Optimizing the Role of Midwives in Early Pregnancy Risk Detection: Implications for Maternal Mortality Reduction

Abstract

Maternal mortality remains a major public health challenge in Indonesia, with pregnancy-related complications often resulting from delayed identification of maternal risk factors and inadequate access to timely healthcare. Midwives play a critical role in maternal health services through early pregnancy risk detection, which enables prompt intervention and appropriate referral to prevent adverse maternal outcomes. This study aimed to synthesize the available evidence regarding the role of midwives in the early detection of pregnancy risks as a strategy to reduce maternal mortality in Indonesia. A Systematic Literature Review (SLR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Literature was searched through Google Scholar using predefined keywords related to midwives, pregnancy risk detection, antenatal care, maternal mortality, continuity of care, community health workers, and the Poedji Rochjati Score Card. Articles published between 2022 and 2025 were screened according to predetermined inclusion and exclusion criteria, and their methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Thirteen eligible studies were included in the final synthesis and analyzed using a descriptive-comparative approach. The review demonstrated that midwives play a pivotal role in pregnancy risk screening, early identification of obstetric complications, health education, antenatal support, community health worker empowerment, family involvement, and continuity of midwifery care. Capacity-building programs improved midwives' competencies in recognizing high-risk pregnancies, particularly preeclampsia, while systematic screening and continuous antenatal care enhanced timely referral and complication management. Family participation and community engagement further strengthened the effectiveness of early pregnancy risk detection. Optimizing the role of midwives through competency development, comprehensive antenatal care, collaborative community-based interventions, and strengthened referral systems can substantially improve maternal health services and contribute to reducing maternal mortality in Indonesia.