Midwives are Essential: Including midwifery in pandemic planning
Overheard during a recent zoom staff meeting, “It only took a global pandemic for this to finally happen…” We rolled our eyes, laughed off decades of being overlooked and immediately returned to our task of figuring out how to safely care for the hundreds of pregnant patients at our community health center — both in our hospital as well as our freestanding birth center. Due to predicted staffing shortages throughout the hospital and the increased demand for doctors to staff other units, we had just been informed that my team of Certified Nurse Midwives would now be covering labor and delivery shifts for our family medicine physicians. Over half to be exact. Until “this” is over.
As our health care system is being tested to its limits, the spread of COVID-19 places a unique stress on one of the top reasons for hospitalization in the U.S. — labor and delivery. Not only are patients getting sick, maternity care providers are also falling ill, and hospitals are becoming overwhelmed and short on supplies, staff and space.
In a recent statement, the American College of Obstetrics and Gynecology (ACOG) encouraged its members to forge even more collaborations with midwives to bolster the nation’s ability to care for its pregnant and birthing people. The governor of New York issued an executive order to temporarily allow midwives from any state to work in New York (something that usually takes several months of licensing procedures). Twenty-one states have lifted some of their restrictions on Advanced Practice Nurses, including Certified Nurse Midwives, granting them expanded practice authority in order to increase patients’ access to care. Other states are encouraged to follow suit.
While the vast majority of America’s midwives practice in hospital settings, hospital-based midwives aren’t the only ones being asked to go above and beyond. Midwives who attend births out of hospitals in birth centers and homes are also being flooded with calls and inquiries from pregnant people who are nearing their due dates, reconsidering whether they want to expose themselves and their healthy newborns to a hospital environment. Given the current state of public health, it’s a reasonable concern. While giving birth outside of a hospital may sound foreign to the majority of Americans, there are thousands of midwives who are literally trained to attend such births. Now is the time to utilize their expertise.
To be sure, physicians and their professional organizations have long expressed concern that giving birth outside of a hospital is universally a step backwards in terms of safety. This is understandable, as medical training and policymaking involves little to no actual experience in this area of health care nor of the clinical process midwives have of determining who is appropriate to give birth at home or a birth center and who would indeed be best cared for in a hospital setting and thus transferred to one (hint: there is a substantial difference). Yet even when adjusted for various risk factors, research has consistently shown that midwife-led models of care produce equal or better outcomes when compared to the physician-dominated model under which America currently operates. Furthermore, evidence shows birth at home or a birth center with a trained and experienced health care provider, with access to consultation as needed and smooth transfer to a hospital if necessary, is safe for low risk pregnancies. Planned, properly screened, properly attended and well-integrated community-based birth is categorically different than unplanned, improperly screened and unattended community-based birth. This crucial distinction needs to be made and reckoned with, especially when analyzing risk factors present in our current public health state.
If health departments, hospitals and community health centers are serious about creating a safety net for pregnant and birthing people in the coming weeks, they should all be actively including and collaborating with midwives in any and all proposed public health strategies. Several professional midwifery organizations on national, state and local levels have already prepared their members for collaborating during the current pandemic. Whether working in hospitals, birth centers or homes, midwives are ready.
In a system that has historically marginalized what midwives have to offer our nation’s maternity care system, we accept this sudden acknowledgment of what we can and do contribute. But we’ve been here all along. Midwives are not new age. We are not even new, as the profession of midwifery is centuries older than that of medicine. We are not something extra but rather are experts in maternal and infant health, and we have a long history of fiercely working to protect birthing people and their infants. We improve outcomes. We know the system. We know the communities we serve. We profoundly know pregnancy, labor and birth. We always have. Now is no different.
Before COVID-19 arrived, the World Health Organization had already declared 2020 the Year of the Nurse and the Midwife. This is not what we had in mind, but we’ll take it.
