Here's to another unsung hero of the coronavirus pandemic—the midwife
Photo by Alex Hockett on Unsplash

Imagine being pregnant in the middle of a pandemic, when a hospital full of potentially contagious patients is the last place you want to set foot. Where and how are you going to bring your baby into the world?

Thousands of parents-to-be facing this question have scrambled to make a plan that keep them and their baby safe during the coronavirus outbreak. And many have turned to the experts in safe birthing in non-hospital settings—midwives.

Depending on where you live, midwife-assisted birth in a non-hospital setting may be seen as totally normal, or it may be viewed with suspicions about safety. In the U.S., midwife-attended births had seen an uptick even before the pandemic, but the vast majority of births still take place in hospitals. In other countries, home births attended by midwives is the norm for low-risk births.


With the new coronavirus likely not leaving anytime soon, folks in the U.S. might want to hop on the "this is normal" train. With restrictions on visitors and birth support people, as well as the risk of infection, more and more parents are opting for an out-of-hospital birth experience.

Despite being the first state hit hard by the virus, Washington state has had a "tremendous leg up" on this front, says Jen Segadelli, Co-President of the Midwives' Association of Washington State and Clinical Education Supervisor of the Department of Midwifery at Bastyr University. Decades of relationship-building between the midwives and OBs in Washington has created a strong culture of collaboration, she says, making childbirth care in a pandemic far easier than in states where midwives and OBs operate mostly in separate spheres.

However, even in a state where doctors and midwives work well together, the unique circumstances of a pandemic create an entirely new set of challenges and considerations. Coincidentally—and thankfully—a playbook for handling childbirth during a pandemic had already been partially written in Washington before the virus even hit.

Seattle-area midwife Tara Lawal, who runs Rainier Valley Community Clinic, had written her Masters thesis on developing a midwife-led community-based model of care, which includes midwife-physician collaboration—a vital piece of the pandemic birth equation. And Emily Jones, a current Bastyr University midwifery student, is nearly finished writing her Masters thesis on the role of midwives in disaster preparedness. The central question of her paper: "What happens when hospitals run out of beds?" Talk about good timing.

Segadelli, Lawal, Jones, and other community birth providers in Washington have created a COVID-19 Response Coalition to address the needs of birthing families during the pandemic using the knowledge laid out in those midwives' research. "The goal is to not get ourselves to a place where we are suddenly New York and like 'Aw crap. We might have to divert two thousand births out of the hospital in two weeks, and where are we going to put them?'" says Segadelli.

For midwives, the specifics of "where" aren't as important as simply having a plan. "We can catch a baby anywhere," says Segadelli. "We would just prefer that there be four walls and running water and heat."

Washington has dozens of licensed freestanding birth centers, which offers a degree of out-of-hospital infrastructure in addition to home birth options. But not all states have those facilities. New York, for example, has just two freestanding birth centers, both in Brooklyn. So creative solutions have to be found when hospitals get overrun and birth centers aren't available.

Segadelli says one option is setting up ad-hoc birth centers in hotels or Airbnbs in addition to home births. However, varying state laws and regulations make those options trickier in some states than others. For example, some states don't allow midwives to carry certain life-saving medications, and some don't even allow midwives to legally practice at all.

Segadelli says differing state laws means a hyperlocal approach must be taken:

"This is the downside to the federalist legal system, right? We essentially have 50 different legal systems in this country. Our legality of practices are different state by state, and our scope of practice is different state by state. There are some states where you can't carry anti-hemorrhagic medication. You can't carry Pitocin to stop a postpartum hemorrhage. So the way that those midwives might be forced to manage this is going to look different than it's going to look like for midwives in Washington, who enjoy a pretty liberal scope of practice and a pretty extensive drug legend for emergency management."


Segadellisays midwives has seen a 25% to 100% increase in demand across the state since the pandemic began. Some requests are from patients who are near their due date, which poses an extra challenge for midwives who are used to working closely with patients throughout their pregnancy. Late-term transfers don't allow much time for relationship-building, and patients may not be prepared for the reality of an out-of-hospital birth without the option of an epidural. But in a crisis, people do what they have to do.

And problem-solving in real time is exactly what midwives do. "I think that's what midwives do well," says Segadelli. "We innovate. We problem-solve. We always have." Midwives also have valuable birth care expertise that traditional OBs don't. Doctors have begun approaching midwives in Washington asking how to get patients out of the hospital after birth quickly, which is standard practice for most midwives. Segadelli says that kind of knowledge sharing will serve birthing patients well, not only during this pandemic, but in any potential disaster situation.

"We are hopeful that we have somewhat managed to avert crisis in this state with early action with social distancing and preventative measures," says Segadelli. "But we are also hopeful that this has started a bigger conversation about when this happens again—I won't even say 'if,' we're way too connected as a global society for it not to happen again—or an earthquake or some other kind of crisis or disaster—when we're faced with it, that we've started to lay some groundwork here with our colleagues and as a healthcare system that recognizes we're going to have to have a plan. Because if we don't have a plan, the people who fall through the cracks are the birthing people and the babies."

