In 2016, I did a two-week elective placement (followed by an obligatory weeks holiday!) in Malta. I had a fascinating insight into Maternity Care in a country smaller than Cornwall and absolutely loved my time there. I spread my time across the Labour Ward, Antenatal Ward, Postnatal Ward, Breastfeeding Clinic and in the Community. The midwives, student midwives, doctors and all other staff were so friendly and I learnt so much. Here's a snapshot of my time there:
So there's one main hospital in Malta, called Mater Dei hospital which has around 4000 births a year and a 37% section rate when I last checked. It's a huge, modern hospital and is situated right next to the only University in Malta. Because of it's history, Malta is not unlike the UK in many ways, with English as a second language to almost everyone and is used in conjunction quite often!
In regards to maternity care, the main differences to care in the UK that I found were:
- Antenatal care is done almost exclusively privately. There is an Antenatal Clinic within Mater Dei but it doesn't have a great reputation as there are often very very long waiting times. It seems the culture is just that antenatal care is done privately by an obstetrician and it's just kind of taken as a given. Only those who cannot afford it go for free care in the hospital. Seeing a doctor antenatally (and never a midwife) undermines the role of the midwife a little from the get go, as women assume 'normal' care is from a doctor.
- Abortion is illegal as Malta is a Catholic country. Although scans are undertaken, there are no abortions allowed even if the baby has a congenital abnormality. I did a couple of shifts on the Neonatal Unit where a baby with hydrocephaly was receiving palliative care, and had been for almost a year. It was so sad to see and really shocked me, having come from a country where it is very rare that this baby would have been carried to term. Women often take a trip over to Italy if they do not wish to continue the pregnancy, although this is all very hush hush.
- All local Midwives and Doctors are trained in the one University. There were only a few who had been trained outside of this University, but this meant within other countries which was rare and expensive. This means that practises are passed down within a very small skills pool, allowing practices such as breech and twin vaginal delivery to be entirely forgotten and therefore never happened. It also made the relationship between midwives and doctors a little bit 'old school' compared the UK, and practices had not changed at such a fast rate as larger countries. Doctors were ultimately in charge and midwives had less autonomy. However, with international programmes such as ERASMUS and others meaning that international study and experiences were more affordable and accessible to midwives, there is the beginning of movement. I spoke to some lovely student midwives who had just been in Nottingham for a few months learning about midwifery over here. They were fascinated by pool births and home births, which are absolutely unheard of in Malta - watch this space!
- High rates of IOLs. For many reasons, often similar to ones over here, but also because they only allow women to get to 40+7 before starting an induction, although many didn't seem to be allowed to even get that far. It does make you wonder if there's a link over there between the private Antenatal care and early inductions...
- Everyone has a CTG during labour. Boo. Hiss.
- Midwives work on the Neonatal Unit too. Their entry-level course is 4 years rather than our 3 years, but includes neonatal nurse skills. Initially instigated because of a shortage of nurses in the past, I found this fascinating. I feel it can only benefit the quality of Midwifery over there, as they would have more detailed information to give to women around Neonatal care. It also massively increased their skillset. Their Neonatal Unit however was the only one in the country, meaning they were massively over-filled. Occasionally a baby would be transferred to Italy for care, however Mater Dei just had to accommodate for babies as and when they came.
- Breastfeeding is massively promoted, and they have the most wonderful drop in breastfeeding support clinic at the hospital for help up to a year after birth. Women could come and spend all the time they wanted with one of the six midwives that worked there. Women-tailored support, advice and reassurance was there in abundance. It. Was. Wonderful.
- Actions such as catheter removal or drug administration (even those that we have on the Midwives Exemption List in the UK) cannot be administered without the direct instruction of a doctor.
- They have a huge problem with gross varicose veins and obesity amongst the natives on the island, however low molecular weight heparin was rarely given to women postnatally, unlike in the UK. I never heard any statistics around postnatal DVTs, but if they were high it would not surprise me!
Myself and a lovely Student Midwife
Having lunch on a day with a Community Midwife to this view!
