While nurses and doctors are working on the frontlines to tackle the COVID-19 outbreak, other health professionals continue to care for patients who are not infected with the virus. To do so, they have had to adjust how they operate and are confronted with new hurdles. Midwives in particular have had to rethink how they can support pregnant women in a time when, in some countries, they cannot even be in close physical proximity.
In 2020, which is the International Year of the Nurse and the Midwife, these two professional groups are as essential as ever. They are also facing extreme challenges. UNRIC previously talked to nurses across Western Europe to find out how they are coping. Now we investigate how midwives have had to change how they work to sustain their care for expectant mothers during the pandemic.
Emotional support for pregnant women
Although WHO says there is no evidence to suggest an increased risk of a more severe illness if infected, or that the virus can be transmitted to the child in the womb, across Europe, women who are expecting are worried about their pregnancy and the prospect of giving birth during the pandemic.
In fact, many women are so concerned they are even reconsidering whether to give birth at a hospital. As the Flemish Professional Organization of Midwives (VLOV) reports, for example, more pregnant women in Belgium are opting to give birth at home.
Their concerns are not unfounded. Though conditions vary by country, new restrictions are in place everywhere. In Germany, some hospitals have prohibited partners from being present at births and women are discharged much sooner than usual, mere hours after giving birth. In Ireland, the UK and France meanwhile, one person is still allowed to accompany the woman giving birth. Visits are prohibited in almost all countries.
Midwives say that this also complicates their work, as they occasionally depend on the mother’s partner. They can massage the mother’s back, put a cold washcloth on her forehead, get her a cup of tea. Most importantly, they are by her side.
The worry of giving birth alone is one that midwives take very seriously. More so than usual, they feel that their role is also to provide emotional support for pregnant women, as well as women with newborns, at a time when they are being asked to keep physical contact to a minimum. “I find this difficult as I value the face to face interactions with women,” says an Irish midwife. Instead, they now talk on the phone more often or leave voice messages to maintain contact.
More frequent calls are just one of the ways midwives are using technology to their advantage. Since prenatal classes can no longer take place, midwives around Europe are devising new ways to prepare women for childbirth.
By making video recordings with dolls, they show future parents how to position and massage babies to relieve their abdominal pain. Others report giving group classes on birth preparation via live-streams. Antenatal classes, on the other hand, are usually cancelled.
Where partners are not allowed to be present at the birth, midwives have resorted to setting up video calls. This allows them to talk to the mother throughout labour as well as to hear the child’s first cry, albeit virtually.
In Germany, a young woman launched a start-up at a time when most businesses are reducing their activities or shutting down. In cooperation with the German Midwifery Association (DHV), she set up a digital platform to connect self-employed midwives with expectant mothers. Pregnant women who are at a stage where they would typically seek out a midwife in person are encouraged to use the platform to find one online.
Midwives need support too
But, as many point out, while midwives are putting in extra effort, they themselves are being let down. “There is no doubt that those working within maternity care are doing everything they can to best support mothers and newborns, but maternity care professionals need to be supported too”, says Joeri Vermeulen of the European Midwives Association.
As with other health professionals, they are struggling with the lack of personal protective equipment (PPE), both for their own protection and that of the women they tend to at the hospital. Together with 11 other European health professional associations, the European Midwives Association is urging authorities to guarantee protection to those in the frontlines against COVID-19.
In Ireland and the UK, some midwives have been redeployed to other areas within the hospital, including intensive care units. As a result, in the UK, a fifth of midwife-led maternity units are closed. While they understand why this is necessary, midwives are voicing concerns that they may not be around if there are complications during pregnancy or to support expectant mothers who have come to rely on them.
The work of midwives has changed dramatically within a matter of weeks. Their work ethic, however, has not. It is clear that the pandemic has not deterred them from supporting women to the best of their ability, with creativity and determination, in difficult times.