While OBs are experts in surgical birth and high-risk birth situations, midwives are the experts in normal, low-risk birth. Both kinds of expertise are needed in a crisis, so the more birth care providers work in conjunction with one another, the better the outcome for all birthing families.

Since his first hit single "Keep Your Head Up" in 2011, award-winning multi-platinum recording artist Andy Grammer has made a name for himself as the king of the feel-good anthem. From "Good to Be Alive (Hallelujah)" to "Honey, I'm Good" to "Back Home" and more, his positive, upbeat songs have blared on beaches and at backyard barbecues every summer.

So what does a singer who loves to perform in front of live audiences and is known for uplifting music do during an unexpectedly challenging year of global pandemic lockdown?

He goes inward.

Grammer told Upworthy that losing the ability to perform during the pandemic forced him to look at where his self-worth came from. "I thought I would have scored better, to be honest," he says. "Like, 'Oh, I get it from all the important, right places!' And then it's taken all away in one moment, and you're like, 'Oh, nope, I was getting a lot from that.'

"It's kind of cool to break all the way down and then hopefully put myself back together in a way that's a little more solid," he says.

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Since his first hit single "Keep Your Head Up" in 2011, award-winning multi-platinum recording artist Andy Grammer has made a name for himself as the king of the feel-good anthem. From "Good to Be Alive (Hallelujah)" to "Honey, I'm Good" to "Back Home" and more, his positive, upbeat songs have blared on beaches and at backyard barbecues every summer.

So what does a singer who loves to perform in front of live audiences and is known for uplifting music do during an unexpectedly challenging year of global pandemic lockdown?

He goes inward.

Grammer told Upworthy that losing the ability to perform during the pandemic forced him to look at where his self-worth came from. "I thought I would have scored better, to be honest," he says. "Like, 'Oh, I get it from all the important, right places!' And then it's taken all away in one moment, and you're like, 'Oh, nope, I was getting a lot from that.'

"It's kind of cool to break all the way down and then hopefully put myself back together in a way that's a little more solid," he says.

Keep Reading Show less
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Each year, an estimated 1.8 million people in the United States are affected by cancer — most commonly cancers of the breast, lung, prostate, and blood cancers such as leukemia. While not everyone overcomes the disease, thanks to science, more people are surviving — and for longer — than ever before in history.

We asked three people whose lives have been impacted by cancer to share their stories – how their lives were changed by the disease, and how they're using that experience to change the future of cancer treatments with the hope that ultimately, in the fight against cancer, science will win. Here's what they had to say.

Celine Ryan, 55, engineer database programmer and mother of five from Detroit, MI

Photo courtesy of Celine Ryan

In September 2013, Celine Ryan woke up from a colonoscopy to some traumatic news. Her gastroenterologist showed her a picture of the cancerous mass they found during the procedure.

Ryan and her husband, Patrick, had scheduled a colonoscopy after discovering some unusual bleeding, so the suspicion she could have cancer was already there. Neither of them, however, were quite prepared for the results to be positive -- or for the treatment to begin so soon. Just two days after learning the news, Ryan had surgery to remove the tumor, part of her bladder, and 17 cancerous lymph nodes. Chemotherapy and radiation soon followed.

Ryan's treatment was rigorous – but in December 2014, she got the devastating news that the cancer, once confined to her colon, had spread to her lungs. Her prognosis, they said, was likely terminal.

But rather than give up hope, Ryan sought support from online research, fellow cancer patients and survivors, and her medical team. When she brought up immunotherapy to her oncologist, he quickly agreed it was the best course of action. Ryan's cancer, like a majority of colon and pancreatic cancers, had been caused by a defect on the gene KRAS, which can result in a very aggressive cancer that is virtually "undruggable." According to the medical literature, the relatively smooth protein structure of the KRAS gene meant that designing inhibitors to bind to surface grooves and treat the cancer has been historically difficult. Through her support systems, Ryan discovered an experimental immunotherapy trial at the National Institutes of Health (NIH) in Bethesda, MD., and called them immediately to see if she was eligible. After months of trying to determine whether she was a suitable candidate for the experimental treatment, Ryan was finally accepted.

The treatment, known as tumor-infiltrating lymphocyte therapy, or TIL, is a testament to how far modern science has evolved. With this therapy, doctors remove a tumor and harvest special immune cells that are found naturally in the tumor. Doctors then grow the cells in a lab over the next several weeks with a protein that promotes rapid TIL growth – and once the cells number into the billions, they are infused back into the patient's body to fight the cancer. On April 1, 2015, Ryan had her tumor removed at the NIH. Two months later, she went inpatient for four weeks to have the team "wash out" her immune system with chemotherapy and infuse the cells – all 148 billion of them – back into her body.

Six weeks after the infusion, Ryan and Patrick went back for a follow-up appointment – and the news they got was stunning: Not only had no new tumors developed, but the six existing tumors in her lungs had shrunk significantly. Less than a year after her cell infusion, in April 2016, the doctors told Ryan news that would have been impossible just a decade earlier: Thanks to the cell infusion, Ryan was now considered NED – no evaluable disease. Her body was cancer-free.

