By Marisa Poverman
As a midwife at Jacobi Medical Center in the Bronx, I see firsthand the crisis of care in this country. The U.S. has some of the highest maternal and infant mortality rates amongst its peers, and these numbers are on the rise. Although the rates of maternal death in New York state are lower than the national average, the rate of black maternal deaths is much higher, at 54.7 deaths per 100,000 live births. Amidst the startling nationwide maternal and infant mortality epidemic, Bronx midwives are on the frontlines, fighting to improve maternal health in their communities.
Public hospital midwives at Jacobi and North Central Bronx Hospitals are involved in every part of the birthing process, from the first pregnancy visit through the postpartum period. My coworkers and I care for anyone in labor, attend all vaginal births and assist in C-sections. On a typical day at Jacobi Medical Center, I might attend three vaginal births, see half a dozen pregnant people for emergency care in our OB triage unit, and admit a handful of patients to the hospital for labor or because they need inpatient care in their pregnancies. Despite our crucial role and range of responsibilities, we are severely understaffed, overworked, and underpaid, which leads to high turnover and burnout. If we want to address the unacceptable disparities in health outcomes for Black mothers and infants in the Bronx, we need to invest in midwifery care.
Pregnancy is a time when people receive more medical attention than ever before in their life, so we often see patients who come in with chronic conditions — like asthma, diabetes, and high blood pressure — that have been previously unaddressed. Most of the patients we see are low-income and underinsured. We take care of high acuity patients who need more of our time and, as a public hospital, we do not turn patients away. To keep up with this need, on any given day, we are scheduled at 105-127% of our capacity — though the daily expectation of my role is that I am doing 127% at a minimum. Our schedule doesn’t begin to factor in the language barriers, lack of stable housing, tenuous immigration status, mental health concerns, and chronic conditions that many of our patients experience. All of these issues have been under-addressed during their lives.
I love my role, my patients, and my coworkers. The work is rewarding; every midwife I know appreciates the privilege it is to help people in what is a vulnerable but powerful time in their lives. However, our employer and healthcare system make it impossible to adequately address bigger picture social determinants of health and take advantage of our dedication to the patients we serve. This means we stay late, take work home or can’t fully meet our patients’ needs. Chronic understaffing places an undue burden on midwives to meet the complex needs of as many patients as possible in a short amount of time and there are days that are so busy that I don’t even have time to eat or go to the bathroom. This is without a doubt an unsustainable way to work.
This work is rigorous, requires attention to detail and the ability to respond quickly when emergencies arise. But on any given day, my colleagues and I are left to do the most with the bare minimum, squeezing multiple patients into individual time slots and doing the work of multiple midwives. Many of us also work two or more jobs and watch as coworkers leave more quickly than the positions can be filled. As a group, we are one of the most diverse midwifery groups in the country. More than half of us are bilingual, and while less than 7% of midwives are Black nationally, at Jacobi, 35% of our midwives are Black or Brown. This is intentional, and we believe that the practice should reflect the patients we care for. We are primarily women taking care of women, which makes us doubly undervalued and undercompensated for the level of skill and responsibility we have. We work extraordinarily hard to do the best we can to take care of patients that all too often also bear the brunt of a broken health care system. The most marginalized people in our society deserve so much more.
Valuing and investing in midwifery care is not only good for our patients in the Bronx, but it is also key to addressing the infant and maternal mortality crisis. Recent studies have shown that increasing and integrating midwives into the health care system could avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths.
Midwives in the Bronx are asking for the resources and time to keep midwives at the bedside. Addressing these issues will allow us to give the care this community needs and deserves and improve maternal and child health in the Bronx.
Marisa Poverman, MSN, CNM, WHNP-BC, is a midwife at Jacobi Medical Center in the Bronx.
This post appeared first on New York Amsterdam News.