Midwives in Transition

This is the dark stuff, just before the light. Then comes growth.

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Image source: World Health Organization

I don’t think midwives knew quite what we were in for when the World Health Organization declared 2020 the Year of the Nurse and the Midwife.

I, for one, imagined it would be a relatively easy year for midwives in the United States, when we could finally be celebrated and start seeing the policy changes we have been working on for decades. I imagined a nice crescendo to a rising tide for midwives, with unprecedented recent interest in our care models and our contributions to quality, equity, and safety. A time to shift from toolkits and advocacy to action.

I thought we’d be like, “It’s 2020, midwives! Let’s do this!”

Instead, on International Day of the Midwife, we find ourselves at the front line of a global pandemic that has upended everything and exposed and compounded every vulnerability in the system.

The people we care for are terrified and in danger, if not from COVID-19 itself (which does seem to confer excess risk, despite the word on the street), then from the many social determinants and stress-related factors brought on and exacerbated by this pandemic. Massive job loss, inadequate protective equipment for essential workers who are disproportionately women, unstable housing, social isolation, rising domestic violence rates, and reduced healthcare access are a toxic combination for pregnant and postpartum people and growing families.

When you layer on what we know about disparities in COVID-19 burden and in maternal and infant health, outcomes like the recent death of 26 year old Black mother Amber Isaac are maddeningly predictable.

As midwives, we have a front row seat to all of this, and to the rapid unraveling of the system. Our relationship-centered care models are being redesigned around face masks and Zoom calls and drive-by visits. Our practices, increasingly owned by for-profit investors and private equity firms, are facing financial losses they never imagined. Our hospitals are turned into infectious disease wards. Our community birth practices, fielding growing demand for home and birth center birth but chronically under-invested-in and marginalized, are strained to capacity.

To the extent that we ever had a maternity care system in the United States (we didn’t), it has been utterly dismantled and will need to be rebuilt. We all feel a growing understanding that we are on the brink of transformative change and a chance to grow something new.

Being in this dark place is not how we should have to spend International Day of the Midwife. It should be proud Facebook posts, community celebrations, and margaritas. But as we think about what else 2020 has in store, it will be the growth and resilience part, too. The world agrees that the healthiest healthcare systems are the ones where midwifery is the strongest. So let’s grow into that strength and midwife the system.

Midwifing the system. CEO at Primary Maternity Care. www.primarymaternitycare.com

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