Midwifery is a profession that strives to provide holistic health care. I believe another term for holistic midwifery care could easily be “multi-level” health care. Looking after the health and well-being of pregnant people is complex and multi-faceted. So many factors and influences impact an individual’s health and well-being and in turn the outcome of pregnancy and the long term health and life span of their children. There is a lot of data supporting that midwifery care improves health outcomes (save that for another blog post!) but I believe it is largely due to our multi-level approach to health, which incorporates the physical, emotional, social and spiritual needs of every individual in our care. I take pride in our excellent professional outcomes.
One challenge that faces modern maternity care is the lack of funding for pre-pregnancy education and access to a maternity care provider. In fact, as a midwife in BC there is presently no pay structure for a midwife to provide pre-pregnancy health services. This results in women arriving in a midwife or physician’s office already pregnant. This is a glaring gap in women’s health is a huge missed opportunity to provide counselling and education around what steps people can take pre-conception to improve their health and have a healthy pregnancy and outcome. Simple interventions like MMR boosters, starting prenatal vitamins and folic acid supplementation, infectious disease screening, etc... are all best started before conception. Yet, in the current health care system, a very large proportion of women are not counselled on these items until they are already pregnant! Add in income levels, life stressors, mental health, and education levels just for starters and it is easy to see how quickly health disparities can add up. It does not come as a surprise then for most health care workers that the health of the next generation begins preconception and that the more privilege one has in the world the more likely it is that their children will benefit not only through access to the privileges handed down from their parents but also from better health starting from the moment of conception.
Ramey et al. explore the multi-level influences that lead to health disparities across diverse populations and developed The Preconception Stress and Resiliency Pathways Model (PSRP) to explore the diverse and complex ways our genetics, environment, community, physical and mental health and so much more weave together and result in consistently poorer health outcomes for minorities and those from low income socioeconomic backgrounds.
Clearly working towards closing the inequities in health across diverse populations is an enormous challenge. A multi-level approach to improving health for all is indeed a daunting task and all areas of health care are going to have to collaborate in the long term for positive health changes to take root. As a midwife my focus is always towards achieving the healthiest pregnancy and birth outcomes for my patients. Imagine if this care started pre-conception for a diverse population. I believe we would indeed see improved health that could have a positive influence over several generations.
References:
Strutz, K. L., Hogan, V. K., Siega-Riz, A. M., Suchindran, C. M., Halpern, C. T., & Hussey, J. M. (2014). Preconception stress, birth weight, and birth weight disparities among US women. American journal of public health, 104(8), e125-32.
Ramey, S.L., Schafer, P., DeClerque, J.L. et al. Matern Child Health J (2015) 19: 707.https://0-doi-org.aupac.lib.athabascau.ca/10.1007/s10995-014-1581-1
Cultural Diversity and Ethnic Minority Psychology, Vol 25(1), Jan, 2019. Special Issue: Understanding, Unpacking and Eliminating Health Disparities: A Prescription for Health Equity Promotion Through Behavioral and Psychological Research. pp. 1-5.
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