Corona Daily 409: The Year of the Midwives

In May 2019, when WHO decided to declare 2020 as the “Year of the Nurse and the Midwife”, it had no idea how fortuitous the choice was. (The decision was based on the 200th birth anniversary of Florence Nightingale).

Since March, midwives are in great demand everywhere. Many pregnant women are terrified of delivering in a hospital. Women in the second and third trimesters are seeking alternative birth options.

In this matter, developed countries may be backward. Between 2000 and 2017, the maternal mortality rate has become worse only in 13 countries of the world. United States of America is one among them, in the civilized company of countries like Syria and Venezuela. Sweden has a 300-year tradition of professional midwifery. India has over two million qualified nurse-midwives and another million diploma midwives. The world is still short of 9 million midwives.

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Currently, the fear is mutual. Pregnant women are worried they may catch the virus in the hospital. The midwife is worried the pregnant woman may transmit the virus to her. During childbirth, social distancing is not possible. In New York City, one out of seven women admitted for delivery tested positive. Most were asymptomatic. Still, they reported a feeling of being shunned by the hospital staff. Their babies were taken away from them at birth, and given back a few days later. Some midwives offered help only through Facetime or Zoom. Initially, the expectant partner was not allowed in the room. Later, Governor Cuomo issued an order allowing the partner or any uninfected substitute.

The pandemic has reshaped the delivery process. Women in labour pain wearing masks, being looked after by midwives in protective gear is a bizarre if not a grotesque experience.

In parts of Scotland, home births were banned, but can now resume from 29 June. A woman wanting to deliver at home must sign an agreement promising a series of safeguards for the attending midwife. If the house has two toilets, one must be reserved exclusively for the midwife. (About toilets and virus, tomorrow).

Netherlands is more civilized. In the last two months, births were allowed to happen in empty hotels where midwives could get enough space to feel safe.

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WHO says safe and effective midwifery can prevent 83% of maternal deaths, stillbirths and newborn deaths. Experienced midwives can handle most low-risk women through labour, leaving only the most complicated cases to obstetricians. Even a non-professional midwife (called doula) is a great comfort for the pregnant woman.  

The medical profession, however, is commercial in many places. Modern doctors are trained to advise medical intervention every time. A C-section has become fashionable. In the USA, 35% of deliveries are C-section. WHO thinks the rate should be between 10% and 15%.

Caesarian is a major surgery that increases the risk of infection, hemorrhage and blood clotting. That risk has to be weighed against the risk of delivering at home.

Birth, a fundamentally natural process, may go back to become natural. A sustained trend of natural birthing will be a great positive contribution of the pandemic.

Ravi