By Fadila Nur'aini and Yuliya Labko
Pandemics and times of crises such as war significantly impact maternal and child health. Even prior to the COVID-19 pandemic, lessons learned from the Ebola Virus Disease (EVD) epidemic revealed that the poor outcomes such as stillbirth and maternal mortality rates rise. During the EVD epidemic, fewer pregnant women had access to healthcare. Today, as the world battles the COVID-19 pandemic, we have little data on how the virus affects pregnancy and even less on how to approach maternal healthcare while decreasing infection rates. We must address the ability of health systems to provide high-quality routine maternal healthcare.
The COVID-19 pandemic is a moment where every woman who is in her pregnancy may be feeling worried and uncertain. Women fear they may not have adequate support during labour as many hospitals limit visitors to decrease the spread of the virus. Helen Simmons, a 28-year-old film producer from London said in The Guardian Newspaper 2020 “It felt like a 1960s-style birth,” she jokes. “The hardest bit of labour isn’t the pushing. It’s the contractions. And doing that alone … you don’t realise you need your partner so much, emotionally and physically, until you can’t have that person there with you.”
What actually happens to women during this pandemic? Women must cope with navigating an unstable and ever-changing healthcare system. Maternity care across the world is vastly different. Prior to the pandemic, we witnessed countries with integrated team-based care of physicians and midwives, access to safe out of hospital birth, and patient-centered approach to care reap the benefits of positive maternal health outcomes. We must not discount these models of care during times of crisis. Pregnant people need more support now than ever.
The World Health Organization (WHO) recommends all pregnant women, including those with confirmed or suspected COVID-19 infections, have the right to high-quality care before, during and after childbirth. This includes antenatal, newborn, postnatal, intrapartum and mental health care. If a mother has been diagnosed with COVID-19, support should be provided to exclusively breastfeed safely, practice newborn skin-to-skin and share a room with the baby.
All women deserve to experience safe and positive childbirth including being treated with respect and dignity, having a companion of choice present during delivery, clear communication by maternity staff, appropriate pain relief strategies and mobility in labour where possible, and birth position of choice. Caesarean sections should only be performed when medically justified. The mode of birth should be individualized and based on a woman’s preferences alongside obstetric indications.
How do we achieve high-quality care for mothers and families? According to the WHO, 83% of all maternal deaths, stillbirths and newborn deaths could be averted with midwifery care (including family planning), 87% of services can be provided by midwives when educated to international standards, and 56 outcome criteria were found to be improved through midwifery practice and philosophy of care.
Now is the time for midwives to unite and take a stance for women’s rights during the COVID-19 pandemic. Midwife means ‘with woman,’ and we are here to support all women, especially those most significantly impacted by this crisis in the marginalized communities across the globe. Women are disproportionately affected by COVID-19 in regards to exposure and economic hardship.
The WHO designated 2020 the Year of the Nurse and Midwife; both governmental and nongovernmental agencies need to support midwifery-led care to help the start future healthy generations one family at a time. Policymakers and providers must balance the safety of frontline workers and communities without compromising the high-quality care mothers deserve.
- Strengthening quality midwifery education for Universal Health Coverage 2030: framework for action. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
- Zaigham, Mehreen and Andersson, Ola. 'Maternal and perinatal outcomes with COVID-19': A systematic review of 108 pregnancies. John Wiley & Sons Ltd 2020. doi:10.1111/aogs.13867
- Jones SA, Gopalakrishnan S, Ameh CA, et al. ‘Women and babies are dying but not of Ebola’: the effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone. BMJ Global Health 2016;1: e000065. doi:10.1136/ bmjgh-2016-000065
Yuliya is a nurse-midwife in the US. She is an active member of the American College of Nurse-Midwives, volunteers with March for Moms, and is a One Young World 2019 Johnson & Johnson Scholar.
Fadila "Dila" Nur'aini
Dila is a registered midwife in Indonesia. She is a Maternal and Child Health Coordinator at doctorSHARE, as well as a health trainer at the 1000 days fund. She is also the co-founder of Naluri Lahir Center.