A congress just held by the International Confederation of Midwives stressed the importance of educating women so that they are better able to participate in discussions about the management of their care.

Speaking to The Times, three of the Maltese midwives who attended the congress - held in Glasgow earlier this month - said pregnant women should have the necessary knowledge to have a say in decisions about their care.

The congress highlighted the importance of keeping birth as natural as possible, with interventions only taking place when there is a deviation from the norm.

"Pregnancy and birth are natural physiological processes and the midwives and doctors need to realise when there is a deviation from the norm," Midwives Association treasurer Margaret Abela said.

Her colleagues agree. Mary Buttigieg Said, a member of the association's council, pointed out that midwives are the experts of normality in pregnancy and birth while obstetricians are the experts of the abnormal.

"Constant assessment during antenatal care should target a natural birth," she said. Unless problems arise during pregnancy or childbirth, interventions are not necessary.

Abroad, the midwives pointed out, attempts are being made to keep interventions, including Caesarean sections, to a minimum.

Malta has seen an increase in the rate of births through Caesarean sections, with a jump of 16 per cent between 1995 and last year.

Figures from the National Obstetrics Information System show that almost a third of births last year were through Caesarean section - more than double the 15 per cent recommended by the World Health Organisation. Antoniette Formosa, another association member, said the way forward is for pregnant women to have access to midwives throughout their pregnancy.

"It is imperative that the relationship between the mother and the midwife is built throughout the pregnancy.

"It is not the ideal scenario for the woman to meet the midwife who will help her give birth when she is admitted to hospital. There needs to be an ongoing relationship," she said.

Thirteen Maltese midwives took part in the congress - the largest group to attend the triennial congress since Malta became a member of the confederation in 1975. Midwives had the opportunity to visit hospitals to look at the maternity care being given to women.