By Allesandra Plourde
The coronavirus pandemic has affected more than 12 million people in the United States alone and of these people affected, pregnant women are at a higher risk according to the World Health Organization. As of mid-November 2020, the Center for Disease Control and Prevention CDC reported there were 40,000 cases of pregnant women with COVID-19 in the United States.
During quarantine and well after stay-at-home orders were lifted pregnancy and the birthing process have become even more stressful. Hospitals have had to limit visitors and test all patients admitted to the hospital making pregnancy and delivery difficult for some patients.
Pre coronavirus pandemic The American College of Obstetricians and Gynecologists reported that 0.9% of births occur at home. Since the pandemic some midwife practices have seen a surge in calls. The American College of Obstetricians and Gynecologists does not deter any expecting mothers from at home birth.
Gaia Midwives, a full scope midwifery practice in Long Island, New York, has witnessed an increase in calls for transfer to home birth firsthand.
“We did see an uptick in calls and I would say the general mentality toward home birth has shifted a little bit to not just one of ‘oh it’s something you can do for fun’ to ‘hey this might not be the worst idea ever,’” Collen Heinze owner of Gaia Midwives, certified nurse midwife and women’s health practitioner said in an interview.
“We have actually seen an increase throughout the fall and through next year already, our numbers are on track to be 30% higher than they were this year,” Heinze said.
Gaia Midwives have taken precautions to protect their midwives, they are required to wear masks when they enter the client’s home but do not require any of their clients to wear masks or be tested. They don’t require their clients to be tested because they ask clients to shelter-in-place before the birthing process. “It’s hard to birth as it is and it’s even harder to birth mask up,” Heinze said.
The mentality from COVID-19 has changed the way mothers to be view at home birth, “I think that a lot of the fear surrounding COVID drove a lot of people into the home setting versus a trust or a desire to be at home,” Heinze said, “there is a difference in that mindset going into birth.”
Heinze said that at home births isn’t necessarily a better option but it is a safe option for those who want to try it regardless of COVID. It is for, “people who are looking to take back their autonomy and their ownership of their birth process,” Heinze said.
“The home setting you set the standard for what happens within your home,” Heinze said. “When people come to our practice, they are looking for just to have a say in what happens to them and what happens in the time surrounding their birth.”
Since the COVID restrictions this ideology of taking back birth into the home has been increasing, Gaia Midwives has been trying to keep the idea that home should be the safe space and not just be a last resort because of fear of the hospital restrictions. “They are not so worried about the disease itself, as to the risk of losing their support person,” Heinze said.
For those mothers of Gaia Midwives who do choose hospital births, Gaia recommends Stony Brook University Hospital, one of the only hospitals in the Long Island area who did not take away a single support person and allowed doulas back in as licensed professional birth workers.
“Now they can have their partner and a professional labor support person with them and that is regardless if they are a midwife patient or an OB patient,” Heinze said.
Heinze says clients are still on edge about the loss of support during birth, “there is definitely a fear that would be taken away from them again in the future.”
Due to the single person limitations in hospitals there has been an increase in breastfeeding rates.
According to the CDC in a study they conducted about the implementation of, “Hospital maternity care practices and breastfeeding support in the context of the COVID-19 pandemic” for the months of July to August 2020, they reported of 1,341 hospitals they studied, 11.3% of hospitals experienced an increase in breastfeeding since the start of the pandemic, 12.2% experienced a decrease, 68.9% experienced the same rate of breastfeeding and 7.5% said they don’t know.
“I have heard from other midwives that are hospital based primarily in our area that they feel like their patients are enjoying their postpartum period in the hospital a little bit more because its quieter,” Heinze said. “It has increased breastfeeding rates and decreased the number of babies that are being admitted for jaundice.”
“Being a home birth practice, we have a 98.9% breastfeeding rate within our practice, so we haven’t seen a change personally, but I have heard it from my hospital-based colleges that it has actually been a benefit to women,” said Heinze.
