I’ve worn many hats over the last several decades. One of the greatest, most awe-inspiring, was that of midwife. I’ve attended more than 1,000 births, in a variety of roles, including Registered Nurse, doula and midwife. Women laboring to bring their babies into this world never fail to inspire me.
Monday, May 5, is International Day of the Midwife. This year’s theme, chosen by the International Confederation of Midwives, is “Midwives: Critical in Every Crisis.” According to the latest United Nations estimates, the 37 countries affected by conflict or institutional and social fragility account for 61% of maternal deaths globally, despite representing only 25% of the live births.
Midwives are often first responders in local crises and deal with sometimes incredibly harsh situations. Neha Mankani, midwife and founder of the Mama Baby Fund, worked on the frontlines of the devastating 2021 floods in Pakistan. “Some women gave birth in the water,” she recalled in a short documentary. “We saw fungal infections. We saw maternal deaths. The sheer amount of tragedy is something you couldn’t understand until you were there, on the ground.”
In the Rohingya refugee camps in Bangladesh, a place I’ve been several times, approximately 400 midwives care for the women of the camps that house over a million people. A midwife in the camps explained in a recent video how midwives worked to gain acceptance in the very conservative Rohingya community, including respecting their religious preferences to remain veiled. Their goal is to decrease maternal and infant mortality, a rate that is significantly higher than that of Myanmar, the home country for the refugees, or Bangladesh, the host country.
Not just developing countries
While the majority of maternal deaths occur outside of the United States, the maternal mortality rate here has continued to stay elevated, especially compared to other technologically developed countries. From 2020-2021, the maternal mortality rate increased more than 40% from 2019, but the country did see decreases in 2022 and 2023. The rates decreased significantly for white women and Hispanic women, but did not change significantly for Asian or Black women. According to the CDC, for white women in the United States, there is a mortality rate of 14.5 per 100,000 live births, but it‘s 50.3 per 100,000 for Black women.
The Commonwealth Fund, an independent research organization focusing on improving healthcare, released a report in 2023 that said “midwives, integrated fully into U.S. maternity care, could help reduce perinatal health disparities and address provider workforce shortages.”
In many countries, including high-income nations such as Canada and the U.K., midwives are key providers of reproductive health care for women. A recent study found that a midwife workforce, integrated into health care delivery, could provide 80% of essential maternal care around the world and potentially avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths.
Midwives like Jennie Joseph, who is a Black midwife practicing out of Florida and was a Time magazine Woman of the Year in 2022, focus on immediate, practical and evidence-based solutions to improve the health and wellbeing of mothers and babies. Joseph says she wants to fix the Black maternal mortality crisis one midwife at a time. In 2020, she became the first Black person in the U.S. to privately own a nationally accredited midwifery school.
Utah also has a midwifery school for direct-entry midwives, as well as training for nurses to become Certified Nurse-Midwives. Midwives who deliver in homes and birth centers are, by and large, direct-entry midwives, often with the credential of “Certified Professional Midwife” (CPM). The Midwives College of Utah, like Jennie Joseph’s, is a private, accredited school, training direct-entry midwives. Certified Nurse-Midwives, the most common type of midwife in the U.S., are trained nurses who go on for further training. In Utah, they are the only type of midwives that can deliver in a hospital.
The politics of midwifery
It was midwifery that drew me into politics, nearly 25 years ago. While I had a license as a Registered Nurse and had worked in Labor and Delivery, when I decided to become a midwife, I chose the direct-entry midwife path. I became a CPM and then, through a series of events that showed the midwifery community that we were not, in fact, legally allowed to practice, I and others began a foray into changing Utah law. The Direct-Entry Midwife Practice Act passed and was signed into law 20 years ago.
In the U.S. today, 34 states license CPMs. Thirteen offer no licensure, with resulting ambiguity on the legal status of midwives. In seven additional states, home birth midwifery is illegal. In a country that continues to lose mothers at a higher rate than the rest of the high-income, high-tech countries, and that continues to have maternal health care deserts, that‘s a shame.
So, on this International Day of the Midwife, I say to my fellow midwives, birth workers and families we serve, thank you. I see you, I honor you and even though I am now retired, I consider myself one of you.
Originally published in the Deseret News
