Midwives
in
a
pandemic:
A
call
for
solidarity
and
compassion
In March 2020, the World Health Organization (WHO) announced,thespreadoftheNovelCoronavirus(COVID-19)asa pandemic.Thevirusisnowaffectingmorethan155countriesand territories worldwide – and growing. According toa report on lessonslearnedfromtheCOVID-19outbreakinChina,publishedin JAMA,1716of44672(3.8%)healthcarepersonnelwereinfectedin China,andinWuhan63%(1080of1716)healthcareprofessionals wereinfected,247ofthesewerecriticalincluding5healthcare professionalswhodied [1].However,thesituationcontinuesto evolve.Atthetimeofwritingexactfigurescannotbegivenand theychangeeveryday;wethereforeadvisevisitingtheresources at the end of this editorial for up to date statistics. What is importantisnottobecomecomplacentinlowriskregionswhere community infection have not occurred. COVID-19has already caused moredeaths than SARSand MERS combineddue toits greaterinfectivityandpandemicspread.Weallneedtobevigilant. Insituationssuchasthis,ourthoughtsarewithourcolleagues aroundtheworldwhoarecurrentlydemonstratingtheir dedica-tion,commitmentandcompassiondaily.Thispandemiciscausing growing concern amongst all health care professionals leaving behindalegacyoftraumaandsuffering.ThisyearistheYearofthe NurseandTheYearoftheMidwife,highlightingthecriticalrole midwivesandnursesplaygloballyduringthischallengingtime.
Theriseinpopularityofsocialmediahasbeenasourceofpanic, spreading immense anxiety and fear as people voice their experiences,concernsandopinions.Ithasalsobeenasourceof informationtomanyinplaceswhereinformationhasbeenlimited orcomplicated. Accurateinformation asit becomesavailable is vitalinreducingtheconfusioncausedbythefear-basedrhetoric. Untangling fear-based rhetoric from the truth is something as midwives we do daily. As always, we need to respond with sensitivity and compassion and not get swept up by this disempoweringrhetoric.Ratherthanfear,thefocusonproviding accurate,and factualinformation fromreliable sourcesis para-mount.Ourfocusneedstobeoneliminatingdiscriminationand theracial undertones that further isolateand increase risk for those most vulnerable. The fluid nature of this emergency is unprecedentedinourtimeandrequiresusalltocometogetherin solidarity.
Various educational meetings and conferences have been cancelledwhichisalsoleadingtoanxietyandprobably,financial distress.Asaresult,somemidwiveswhoworkaloneorinsmall groups may feel isolated. For example, the International
ConfederationofMidwives(ICM)havemadethedifficultdecision topostponetheCongressuntil2021inordertocomplywiththe publichealthrecommendationtomaintainsocialdistancing.Now is a time for midwives to provide support (informational and emotional)foreachother.Socialmedia(e.g.WhatsApp,Twitter, blogs) has proved useful for this purpose, strengthening the midwiferycommunity by sharingeach other’s experiences and timelyaccesstoaccurate,reliableresources.Itisimportantthat midwives’ voices are present in this discussion to reassure pregnantwomen.Duetosocialdistancingand thosecolleagues working alone and/or in higher prevalence regions, virtual communication opportunities have a vital role in keeping the profession connected. Importantly, this distancing concerns ‘physical’ distancing and doesnot require usto sociallyisolate ourselvesfromeachother.TheInternationalDayoftheMidwife Virtual(VIDM)conferenceinMayisoneconferencethatdoesnot need to be postponed and may prove to be an important connectingopportunity.
Challengesformidwives
Recent experience in Italy has shown that many pregnant women(especiallywomenwithpreviousloss)arereallyafraidof beingCOVID19positiveandfeelinsecureandanxious.Thismeans that many women have an increased need for support and reassurancebyallhealthcareprofessionals,bothduringpregnancy andalsoduringchildbirthandpuerperium.
Moreover,in the current pandemic, manywomen and mid-wiveslive,givebirthandworkinhighriskareas.Midwiveshave been and continue to meet unprecedented circumstances for whichtheymayfeelunderprepared.Preparingmidwivestowork inriskysituationsandstemthespreadofinfectionwhilstmeeting the needsof women is an ongoing balance of priorities.Some midwivesmayevenfeeltheyareworkingoutsidetheirregional scopeofpractice.TheEbolaoutbreakhighlightedhowpracticecan beaffected.Forexample,midwivesworkinginSierraLeoneduring theEbolaoutbreakfearedbecominginfected,whichaffectedtheir professionalandpersonallives[2].Inthestudy,motivationand support impactedtheability of the midwivestocope in these challengingcircumstances.Midwivessenseofdutyobligatedthem tostepintoriskysituationsina timeofcrisis.Likewise,similar scenariosareplayingoutwiththeCOVID-19pandemicinChina, Iran and Italy. The Erland study highlighted the need for http://dx.doi.org/10.1016/j.wombi.2020.03.008
1871-5192/©2020AustralianCollegeofMidwives.PublishedbyElsevierLtd.Allrightsreserved.
