The Role of the Midwife in the First 1000 Days

Midwifery Today, Issue 141, Spring 2022.
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It is the universal joy of every community midwife to run into a family months or years later and see them with the baby you so lovingly helped them bring into the world. I have been a midwife for more than 40 years at this point, so I have long known the joys of meeting families who now have grown children to show off to me, and the babies of those children I midwifed for them long ago! Many midwives feel a bit of secret pride as they watch “their babies” grow up in the community.

But imagine another outcome, one that has become too frequent and heartbreaking for me in my community in the Philippines over the years. Sometimes when I run into a woman on the street or in a neighboring village who had a baby in our birth center, she sadly tells me that her child died in early childhood. Often it is something entirely preventable, like measles, diarrhea, or pneumonia, or one of the other diseases of deprivation that so often take the life of children in infancy or early childhood in low-resource countries. Even when children don’t die in early childhood, it was not infrequently that I would encounter a baby who had been born healthy at birth but was now struggling with a level of malnutrition and growth stunting. We know that any stunting in a child’s body is most likely also negatively impacting the developing brain.

A few years ago, I read the book The First 1,000 Days, by Roger Thurow, and something clicked for me. I realized I did not have to feel helpless, but that I could extend my role as a midwife just slightly to protect this unique and vulnerable time in every baby’s life.

The first 1000 days of life are defined as the time in the womb and up to the second birthday. In my reading, I learned that an entire nation’s future is determined by the quality of nutrition and loving interaction in the first 1000 days of the lives of its citizens, when the vast majority of brain cells are formed and connections are made. Childhood malnutrition is often called a silent emergency, because it can be hard to see the damage it does to children around the world. The same is true of neglect and lack of stimulation. But midwives are in a perfect place to mitigate that damage, by educating all parents about the vital importance of the whole first 1000 days—not just the pregnancy and birth.

Here are a few of the things that are happening in the first 1000 days of life.

Building the Child’s Brain

Good nutrition during the first 1000 days provides the building blocks for healthy brain development. This starts with breastfeeding within the first hour of birth, something midwives understand, and we could extend our breastfeeding teaching with just a bit of extra effort. We could talk extensively about the power of breastfeeding to the growing brain and encourage continued breastfeeding throughout the first year, even after they officially leave our care. We can teach parents and the entire family how important to brain growth it is that they play with the baby, read to the baby, and stimulate the baby in positive ways. This should include lots of holding, cuddling, and baby-wearing, starting at birth and continuing through childhood.

Building the Child’s Health

The first 1000 days set the foundation for health for all the days that follow. Stress the vital importance of breastfeeding for the first year at least, and examine the possibility with the mother of pumping breastmilk for the baby if she must go back to work. Educate on how to make healthy choices for the weaning foods at six months of age and healthy first foods into the second year. The American Academy of Pediatrics now talks about the first 1000 days as a time that builds not just child health, but has a large influence on future adult health as well.

Building a Fair Start for the Child

The first 1000 days are a window of opportunity to enable each child to reach his or her potential. When I teach this to health professionals and parents, I often bring up images of a foot race. Children who did not have an optimal first 1000 days of life are starting farther back than the other racers. Focusing on the first 1000 days is a powerful tool for helping a child get a fair start in life that will make a real difference throughout life.

The Midwife’s Role

The first 300 or so days of a child’s life are in our care as maternity care providers. As midwives who have built a trust relationship with the parents, we are in a powerful place to positively influence the coming 700 days with our advice and support. We are uniquely situated to help parents by teaching them about the importance of the first 1000 days from the very beginning of their pregnancies.

What This Would Look Like

In America, most midwives discontinue care when the baby is six weeks old. Even though we might not give any medical care after that point, we are certainly free to share advice and encouragement for the new family. Even just stressing the importance of the concept with First 1000 Days handouts and posters on your walls will go a long way. During pregnancy, the midwife can share the language and the concept of the importance of the first 1000 days with the expectant mother and her family, making clear that this is a unique time to shape a child’s future health—physical, mental, and emotional.

In the birth centers we sponsor in the Philippines, the midwives work closely with our community health visitor, who follows up with all the babies, making a monthly home visit to weigh the child and make notes of growth and development milestones, along with any immunizations or illness, until the second birthday. These home visits throughout the first 1000 days allow us to give ongoing breastfeeding support and education on proper weaning foods and toddler nutrition, as well as a chance to encourage parents to stimulate their child’s brain by reading books and playing games.

Babies have only one start in life; as midwives, we can take even more responsibility to make it a strong one, for life, with this minor addition to our current role!

Vicki Penwell has recently created an online MEAC-accredited CEU course on this subject entitled: Midwives and the First 1,000 Days, available on the Mercy In Action College of Midwifery website for anyone interested in learning more:


About Author: Vicki Penwell

Vicki Penwell is known by many titles—midwife, educator, nonprofit founder and director, student, mother, Lola, and her least favorite: new widow. She divides her time between living in the Philippines and the USA while training midwives through the Mercy In Action College of Midwifery, the Mercy In Action Diploma in International Midwifery & Maternal/Child Health, and numerous seminars and workshops, including a 10-Day Learn and Serve held annually at her home in the Philippines. Vicki has a Masters in Midwifery and a Masters in Intercultural Studies and is currently finishing her second year of a doctoral program in Creative Leadership.

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