Sara King was a labour and delivery nurse at Langley Air Force Base hospital. Langley is a low-risk hospital for pregnancy which means they do not accept any deliveries below 35 weeks because they do not have the facilities to care for the premature babies.
The hospital is allowing one support person to be with the mother during her birthing process. “That person had to be the same once they were admitted and that person can’t swap out,” King said in an interview.
“We also had moms who had to choose between their parent being in the room or their spouse and a lot of the moms want their moms to come on the floor and they can’t do support persons swapping,” King said. “Once that person is chosen that’s the only one from the beginning to the end.”
Langley being an Air Force Base the hospital deals with many military families and this can be difficult with the COVID single support person restrictions, “Especially for the parents, being military, we have a lot of people in Virginia who don’t have family in Virginia,” said King. “It’s just them and their spouse and many of them have kids so their spouse would be their support person, but we wouldn’t allow children on the floor. So that spouse would be taking care of their children and at that point the mom is alone.”
Amber Wilson is a certified nurse midwife also at Langley Air Force Base hospital. “I would say the biggest change is having to wear personal protective equipment (PPE) for every patient encounter and we are only permitting one support person for labour and birth,” Wilson said in an interview.
Wilson said that there is a lack of connection sometimes with the patient because of the protective gear, “I am sad that families cannot see our faces and I do feel that takes away from the experience that is supposed to be so special,” Wilson said. “But also no one is complaining, and everyone understands it’s necessary for safety.”
Both King and Wilson said that Langley has prepared their expecting mothers well for a single support person during birth, “I think they did a really good job in our pre-natal clinic where they got their pre-natal care prepping them for that, so it wasn’t such a big deal when they got to the floor,” King said.
Despite COVID-19 many patients are comfortable and still seek delivery at a hospital, Brooke Murray a mother of four just recently, as recent as last week, gave birth to twin daughters. She delivered at Sentara hospital in Williamsburg, Virginia where she had previously given birth to her sons Tucker, 4, and Preston, 2. Her support person was her husband.
“They don’t have a NICU (Neonatal Intensive Care Unit) at Sentara, so if they [the twins] were before 35 weeks, I was going to have to go either Norfolk or Richmond,” Murray said. “That was a little bit stressful because I didn’t want to have to think about that, I didn’t want to have to worry if they came early.”
Murray was lucky in that the twins were past 35 weeks and she was able to be induced for birth the day she had planned but she had to be induced in the OR in case of complications. This was lucky because she ended up delivering one baby vaginally and the other through cesarean section. “I had to recover from both which was the worst-case scenario,” said Murray.
In terms of COVID restrictions in the hospitals Murray said since she didn’t deliver in the height peak—March and April—so there wasn’t very much that was different.
“The only thing that I noticed that was the biggest difference was when you went in the hallways it was dead quiet, everyone’s doors were closed.” said Murray. “There wasn’t a lot of people walking around, probably because the visitors weren’t there because usually you see them in the hallways and little kids running around.”
“When I was going through the hallways, they made sure I always had a mask on. All of the nurses and doctors had masks on but other than that I didn’t feel all that different,” Murray said.
The other difficulty for her was also the lack of family that was allowed to be there with her, “The boys weren’t allowed to come see them [the twins] in the hospital,” Murray said. “That was something we definitely missed, that time to get the kids together in the hospital and take the family pictures there. Kind of like the first time they get to meet your sisters and my parents couldn’t come.”
Murray chose to give birth at the hospital because it was where she was most comfortable. She had gotten COVID tested the Friday before her induced labour date and this eased the pressure of delivery day complications.
“I feel like if something happened with a home birth and it’s an emergency, you have to go to the hospital, then you’re going through the ER and all these people who are in the waiting area,” Murray said. “Compared to walking in already having done the tests and are clear, even before COVID with home births in general I couldn’t imagine if something went wrong. I would rather be at the hospital.”