mentioned in this context. Dr. Gertrud Ayerle is the contact at the Martin Luther University. In Osnabrück and Bochum, technical colleges were actively involved. At the moment, approximately ten midwives have graduated in the subject, and there are four midwives currently working as professors at technical colleges.
Considering the immense responsibility midwives have every day in their field, it is necessary to ensure a corresponding level of education. At the Hanover Medical School, we have been developing a concept which, in collaboration with the Department of Obstetrics, Gynaecology and Reproductive Medicine, empowers midwives to combine scientific aspirations with clinical work. This perpetual exchange between clinical case reports, research and teaching enables the students of midwifery to witness firsthand the interconnection of scientific midwifery with practical work. This is an effective way to prevent the possible brain drain of capable midwives away from the university setting. The challenge is for obstetrics to let academically qualified midwives participate with the appropriate level of responsibility, so that not only the women and children, but also the students and junior staff in medicine may profit from the educational insights offered by highly qualified and skilled midwives.