What do midwives hold back of making a bigger dent in the fight against climate change? For starters, there aren’t enough. The United Nations reports that one shortage of approximately 900,000 midwives worldwide. This shortage is spreading to the US, where maternal mortality rates are higher compared to other high-income countries where midwives play a central role in care.
Especially in the US, several insurance related There are hurdles between patients wanting to work with a midwife or doula and actually doing so. “What is concerning from an equity point of view is that black, Indigenous and Latinx people often live in states where there are more barriers to accessing the midwife,” says Saraswati Vedam, the principal investigator of the Birth Place Lab and professor of obstetrics at the University of British Columbia. from Vedam Research shows that the integration of midwives in the US health care system has a positive impact on equity and health outcomes.
There is a through line between these barriers to access to midwives and the racist campaign to undermine midwifery in favor of the medicalization of childbirth and the turnout of white male obstetricians and gynecologists. In the early 1900s, these doctors focused midwives, who were often black criminalize and discredit their work. A prominent early obstetrician, Joseph DeLee, called midwives a ‘remnant of barbarism’. This history is at the root of why many Americans view obstetrics as unsafe at worst or don’t even think about it at all. “I’ve been a midwife for 37 years and it still amazes me how little the average person knows about professional midwifery and what it has to offer,” says Vedam.
Connecting patients to birthing workers who can provide climate-focused care — to the people who ask their patients if they have air conditioning, if they have a plan if their house floods, and if they know how to apply for an electricity allowance — requires dismantling the stigmas that underlie and impede structural barriers.
Support from the staff themselves is also essential: Wheeler and her colleagues at the National Birth Equity Collaborative are currently to ask midwives, doulas and other maternity nurses about what they are already doing to tackle climate impacts and what else they would like to do. The idea is that these results could help develop collaborative training between birth workers and other professionals, such as epidemiologists and climate scientists. She views the work as building solidarity, noting that “the climate crisis is teaching us that we need to be intersectional in how we approach health.” This kind of collaboration has happened before, albeit through piecemeal efforts. In 2018, for example, researchers hosted training on heat exposure and maternal health in the community room of a birthing center in El Paso, Texas. After the pilot, the treating doulas and midwives reported talking to their clients more often about the risks of heat.
But there is room to grow. Davies also thinks that “sustainability literacy should become a core component of any midwifery curriculum” – a codification that goes beyond midwifery’s entrenched connection to sustainability. Her point and her work on the subject have already influenced midwifery in her country, New Zealand. Alison Eddiechief executive of the New Zealand College of Midwives, says Davies’ obstetrics and sustainability Research was a catalyst for the profession and inspired them to seriously think about how they can serve as a climate solution.
There is a responsibility to “educate and lead midwives to become climate change champions in their work, to think and act critically about how they use resources in their practice, and to consider their role in advocacy to hold governments, hospitals and politicians accountable. ”, says Eddie. She has put this conviction into practice: the College has advocated for recognizing the special needs of pregnant people and babies in New Zealand’s Climate Change Response (Zero Carbon) Amendment Bill.
In the US, there is some movement towards investment in midwives because of their link to improved health outcomes: in June, the Biden administration issued a “blueprint” for addressing the maternal health crisis, including a pledge to work with states to expand access to doulas and midwives. Particularly in women vulnerable for the impacts of climate change, a comparable effort should be made that reflects their connection to climate-related concerns.
So much talk about the climate crisis is about what we have to give up. But obstetric comprehensive care is a rare example of something we can gain.