In Oahu, midwives provide vital care – along with food, cribs, and social services
On the Hawaiian island of Oahu, a pregnant woman in her third trimester received a troubling phone call from a friend.
“She told me that she tested positive for Covid,” the woman recalled. “She was sick, she had symptoms.” The two women had only spent time together the day before.
Unfortunately, the friend passed on Covid-19 to her. “It was really scary. I was worried about my own health and that of the baby, being pregnant and being ready,” the woman said.
Unsure of what to do, she turned to midwives at the Oahu-based Healthy Mothers Healthy Babies Coalition of Hawaii (HMHB).
The midwives provided her with a doppler, blood pressure cuff, thermometer, and pulse oximeter, and taught her how to monitor herself and her baby during quarantine. They also brought food into the house for her and her boyfriend. âThey never made me feel ashamed and ashamed of this,â she said. “If I hadn’t had her, I would have been all alone.”
When she went into labor at 38 weeks, a midwife took her to the hospital and acted as her doula. When their little girl had trouble locking, they were there to help and answer questions.
It was a matter of course for the midwives at HMHB. They are used to adapting to give their clients everything they need – whether it falls within the scope of the traditional midwife or not. (They prefer to call the women they care “clients” rather than “patients” – to emphasize that pregnancy and childbirth are normal parts of life.)
A new mom may need access to food aid. A pregnant woman who cannot speak English (HMHB midwives speak a total of five languages) may need childbirth preparation. A woman already in labor at a local hospital and overwhelmed by her experience may need a doula.
As of January 2021, Direct Relief has assisted HMHB with more than $ 34,000 worth of medicines, equipment and supplies, including 4,200 PSA units and a solar refrigerator designed for the organization’s new mobile van.
Roots in the community
In 1992, HMHB became a non-profit organization. Midwives were initially not included – instead the organization focused on advocacy and direct social services, including the provision of food, cots and other supplies. Health centers and other community organizations would refer pregnant women and young parents to the organization to help with everything from diapers to rentals.
“Nothing I say about safe sleep, breastfeeding, and mental health will go down to a mother if she suffers from food or housing insecurity,” said Sunny Chen, managing director of HMHB.
But as time went on, the need for health services became increasingly apparent. “Our mothers have so many barriers to access to care,” said Chen.
Jacquelyn Ingram, Program Director at HMHB, agreed. When it comes to Hawaii, “people might think of tourism and the glamorous side,” she said, but many of her clients are unable to keep up with the cost of living.
Additionally, “the high social risk mothers we care have even higher rates of depression and anxiety,” said Chen. “The dream has always been to add a clinical arm” to largely address these serious concerns.
HMHB began with a contract with licensed clinical social workers to care for women with postpartum depression, sexual trauma, and other mental health problems.
Then, in 2020, when Hawaii began requiring approval from midwives – a major change in which HMHB played an advocate role – they began providing maternity, postpartum and breastfeeding services to families in the community.
The midwife model
Chen and Ingram firmly believe in the power of the midwifery model. Midwives “are at home with the community and with the people … they just have this amazing, worldly approach to maternal care,” said Chen.
Many of their clients are unfamiliar with midwives – in part because midwifery services in the US are often inaccessible to low-income clients. (Midwives play a more integrated role in many other health systems around the world.)
In particular, providing midwifery services to patients from racial and ethnic minorities whose birth outcomes are statistically poorer is a high priority. “Our niche is high social risk mothers,” said Chen, although people who see a midwife should have lower-risk pregnancies from a medical perspective.
A high-risk pregnancy is easier to monitor in a traditional medical setting, said Chen: “Then our midwives just become their doulas … and work hand in hand with their providers.”
For Ingram, a community-based midwife is a natural addition. As a certified professional midwife and lactation consultant, she trained and volunteered with the Indonesian midwifery group Bumi Sehat at the beginning of her career. It’s a type of care that she described as âlow cost, little technology, but lots of loveâ.
The midwifery model is based on the belief that, as Ingram says, âBirth and pregnancy are part of life. It’s not like anything is wrong. âHMHB midwives help clients make informed decisions about their own pregnancy, childbirth and aftercare. A big part of it is “spending time … getting to know you, your family, your situation”.
Although the organization’s midwives do not currently perform home births, they act as doulas for women in labor at local hospitals.
“Work to do”
The newest tool in HBHM’s belt is a âbeautiful mobile van, fully stocked with amazing supplies of Direct Reliefâ.
The mobile unit was originally a coach that Chen bought from a used car dealer. She parked it in her driveway and she and her husband expanded it themselves – a gigantic effort that Chen estimates required 300 hours of work and “my daughter doing homework at night in the van” while they worked.
The transporter enables midwives to overcome transport barriers for customers and ensure prenatal care in a safe and private space. It’s been shown to be beneficial for everything from social distancing – “You can’t have social distancing in a small apartment of 15 people,” Chen said – to midwives who safely screen women for intimate partner violence and sexual trauma.
The press they received from the mobile clinic has contributed to a dramatic increase in requests for their services. More than ever, pregnant women and new parents are reaching out to them directly rather than receiving referrals from a health center or other community partner. Of around 1,000 calls over a period of six months, HMHB now receives 4,000 calls over the same period.
And community organizations are still reporting back regularly. A maternal clerk can contact HMHB if a new mother needs a cot or is at risk of missing postpartum appointments. “As long as she’s not a high-risk mom … we can fill that void,” said Chen. “It often accompanies some kind of social service.”
In addition to maternal and prenatal health care, HMHB also offers culturally aware doula training and emergency training to other birth professionals. They help pregnant and parenting teenagers with access to food stamps and other perks. And they are conducting a number of ongoing lobbying efforts, including a recent effort to encourage the state of Hawaii to expand the data it has collected on maternal morbidity and mortality.
“There is a lot to do here and we have to approach it from all angles,” said Chen.