A midwife–especially a Black midwife–can tilt the balance between life and death for African American infants and their mothers. Regardless of income and education level, childbirth for Black women is more dangerous than it is for White women. Even Serena Williams had a dangerous close call during her pregnancy, after doctors failed to heed her request for a CT scan and blood thinner medicine. Despite her history of blot clots, it was posited that “Williams’ pain medication must be making her confused.”
The Centers for Disease Control reports
that African American mothers die at three to four times the rate of White
women, and the mortality rate of Black infants is higher than that of any other
ethnic group in the US. Why? As AmericanProgress.org states in a 2019
policy blueprint, “Racism is part and parcel of being black in the United
States, and it compromises the health of African American women and their
infants… Put simply, structural racism compromises health.” According to Dr
David Williams, a pioneer in measuring the effects of racism on health, “We now
know that discrimination is linked to higher blood pressure, to high levels of
inflammation, to low infant birth weight…”
Enter the Midwife
One action that promises to change these dire
statistics is expansion of the midwifery movement, especially within the
African American community. Angela
Doyinsola Aina, interim director of the Black
Mamas Matter Alliance (BMMA) recently told an American Public Health
Association (APHA) conference, “We have to go beyond just talking about giving
people, especially low-income people, access to care…. We also need to ask
whether that care is high quality and culturally relevant.”
Where do Black midwives come into the picture? ProPublica
notes in a report
on how increasing the role of midwifery in the US could reduce maternal
complications and mother/infant mortality rates, “Many… [US] states
characterized by poor health outcomes and hostility to midwives also have large black populations, raising
the possibility that greater use of midwives could reduce racial disparities in
maternity care.” And Lamaze.org
suggests, “When Black families are cared for by Black health professionals,
like midwives, they are better heard, seen, respected, understood, and get
their needs met, which relates directly to health outcomes.”
One of the women at the forefront of the Black Midwives
movement is Jennie Joseph, founder of the Birth
Place in Winter Garden, FL. Joseph’s work as a provider of perinatal
services to underserved and uninsured women of color has already brought about
positive change in the CDC numbers. Trained in the UK, where half of all babies
are delivered by midwives, Jennie Joseph arrived in the US to find that in the
most affluent country in the world, owing to concerted opposition from doctors
and hospitals, midwives attend only 10% of all births. She also found that the
US has a much higher incidence of maternal and infant mortality
rates—particularly among minorities and the disenfranchised—than in countries
such as Canada, Sweden, and the UK, where midwives attend the majority of
Joseph’s “open access” clinic at the Birth Place provides pre-natal
and post-partum care for women regardless of their ability to pay and focuses
on minority and underserved women in the area. As Miriam Zoila Perez marveled
in the New
York Times, the Birth Place manages to beat the dire maternity figures for
women of color: “When you look into her statistics, you find something quite
rare: Almost all of her patients give birth to healthy, full-term babies… maybe
not surprising until you learn that the majority of them are low-income
African-Americans, Haitians and Latinas….”
Expanding the Midwives’ Movement
Another pioneering Black midwife is Shafia Monroe, who has long been one of
the major forces behind the Black midwives’ movement. Founder of the
International Center for Traditional Childbearing (which was re-formed in 2018
as the National Association to Advance Black Birth) and winner of a Lifetime
Achievement Award from the Human Rights in Childbirth Foundation, Monroe
started working with mothers and infants as a nurse’s aide in the postpartum
ward at Boston City Hospital at the age of 17. It was in 1991, when she
encountered difficulties in finding a midwife of color for her own pregnancy, that
Monroe founded her influential International Center for Traditional
Childbearing. Under the auspices of the ICTC, she became a pioneering figure in
the cause of Black midwifery. Monroe has worked tirelessly to reduce
mortalities linked to pregnancy and to increase the number of Black midwives
and doulas. To women who are interested in becoming midwives, Moore urges, “Join
an organization! There’s MANA (Midwives Alliance
of North America), ICTC, ACNM (American College of Nurse Midwives);
there’s so many organizations. Look into organizations that are familiar with
black reproductive issues, and our history.”
As the co-director of Black Mamas Matter Alliance (BMMA), Elizabeth Dawes Gay, says, “If even one more person just says they want to take up the cause, they want to become a doula, they want to become a midwife, they want to start an organization—to me that’s a success.”
A History of Midwifery in the United States: the Midwife Said Fear Not
Written by two prominent leaders in the field of midwifery, this book spans the historical evolution of midwives as respected, autonomous health care workers, and discusses the strengths, weaknesses, threats, and opportunities for midwifery in the US. Featuring a range of photos and illustrations, and engaging stories filled with cultural and spiritual content, this book is a must-have resource on the history of midwifery and women.
As I said in my previous blog entitled “The Joy of Working with Pediatric and Neonatal Nurses,” when I took care of critically ill newborn infants and children, young adults for about 30 years, I relied on the nurses I had the privilege of working with in the infant special care unit, the pediatric floor, the emergency department, and in the intensive care unit. These nurses are truly on the front lines and are first responders for these patients and their families, just as paramedics, EMTs, and battlefield paramedics are on the front lines!
Wherever I was, including when we were transporting these infants and children, I listened critically and thoughtfully to everything they told me about the patients we cared for. When they were worried and concerned, it was important that I also worried. I can literally give you hundreds of anecdotes of clinical situations, including instances in the delivery room with newly born critically ill infants when the nurse and I worked together to stabilize the baby with clinical issues ranging from being born at 24 weeks gestation with respiratory distress to a term newborn with undiagnosed probable Down syndrome.
In the ED, we had a well tanned 19-year-old male who presented in cardiac arrest one winter evening and a young girl with fever and purpuric lesions who presented in shock with meningococcemia.
