Revealing the Faults in Our Care

Posted by Katie Moriarty on April 20, 2020
Spoiler Alert: This post discusses events in Season 9 Episode 4.
Ctm s9 04 002 katie blog
“The Heavens don’t always protect us. They choose on occasions to throw down challenges - instead of just showering more blessings on our heads. Not every tempest passes in an instant. Not every deluge can be brushed off. We can cower. We can wait for blue skies to be restored… or we can take the plunge, defy the elements, ….and we can seize the day..”

As a Modern Day midwife what I took away from this episode was the feeling of fear with changing times. I felt concern from the nuns and the midwives with issues that they were facing. The issues that jumped out to me as they are still relevant as a Modern Day Midwife in 2020 were: the changing dynamic of where to give birth (hospital versus community) and the varying options that this entails; along with varying midwifery or medical models of care. Sister Julienne stated “times are changing and if we don’t change with them – we will become obsolete.” When they framed it as “an exciting opportunity to help shape their (the doctors) training”—I must admit I thought of things within the context of birth in the United States. In England and other developed countries the midwifery model of care is as common as obstetrical care for low risk women; however, in the US midwives only attend approximately 8% of women giving birth. Power and control can at times be at the center of many decisions. Childbirth is the leading reason for hospitalizations in the United States and over 32% of women have major abdominal surgery with a Caesarian Section as their route of birth. We are the only industrialized country where our maternal morbidity and mortality is increasing. And inequities shed a light on many of our shortcomings.

We need to support women’s choice for provider, place of birth, and a myriad of decisions that go into how patients/ consumers/ birthing families face their healthcare, pregnancy, labor, along with the support of normal in the birthing process. However, in the U.S. midwives cannot practice to the full extent of their education and training in most parts of this country.

In the midst of COVID-19, I found a fabulous article that was just published in the Journal of Global Health Science entitled “Where do women birth during a pandemic? Changing perspectives on Safe Motherhood during the COVID-19 pandemic.” I put the citation at the bottom if you want to read the article as it is an open access article.

The authors pose a question and ask if hospitals (that are for the sick) are the appropriate birthing facilities for healthy low risk women during a pandemic? It acknowledges that specialized hospital care during childbirth in the face of obstetric complications can be lifesaving. It also acknowledges that COVID-19 symptomatic women also need specialized hospital care. However, this article examines or proposes expanding the use of midwifery units both alongside the obstetric unit and to utilize freestanding (in the community) facilities. They suggest that pop-up units can be created quickly. We have developed the needed field hospitals to take care of the COVID-19 clients and they suggest thinking of implementing something like this: pop-up maternity units. We need strategies to optimize working together to prevent the spread of COVID-19 and to protect our birthing families. Yes, we would need strong collaborations and integration between nurses, midwives, obstetricians, and neonatologists. They discuss coordination within the spectrum of primary care and acute care services. It shines a light that these things need to be strengthened in this country and within our maternity care system. They outline recommendations on how to address issues. We need to increase integrated out-of-hospital birthing facilities and enhance policy initiatives, strategic action plans, and coordination to ensure safety. The article states we have an ethical duty to ensure women’s human rights are respected during this period of crisis while being evidence based.

This is an unprecedented time but I have been impressed with how quickly organizations have come out and pulled together to face this crisis. I have faith, belief, and hope that we will face the challenges ahead of us.

“Sometimes our lives overlap with others only briefly. We share troubles, or laughter, or learning and move on. Afterwards all we will hold in common is the memory. The chapter passes like a storm or sunshine or an ordinary day; but, the heavens always send us something new …. a chance, a lease of life, a soulmate or a friend. And the best, like love itself, fly back to us …. in us they make a home.”

Reference

Rocca-Ihenacho L, Alonso C. Where do women birth during a pandemic? Changing perspectives on Safe Motherhood during the COVID-19 pandemic. J Glob Health Sci. 2020 Jan;2:e4. 

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About the Author

Katie Moriarty, PhD, CNM, CAFCI, FACNM, RN is a professor on faculty at Frontier Nursing University and a Certified Nurse-Midwife with WSUPG CNM Service at Hutzel Women’s Hospital in Detroit, Michigan. Katie serves on the Board of Directors for the American College of Nurse-Midwives as the Region IV Representative. Previously she was the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.