Pregnant for COVID 19: Choosing to Give Birth at Home During the Pandemic
Across the country many pregnant women are facing a difficult decision: where to give birth during a rapidly changing, global healthcare crisis? Hospitals are facing increased need for beds for sick patients and hospital birth centers are implementing protocols which may change a woman’s birth plan. Many women are choosing homebirth. Some women are accessing midwifery care days or even hours before going into labor.
Homebirth is a safe option for low-risk women and the norm in many countries with excellent healthcare statistics. Healthy women over 35, women who have had a previous cesarean, and women carrying twins are also candidates for homebirth. For high-risk women, with underlying medical issues or complications during the current pregnancy, giving birth in the hospital is still the safest option.
Midwives are experts on normal, physiologic birth. A Midwives of North America (MANA) study, published in 2014, which examined nearly 17,000 courses of midwife-led care found that “low risk women who plan home births have fewer interventions without an increase in risk to mothers or babies”. Many local midwives, including myself, contribute to MANA Statistics which collect this data to study midwifery outcomes. Especially noteworthy is that the cesarean rate is 5.2% for midwife-led care in comparison to a 31% national average for full-term pregnancies. Women in midwife-led care groups also had a marked decrease in interventions including fewer episiotomies, Pitocin for labor induction and augmentation, and epidural usage.
Midwife-led care during pregnancy (per MANA stats) also leads to more babies carried to full-term (97%) and being breastfed (98%) at the six-week postpartum visit. We have a wide knowledge base which supports that carrying to full-term and breastfeeding are huge factors in not only neonatal health but lifelong health and well-being. Midwifery care provides nutritional counseling during pregnancy and individual lactation support which contribute to these statistics. Babies are not sterile before birth, but at the time of birth, bacteria from the mother and the birthing environment provide the basis for their gut health and protection against disease. Giving birth at home benefits your baby through colonization by the microbiome found in your home; those bacteria to which you develop and pass on immunity to your baby, rather than foreign microbes.
Midwives practice informed choice; giving women/families information about their options to make educated and individual decisions. Obstetrical laboratory tests and ultrasound studies can be ordered by midwives. Many midwives are also experienced with herbal, homeopathic, and other natural healing modalities. In addition, licensed midwives carry pharmaceutical medication, IV supplies, and oxygen. Midwives are trained in both neonatal and maternal resuscitation, administration of obstetric pharmaceuticals and IV fluids, and suturing. Though many birth complications can be cared for at home by competent midwives, there are rare circumstances when increased transport time to hospital during an emergency can increase morbidity. Generally, if transport to hospital is indicated there is adequate time to go by private vehicle to access care needed in a non-emergent manner.
It is a good idea to know what your closest hospital’s current policy changes are in relation to COVID-19. Most hospitals are limiting to one support person, over 18 and without symptoms. The American College of Obstetrician and Gynecologists (ACOG) recommendation is to separate moms and babies with positive COVID-19 results or presumptive COVID-19 by symptoms or through exposure risk.
Fortunately, we live in an area with several well-trained and experienced midwives who are ready to meet the increased demand for homebirth locally. We are co-creating protocols to keep ourselves and the families whom we serve healthy, and attending statewide and national obstetric meetings to stay current on recommendations. Many of us are opening our practices to late transfers who are choosing to birth at home given the current healthcare circumstances. Oregon Midwifery Council’s website has a Find A Midwife directory, as does Southern Oregon Birth Connections.