Midwifery

Alina D. Bishop Velarde, a midwife in Morelos, Mexico, is seeking to promote the humanization of birth. “It’s something many women in Mexico do not experience during childbirth,” she says. “In this world everything is going so quickly, we forget about this human ingredient.”

At the Johnson & Johnson Center for Health Worker Innovation, we recognize that frontline health workers are the heart of strong community and primary care systems. When the world shifted its attention to health workers amidst COVID-19, the Center was already working with partners around the globe to strengthen community-based health systems by supporting frontline health workers to achieve health for all by 2030.

Lancet Global Health published a new study, Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study, that documents the potential impact of midwives in preventing and reducing maternal and newborn mortality and stillbirths. Led by the United Nations Population Fund (UNFPA), the International Confederation of Midwives and the World Health Organization, the study—based on data from 88 countries—calls for greater investment in the profession, not only to increase the numbers of midwives but to improve their education, training, regulation and working environment.

John Lazame Tindanbil, Executive Director of MABIA-Ghana, is a recipient of the 2020 Aspen Nurse Innovator Grant in collaboration with Johnson & Johnson Foundation. The grant recognizes nurse/midwife innovators for their innovative practices to provide healthcare access to marginalized communities.

The day of birth should be among the happiest days for a family. However, this joy may turn into sorrow and anguish when the baby is born preterm (before 37 completed weeks of pregnancy) and struggles for survival. Worldwide, an estimated 15 million babies are born preterm, which is more than 1 in 10. Complications due to preterm birth are the single leading cause of neonatal deaths, accounting for 35% of the 3.1 million neonatal deaths every year. Among the babies who survive, some may face life-long health issues related to preterm birth such as hearing, visual and learning disabilities.

A 2018 study in The Lancet showed that 5 million people in low- to middle-income countries died in 2016 from poor quality healthcare, and an additional 1.5 million people from not having access to care itself.

A few years ago, I met Wang Linyun, a nurse/midwife from Taiyuan Maternity Hospital in Shanxi, China. The photo below is a screenshot from an interview—she is expressing the utter desperation and helplessness she felt when she did not know how to help a baby experiencing childbirth complications. If a baby died or suffered a long-term disability, she blamed herself!But one may ask, how could a nurse/midwife in a maternity ward not know what to do? To answer that, let’s look at Wang Linyun’s pathway to becoming a midwife. Like many nurses/midwives in China and elsewhere, Wang completed her 3-year general nursing education, which included few midwifery specific courses. After attending 20 supervised births at a local hospital where she was expected to “learn on the job,” she was licensed to work as an obstetric nurse (Chinese title for midwife). In short, Wang became a midwife with little midwifery education or training.

Frontline health workers, including nurses, midwives and community health workers (CHWs), are vital for effective, strong primary healthcare systems that deliver for everyone, everywhere. These cadres of health workers are the first, and in some cases often the only, point of contact with the health system for millions of people. Through the COVID-19 pandemic, for example, nurses stepped up to lead not only at testing sites but in critical care of very ill patients, and community health workers played key roles in contact tracing and testing in many countries around the world.

Frontline health workers usually have higher than normal levels of stress while providing healthcare in communities. They are facing tremendous stress now in providing care and services, sometimes managing acute cases, through the difficult times of the COVID-19 pandemic. UNICEF has committed to addressing the mental health and psychosocial needs of frontline health workers across all of their work.

At the Johnson & Johnson Center for Health Worker Innovation, we believe that sustainable improvements in the delivery of and access to quality primary care require a long-term commitment to enabling and supporting the well-being of the deliverer of care—the frontline health worker.