On the pediatric floor, the nurse called me when her infant patient was having apneic episodes with oxygen desaturation with an RSV infection.
In the intensive care unit, there was a young girl with malignant cerebral edema after head trauma. Her nurse and I stayed by her bedside all day and night as we needed to manage her increased intracranial pressure. Thanks to our team, she survived and is now living a normal life.
In each of these clinical situations, I relied on the nurses I worked with who were almost literally on the front lines! I also worked with my wife, Sally, at Children’s Memorial Hospital, when I was a senior resident in 1979 when I covered our patients on our service. She worked on the front lines with a number of critically ill children and came up with some instrumental clinical observations and interventions that helped us in the care of these patients. She and her colleagues in the infusion area at what is now Ann and Robert H. Lurie Children’s Hospital of Chicago are on the front lines caring for children with cancer, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and numerous other chronic illnesses. They do clinical assessments in addition to providing intravenous access for chemotherapy, infusion of biologics, and enzyme infusions for these sometimes critically ill patients. They work with nurse practitioners to care for these children.
I hope everyone has a sense for what these nurses do on the front lines and how instrumental they are in the care of these children and their families.
Early in 2019, the World Health Organization (WHO) announced that 2020 would be the Year of the Nurse and Midwife. WHO is planning lots of programming and reporting around the year to celebrate nurses and support the profession. Here are six reasons why 2020 is the perfect time for the Year of the Nurse.
1. It’s the 200th anniversary of Florence Nightingale.
Florence Nightingale was born on May 12, 1820,
making 2020 the 200th year anniversary of her birth. The “Lady with the Lamp”
became the founder of modern nursing and the first woman to receive the Order
of Merit. During the Crimean War, Nightingale was put in charge of nursing
British and allied soldiers in Turkey. Her time in the wards, especially her
night rounds, earned her the nickname “Lady with the Lamp” and helped her begin
to formalize nursing education. She went on to found the first scientifically
based nursing school—the Nightingale School of Nursing at St. Thomas’ Hospital
in London—in 1860. She also helped institute training for midwives and nurses
working in workhouse infirmaries. Nightingale continues to inspire nurses all
over the world with her legacy of dedication and innovation. While
International Nurses Day commemorates her birthday every year on May 12, the
2020 celebrations will take place year-round and further champion nurses’ work.
2.It’s the release of the first State of the World’s Nursing Report.
In conjunction with the Year of the Nurse, WHO will be releasing its first-ever wh prior to the 73rd World Health Assembly in May 2020. According to WHO, “The report will describe the nursing workforce in WHO Member States, providing an assessment of ‘fitness for purpose’ relative to GPW13 targets.” GPW13 refers to the Thirteenth General Programme of Work 2019−2023, which lays out WHO’s leadership priorities in five-year blocks. Some of WHO’s 2023 goals include reducing the global maternal mortality ratio by 30% and reducing malaria case incidences by 50%. WHO will also be a partner on the State of the World’s Midwifery 2020 Report, which will be launched around the same time as the State of the World’s Nursing Report.
3. It’s the culmination of the Nursing Now campaign.
The three-year Nursing Now global campaign launched in 2018 and will wrap up at the end of 2020. Nursing Now is a collaboration between the World Health Organization and the International Council of Nurses and is championed by Kate Middleton, Duchess of Cambridge. Nursing Now focuses on five core areas: ensuring that nurses and midwives have a more prominent voice in health policy-making; encouraging greater investment in the nursing workforce; recruiting more nurses into leadership positions; conducting research that helps determine where nurses can have the greatest impact; and sharing of best nursing practices. Nurses can support Nursing Now by signing its support pledge, sharing about the campaign on social media, hosting events, sharing their experiences with other nurses, and organizing to advocate for the nursing profession. You can also start or join a Nursing Now group in your local or regional area. There are currently groups in more than 100 countries worldwide.
4.Nurses make up a majority of the worldwide healthcare force.
While doctors get much of the attention, especially in Western nations, nurses and midwives make up more than 50% of the health workforce in many countries. Nurses armed with clinical supplies are usually the front line of care and, in some cases, may be the only provider in the area, especially in developing countries. They make a difference not just in individual patients’ lives but also in the community as a whole. Due to their sheer numbers and the locations where they often work, nurses are vital players in improving public health outcomes around the world.
5.Nurses are a huge part of the health care worker shortfall.
Due to the major role they play in the worldwide healthcare workforce, nurses and midwives also make up a significant part of the nursing shortage–more than 50% of the shortfall in the global health workforce to 2030. Looking at just the U.S., the Bureau of Labor Statistics (BLS) predicts that employment of registered nurses is projected to grow 12% from 2018 to 2028, much faster than the average for all occupations. BLS also predicts that the U.S. will need an additional 200,000+ nurses per year from now until 2026, adding up to more than one million additional nurses. And that’s just one country that already had a health care infrastructure that’s significantly more developed than some others.
6. Supporting nurses boosts economic growth and gender equality.
As part of Nursing Now and its other efforts to support nurses, WHO often speaks of the “Triple Impact” that comes from giving nurses what they need: better health, stronger economies, and greater gender equality. While the first outcome is more obvious, the second ones are equally important. While men can and do become nurses, worldwide the vast majority of nurses are women. Becoming a nurse opens up opportunities for women, giving them the chance to receive formal education, enroll in training programs, secure a license, and finally get a job and its accompanying income. This improves overall economic growth and also increases gender equality in the workforce.
Nurses should already be
proud of themselves when they don
their scrubs for a shift, but in 2020, they’ll do so with the extra
confidence of knowing that it’s the Year of the Nurse and that organizations
all over the world are supporting their profession.
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