The Impact of Coronavirus on Community Birth

The Impact of Coronavirus on Community Birth

 

By now, most if not all of us, have heard of coronavirus. Regardless of which media outlet, news of the coronavirus outbreak has spread faster than the virus itself. Named COVID-19 by the World Health Organization in late January 2020, the disease is being considered an “emergency of international concern”. As it spreads across borders, warnings from federal and state agencies are showing up in my inbox with advice to plan for the “eventuality of community spread”.

While thinking I’d much rather spend my time planning how to spread community midwifery, I realized how the two – virus and midwifery - may impact each other. In a true epidemic/pandemic, we can expect medical facilities to be pushed past their capacities as they care for those stricken by the disease, especially those who need intensive care. Hospitals will become epicenters of virus habitat, their beds full, and their staff overworked. The already low resources of the maternity care units will be stretched even further making the hospital birth setting riskier and not just in terms of contagion. It only makes sense for out of hospital birth to become the safer choice for the majority of people in a crisis like this.

I began thinking of my West Virginia friend Ruth Walsh (former MANA board member and original chair of NARM) and her involvement in some of the emergency preparedness meetings that were held after 9-11-2001. From what she was seeing then, no one was thinking realistically about the needs of pregnant people except for including them in lists of people with “special needs” such as the elderly, children, and disabled. The only plans for laboring people assumed access to basic needs and supplies as well as the expectation that any in-place birth would be followed by transporting to a medical facility.

Like anyone who has lived through a natural disaster, I know that such plans might look good on paper, but not really be feasible. Evacuations, road blockages, power outages, and emergency services overload are just some of the problems that create barriers to access and increase the need for collaboration among community members. There’s something about these disasters that often result in a community working together to use its resources to survive and recover. It’s easy to see how the presence of a community midwife, supported by community families who have experienced community birth, becomes one of those essential community resources in these situations.

An epidemic/pandemic provides even more challenge. Now, the best way for people to protect themselves and others is stay home and out of public places, making quarantine an important strategy to limit exposure. Is our best advice to pregnant/laboring people to travel out into the public, to a hospital full of those very people they need to stay away from? With medical facilities full of the sick and those caring for the sick, the benefits of staying home for physiologic childbirth and successful lactation become even more obvious.

Again, the presence of a midwife in each community or neighborhood could certainly be one of the containment strategies in the event of this level of disease. One midwife – an assistant would be nice – using hygiene precautions and serving her neighborhood or community as needed. Simple. Unfortunately, also not currently possible because we don’t have enough midwives, especially midwives who are trained to be comfortable in the low tech setting of home birth.

Try to imagine, then, that long before any emergency occurred, maybe back after 9-11-01, someone like my far-thinking friend Ruth, had developed a straightforward training program aimed at helping the “lay” public understand what to do should they find themselves in a situation like a disaster, be it natural, man-made or a disease-crisis, and someone who is in late pregnancy or labor/birth needs their assistance. Think of it like a Girl Scout badge approach to understanding physiologic birth by knowing how not to disturb normal but rather how to support it through privacy, hydration and nutrition support, confidence, and the importance of the person who is giving birth being in charge. Entry level physiologic birth taught as emergency preparedness to every church group, scout troop, school health class, civic club, you name it. Imagine what that might do to the birth culture in the meantime…

But, I digress. For now, we don’t know what will happen with this new virus, but if we believe that history repeats itself, we can expect an epidemic/pandemic sooner or later. While also wondering when and where the next natural or man-made disaster will be, it is important for us to realize the essential place of the work of midwives in communities. I have always believed that midwifery is a survival skill and life continues to confirm that belief. We can’t afford to be complacent or to let midwives continue to struggle to sustain their practices.

Through MANA’s many phases, the power of the organization has always been and will always be grassroots. The need for that power to work “on the ground” with the midwives as we move into an uncertain future is obvious. Because what isn’t uncertain is that a thriving midwifery profession is essential to community health and that not only can midwifes make a difference now, but may well be one of the most important elements to make a difference in the future. It’s going to take all of us to be ready.

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