Midwives tapped for home births as hospitals deal with coronavirus patients

As hospitals in North America are either overwhelmed or on the brink of it, pregnant women are taking note of the shortage of facilities and trying to make alternative birth plans.
Libby Emmons Brooklyn, NY

As hospitals in North America are either overwhelmed or on the brink of it, pregnant women are taking note of the shortage of facilities and trying to make alternative birth plans. There have always been alternatives to hospital births, and women have been taking advantage of the extra-medical support system for years, but there is now concern among pregnant women for their safety in hospitals.

“We’re finding that people are wanting to be away from the hospitals because they don’t want to be exposed to the virus if they don’t have to be,” said Aly Folin, CPM, LM, of Minnesota’s North Star Midwifery. “Some people are saying that they don't want to take up space in the hospital.”

Moms who thought they had their birth plans all sorted out are suddenly worried that there’s no place for them in an overburdened medical system. Whether early in their pregnancies or nearing the end, women are trying to figure out their best strategy for a healthy birth.

As a midwife, Folin is well versed in the practices of preparing women for natural childbirth. Still, she knows that homebirth can be dangerous. “Everybody needs to birth where they feel the safest,” she said, “if someone doesn't feel safe doing home birth then that’s not a good plan for them.”

What’s happening now is that women may be more afraid of catching coronavirus in hospital than delivering without the benefit of modern medical tech. Many women are thinking that it would be safer for them to give birth at home. Things ramped up for Folin as things began to heat up with the spread of the coronavirus contagion.

“What I'm finding is that since last weekend,” Folin said, “is that I’ve gotten an influx of phone calls, emails, Facebook messages, from people asking ‘can you take me on late?’ Anywhere someone at 34 weeks to— I was hired by someone at 40 weeks and one day, she had a beautiful birth on Friday.”

She said that “Part of what makes home birth safe is that people are mentally and emotionally prepared, have developed a relationship with their midwife, and they're low risk medically.” Her late term mom who gave birth at 40 weeks and a few days had been planning a natural birth, albeit in hospital.

That mom’s concern was that her doula, who had been with her during her pregnancy, would not be allowed into the hospital as the number of visitors had been limited by the new regulations in place since the advent of the coronavirus. Doulas are not considered by hospitals to be essential members of the birth team.

Doulas and midwives are great advocates for birthing women. Doulas serve as prenatal mothers’ aids, helping women navigate a birth infrastructure that can be daunting, confusing, and scary. Midwives give women another route than the traditional western obstetrician. They can facilitate home births, deliver in birth centers, or depending on licensing, in hospitals.

A statement released from the New York Homebirth Midwives mirrored Folin’s concern. They say that “While homebirth midwives support every birthing person’s ultimate autonomy in choosing the birth space and attendant that feels safest to them, we also have reservations about the practice of ‘birthing in place,’ or choosing late in pregnancy or even in labor, to stay home without a skilled attendant and without any planning, education, or preparation.”

“While birth is a physiologic event, it does carry the potential for emergencies. Midwives are extensively trained and skilled in responding to emergencies (and have the appropriate medications and equipment to respond to them), but we are also highly trained and skilled in interpreting the warning signs that often precede them. The one on one expertise we provide in continually assessing and resolving elements of a labor that might otherwise result in an emergency is another important component of what keeps homebirth safe.”

Folin noted that a home birth is best for those who are low risk, which is defined as when a mom is carrying a single baby, who has her head down, without any pre-existing conditions like hypertension or gestational diabetes.

A big problem for the alternative birth infrastructure is the struggle to figure out how, and if, it’s possible to scale up to meet increasing demand in light of the influx of contagious coronavirus patients to the hospital infrastructure.

“In midwifery school, we always talked about out-of-hospital midwives as being the best people to take care of low risk people in low resource settings” Folin said. “We know how to take care of moms and babies without all the bells and whistles of hospitals. We talked about this in a theoretical sense, and now we’re talking about how to scale up as to how to take care of healthy birthing people who don’t need to be in the hospitals.”

“The problem is, we’re used to dealing with low numbers. The average home birth practice does anywhere from 2-6 home births a month, sometimes more if you have a group practice, or lower if you’re a one-person practice, and most of us are fully booked.”

Folin has her own concerns about her practice. “I find that I'm having to think about how many first time moms I want to take on. Their births can be longer and somewhat draining, and how many VBAC (vaginal birth after cesarean) I want to do, which are more involved.”

Her main concern is “how to conserve resources while also being able to help. It’s tricky for sure,” Folin said.

Pregnancy is not known to be a risk-factor for coronavirus, and there have been reports of children being spared the worst effects of the illness.

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