Ryan is still NED today and continuing annual follow-up appointments at the NIH, experiencing things she never dreamed she'd be able to live to see, such as her children's high school and college graduations. She's also donating her blood and cells to the NIH to help them research other potential cancer treatments. "It was an honor to do so," Ryan said of her experience. "I'm just thrilled, and I hope my experience can help a lot more people."

Patrice Lee, PhD, VP of Pharmacology, Toxicology and Exploratory Development at Pfizer

Photo courtesy of Patrice Lee

Patrice Lee got into scientific research in an unconventional way – through the late ocean explorer Jacques Cousteau.

Lee never met Cousteau but her dreams of working with him one day led her to pursue a career in science. Initially, Lee completed an undergraduate degree in marine biology; eventually, her interests changed and she decided to get a dual doctoral degree in physiology and toxicology at Duke University. She now works at Pfizer's R&D site in Boulder, CO (formerly Array BioPharma), leading a group of scientists who determine the safety and efficacy of new oncology drugs.

"Scientists focused on drug discovery and development in the pharmaceutical industry are deeply committed to inventing new therapies to meet unmet needs," Lee says, describing her field of work. "We're driven to achieve new medicines and vaccines as quickly as possible without sacrificing safety."

Among the drugs Lee has helped develop during her career, including cancer therapies, she says around a dozen are currently in development, while nine have received FDA approval — an incredible accomplishment as many scientists spend their careers without seeing their drug make it to market. Lee's team is particularly interested in therapies for brain metastases — something that Lee says is a largely unmet need in cancer research, and something her team is working on from a variety of angles. "Now that we've had rapid success with mRNA vaccine technology, we hope to explore what the future holds when applying this technology to cancers," Lee says.

But while evaluating potential cancer therapies is a professional passion of Lee's, it's also a mission that's deeply personal. "I'm also a breast cancer survivor," she says. "So I've been on the other side of things and have participated in a clinical trial."

However, seeing how melanoma therapies that she helped develop have affected other real-life cancer patients, she says, has been a highlight of her career. "We had one therapy that was approved for patients with BRAF-mutant metastatic melanoma," Lee recalls. "Our team in Boulder was graced by a visit from a patient that had benefited from these drugs that we developed. It was a very special moment for the entire team."

None of these therapies would be available, Lee says without rigorous science behind it: "Facts come from good science. Facts will drive the development of new drugs, and that's what will help patients."

Chiuying "Cynthia" Kuk (they/them) MS, 34, third-year medical student at Michigan State University College of Human Medicine

Photo courtesy of Cynthia Kuk

Cynthia Kuk was just 10 years old when they had a conversation that would change their life forever.

"My mother, who worked as a translator for the government at the time, had been diagnosed with breast cancer, and after her chemotherapy treatments she would get really sick," Kuk, who uses they/them pronouns, recalls. "When I asked my dad why mom was puking so much, he said it was because of the medicine she was taking that would help her get better."

Kuk's response was immediate: "That's so stupid! Why would a medicine make you feel worse instead of better? When I'm older, I want to create medicine that won't make people sick like that."

Nine years later, Kuk traveled from their native Hong Kong to the United States to do exactly that. Kuk enrolled in a small, liberal arts college for their Bachelor's degree, and then four years later started a PhD program in cancer research. Although Kuk's mother was in remission from her cancer at the time, Kuk's goal was the same as it had been as a 10-year-old watching her suffer through chemotherapy: to design a better cancer treatment, and change the landscape of cancer research forever.

Since then, Kuk's mission has changed slightly.

"My mom's cancer relapsed in 2008, and she ended up passing away about five years after that," Kuk says. "After my mom died, I started having this sense of urgency. Cancer research is such that you work for twenty years, and at the end of it you might have a fancy medication that could help people, but I wanted to help people now." With their mother still at the forefront of their mind, Kuk decided to quit their PhD program and enter medical school.

Now, Kuk plans to pursue a career in emergency medicine – not only because they are drawn to the excitement of the emergency room, but because the ER is a place where the most marginalized people tend to seek care.

"I have a special interest in the LGBTQ+ population, as I identify as queer and nonbinary," says Kuk. "A lot of people in this community and other marginalized communities access care through the ER and also tend to avoid medical care since there is a history of mistreatment and judgement from healthcare workers. How you carry yourself as a doctor, your compassion, that can make a huge difference in someone's care."

In addition to making a difference in the lives of LGBTQ+ patients, Kuk wants to make a difference in the lives of patients with cancer as well, like their mother had.

"We've diagnosed patients in the Emergency Department with cancer before," Kuk says. "I can't make cancer good news but how you deliver bad news and the compassion you show could make a world of difference to that patient and their family."

During their training, Kuk advocates for patients by delivering compassionate and inclusive care, whether they happen to have cancer or not. In addition to emphasizing their patient's pronouns and chosen names, they ask for inclusive social and sexual histories as well as using gender neutral language. In doing this, they hope to make medicine as a whole more accessible for people who have been historically pushed aside.

"I'm just one person, and I can't force everyone to respect you, if you're marginalized," Kuk says. "But I do want to push for a culture where people appreciate others who are different from them."