WomenandBirth33(2020)205–206
ContentslistsavailableatScienceDirect
Women
and
Birth
competency,creativityandcouragewhenfacedwithchallenges andethicaldilemmas.
Midwives cannot address the needs of those in their care in isolation. What is important is that midwives engage with colleagues, the community, primary health care and health promotionactivities.Thisisnotlimitedtoeducationandpractices suchashandhygieneandphysicaldistancing,butalsoembrace workingacross professional boundaries and collaborating with otherdisciples.Midwivesneedtolearnfrompreviousexperiences withSARS,EbolaandH1N1thatforegroundedhowprofessional silothinkingisunhelpful.COVID-19callsforacomingtogether,a blurring of traditional professional boundaries in ways that promote greater coordinated cooperation between all stake-holders.Irrefutablymidwiveshavetheskillsand experiencesto dothisinexemplaryways.
Leadership is important both clinically and academically in addressing the COVID-19 pandemic. While teams of dedicated researchers have rapidly produced a plethora of guidance and policies(seebelow),andfast-trackedtheopen-accesspublication ofresearchinTheLancetinthepublicinterest(seebelow),our understandingofthisviruscontinuestounfolddaily.Atthetimeof writingthereisnovaccineandthoseonthefrontlineputtheirlives atriskeveryday.COVID-19hasshownus(again)howtheworld, nowmorethanever,needsarobustproactiveinvestmentinpublic healthinfrastructures,forwhichmidwivesarekeyinreproductive healthstrategiesglobally.
Supportingoneanother
Wealsoknowthatthereisanongoingsignificantimpacton midwivesastheycontinue toprovideusualmidwiferycarebut nowalsotakeonallthenewproceduresrelatedtopreventionand treatmentofCOVID-19.Midwivesfaceoverload,bothemotional andpractical.Allcountriesneedtoensurethattherearesystems andprocessesinplaceearlyinthetrajectoryofthepandemicto support and care for midwives and all other health care professionals. Weneed to alldevelop and implement practical strategies maintain well-being and reduce the risk of post-traumatic stress disorder and burnout. Psychological support, socialconnectednessandcareforthehealthworkforceisessential. Finally,theWomenandBirtheditorialboardurgeseveryoneto advocate for global solidarity and unity at this time. We acknowledge and pay tribute to all health workers, including midwives,whohavelosttheirlivesduetoCOVID-19andextend our compassion to their families and communities. We are
thinking of all– women and health workers – whoare at the frontlineofthiscrisisandhopeitwillbeoversoon.
Recommendedresources
The following list is not definitive. This is proffered as a beginningtoensureyouremainupdatedandinformedinavery changeablelandscape.
World Health Organization. ( https://www.who.int/emergen-cies/diseases/novel-coronavirus-2019)
Royal College of Obstetricians and Gynaecologists (RCOG) 2020Coronavirus(COVID-19)andpregnancyVersion2published online 13th March 2020 https://www.rcog.org.uk/globalassets/ documents/guidelines/coronavirus-covid-19-infection-in-preg-nancy-v2-20-03-13.pdf(Accessedonline16thMarch2020)
TheLancetCOVID-19ResourceCentrehttps://www.thelancet. com/coronavirus
FuturelearnonlinecoursefromtheLondonSchoolofTropical Hygienebeginning23rdMarchfor3weeks:COVID-19:Tackling the Novel Coronavirus https://www.futurelearn.com/courses/ covid19-novel-coronavirus?
References
[1]Z.Wu, J.M.McGoogan, Characteristics ofand important lessonsfrom the coronavirusdisease2019(COVID-19)outbreakinChina:summaryofareportof 72314casesfromtheChineseCenterforDiseaseControlandPrevention,JAMA (2020),doi:http://dx.doi.org/10.1001/jama.2020.2648.
[2]E. Erland, B. Dahl,Midwives’ experiences ofcaring for pregnantwomen admittedtoEbolacentresinSierraLeone,Midwifery55(2017)23–28.
MaeveO’Connell RCSI,Bahrain SusanCrowther AucklandUniversityofTechnology,NewZealand ClaudiaRavaldi CiaoLapoFoundation,Italy CarolineHomer* BurnetInstitute,Melbourne,Australia * Correspondingauthor. E-mailaddress:caroline.homer@burnet.edu.au(C.Homer). Received18March2020
