Sarah Bar-Zeev and Petra ten Hoope-Bender of UNFPA discuss how midwives play a crucial role in ensuring a positive pregnancy experience for all women while the pandemic continues
Nobody told the 140 million babies that will be born this year that there’s a global pandemic – they’re coming into the world regardless. Nurses and midwives have more than risen to the challenge since the crisis began, showing their highly-developed professional knowledge and skills, breadth of experience, and natural warmth as invaluable during a difficult time for everyone.
The physical and mental health and wellbeing of pregnant women and their babies is always of paramount importance. Access to quality maternal health care ensures this, but the coronavirus pandemic has disrupted all aspects of healthcare.
Petra ten Hoope-Bender is a Technical Advisor on Sexual and Reproductive Health at the United Nations Population Fund (UNFPA) Geneva Office and Former Secretary General of the International Confederation of Midwives (ICM), while Sarah Bar-Zeev is a Midwifery Technical Specialist in the Sexual and Reproductive Health Branch at the UNFPA New York Headquarters.
They spoke to Safe Motherhood Week about how their thoughts on how the pandemic could transform sexual and reproductive care – for better or worse. A topic close to both their hearts is the positive pregnancy experience, and as midwives, they have strong opinions on what that means for every expectant mother and how midwives can enable this.
Ten Hoope-Bender acknowledged that Covid-19 has caused the tectonic plates to shift in maternal healthcare; what remains after the initial disruption will have positive and negative elements.
“In terms of the thinking around the pandemic and how it transforms reproductive care, it can be for better or for worse,” she mused.
“There are changes that are happening in the system that are helping women to determine and choose their care. That would be an advancement, people having more control and being more informed about the kind of care they would like to receive.”
This concept of the woman being in control of her care aligns with the core principles of midwifery care, noted ten Hoope-Bender.
“In principle, pregnancy and childbirth are normal events and we accompany those to keep them normal, rather than us intervening because there’s something that could go wrong – it’s about maintaining health rather than trying to cure something.”
The changes to routine care include mobile clinics and counselling, an increased use of telehealth and technology, as well as remote prescribing and monitoring, as hospitals and clinics endeavour to keep “well” people at home and away from a potentially risky Covid environment.
“Those changes in how health systems deal with pregnancy and childbirth during something like a Covid pandemic is really an opportunity to revisit some of the ways that health systems work,” said ten Hoope-Bender.
“As a Dutch midwife we are used to home births. Of course we work very closely with obstetricians/gynaecologists, but in principle we start from the basis of it being a normal pregnancy which doesn’t need constant hospital care. The Covid pandemic offers an opportunity to strengthen this approach,” she stated.
“Telemedicine is a way to maintain and nurture the connection between midwife and pregnant woman without having to enter a health facility which in this Covid time could be the wrong place to be. Those are good transformations and many midwifery practices are changing their ways of working and finding it very pleasant, while women are also much appreciating it.
“You can have shorter but more interactions with your care provider – perhaps at the start you might only be seen once in hospital but that’s actually the time when you need more support because you have more questions.”
Bar-Zeev echoed this, explaining that it is still too early to say how the rapidly-evolving pandemic could transform reproductive care in the long-term but she also feels the crisis has opened up new ways of working, with more community-based care being provided and she also welcomes the advent of telehealth as an effective and convenient mode of care. The UNFPA Asia and Pacific Regional Office will carry out an evaluation across South-East Asia to look at the impact of telehealth used for antenatal and postnatal care “because in many of these places it’s never been done before”, she explained.
“But we are still seeing the fallout of the pandemic on girls and women, as well as midwives,” she said, noting that for many it has had a negative impact. Worryingly, in some jurisdictions maternity services are being reduced, while some are closing completely.
“In many countries we are seeing midwives redeployed away from their primary work of caring for girls and women. Some maternity facilities have been repurposed for general Covid care and that’s a massive concern – we are hearing reports of women turning up to have their baby and where they expected to give birth is no longer available. We are unsure if things will remain this way or whether these facilities will go back to their intended purpose of providing maternity care,” she adds.
Meanwhile, general concern around the virus is affecting women on a personal level.
“We know in some cases women are fearful to access services because of the stigma around Covid and and fear of the consequences for themselves and their baby,” said Bar-Zeev.
Both midwives agree, however, that the crisis has also highlighted the commitment of their profession to providing care to pregnant women; stories have emerged of midwives providing care out of the back of cars, empty churches and schools. The flexibility and adaptability of midwifery as an essential service has been proven the world over.
“Midwifery is more essential than ever,” says ten Hoope-Bender. The designation of 2020 as the Year of the Nurse and Midwife is an attempt to offer recognition for the “massive” amount of work that midwives and nurses do every day, she adds.
Bar-Zeev agrees, saying what the pandemic has done is simply highlight the chronic underinvestment in midwifery over the years. “It has exposed that. Midwives play a critical role from the pre-pregnancy period right through to those early weeks after birth.”
Despite the current crisis and complete recalibration of care it has necessitated, midwives around the world are still working hard to ensure that expectant mothers have as positive a pregnancy experience as possible. According to Bar-Zeev, pandemic or no pandemic, this should still be possible.
“A positive pregnancy experience is one where women are put at the centre of their care and are fully empowered to participate in decision-making around their care,” she says. “ Midwives and other healthcare professionals work hard to improve women’s experience which is critical for the women, their newborns and their families.”
Ten Hoope-Bender cites the “Every Woman, Every Child” Global Strategy, which is based around the principles of “survive, thrive, transform”.
“To me, the positive experience really contributes to the ‘transform’ piece. It transforms women from careseekers and care receivers into directors and drivers of their care,” she says.
“That autonomy changes women forever – I see them grasping it and saying this is my life, I can do this. As women tend to do, they share that with their family and the community around them and in their work. That’s what I think midwifery care can give women and their communities.”