Midwifery has long-been viewed as a reliable source of maternal care for low-risk expectant mothers and their families, and while there are still many people who aren’t completely aware of their birthing options, more people are exploring birthing plans that allow them to deliver at home or rather than the hospital.
Fears over transmission of COVID-19 and strict visitation guidelines in hospitals are causing many families to seek the services of midwives so they can birth at home and now, more obstetricians are referring expectant mothers to midwives as the medical community works to provide maternal care and COVID-19 relief effectively.
Some hospitals have begun to ease restrictions on visitation guidelines, but midwives are still receiving more inquiries for home birth as some families explore birthing options outside of the hospital for the first time.
Changes to Home Birth During COVID-19
While much of the way midwives provide care remains the same during the COVID-19 pandemic, there are certain aspects of midwifery care and home birth that are changing to prevent the potential spread of the virus.
The World Health Organization changed their recommendations about how frequently pregnant women are seen for prenatal visits, and according to Dr. Elizabeth Winter, San Diego’s robust midwife community is taking the COVID-19 outbreak very seriously. “I would say all of the home birth midwives that I’ve connected to professionally have really changed their practices,” she says. “The majority of the midwives I know have adopted those recommendations with more telemedicine and less in-person appointments.”
Winter is a certified professional midwife, a licensed midwife and a naturopathic doctor and is the founder of Mosaic Integrative Medicine in San Diego where she provides integrative medical care and provides prenatal, intrapartum and postpartum care. She completed her medical training at Bastyr University in Seattle, WA which offers one of the only master’s programs specializing in midwifery in the country.
She says that she and other midwives are also limiting contact with some family members and partners throughout the birthing process, which challenges the way midwives usually practice. “I think almost every midwife sees birth as a family, community and social experience, so to have to exclude members of the family, in any case, is a real shift for a lot of people.”
For most midwives, the job isn’t finished even after a baby is born. Postpartum care is a critical aspect of most midwifery practices, and some midwives are also adjusting the way they provide postpartum care with less in-person visits. “Very few postpartum care visits are in person and if the mother ends up being transferred to the hospital, that also impacts whether their postpartum visits end up being in person which is also a real departure from how I think most midwives want to practice,” says Winter.
Access to Medical Equipment
Most midwives are wearing masks and other protective materials they wouldn’t normally use, but according to Certified Professional, Licensed Midwife Lauren French Hoy, she and other midwives had trouble getting gloves and other equipment usually found in birthing kits. “Sometimes they’re not sending everything that would usually come in a birthing kit you order because they’re trying to make sure that they don’t run out, or some places are limiting how many times you can order in a month.”
French Hoy is the founder of madreluzLA in Los Angeles, CA where she supports families with prenatal, intrapartum and postpartum care. She also earned her masters in Science in Midwifery from Bastyr University and went on to complete an additional master’s of science in midwifery from Bastyr years later to fortify her clinical skills.
Both Hoy and Winter report increases in the number of inquiries they’re receiving for home birth care during the pandemic and they say they’re going as far as helping clients to get blood pressure cuffs and dopplers so families can monitor their vitals throughout pregnancy without as many in-person meetings. Hoy says that a benefit of home birth is the opportunity for families to become more educated about pregnancy, the birthing process and managing their health. ”I’ve always taught my clients how to use those anyways, so now I’m teaching them a little bit earlier,” she says. “I think it’s empowering for them to learn more.”
Changing Birthing Plans
Some families who originally planned to give birth at the hospitals are adjusting their plans so that they can birth at home with less worry about viral transmission or having to go through the experience without their support system. Winter and Hoy both say some of the inquiries they’re receiving are from people who are changing their birthing plans during COVID-19 and that if midwifery care is available in your area a change isn’t out of the question. “I don’t think that there is anything inherently problematic with that,” says Winter. “Many women have that thought at some point in their pregnancies anyway—they’re thinking: ‘Is this the right choice for me? Is this what I want, and does it align with my values?’”
Many midwives help expectant mothers focus on mental preparation that helps them through their home birth and Winter mentions an important consideration for people that are thinking about adjusting their plans. “Home birth is not just about a location—it’s philosophy,” says Winter.
The idea of changing birthing plans during a pandemic can seem daunting, but there are a number of things families can do to aid their success as they explore different birthing options. Lauren French Hoy recommends obtaining medical records ahead of time and also says that focusing on emotional support can help ease the transition. “For moms that are coming later, I’m trying to refer them to classes that focus on the emotional side because it is hard to let go, and the nice thing about home birth is that it allows the time and privacy for that,” she says. “It takes time, because to open up mind, body and soul and let go—it’s almost like you have to let go of your life story as you begin a new journey.”
Key Differences Between Hospital Birth and Home Birth
According to current World Health Organization and Pan-American Organization guidelines advise that expectant mothers with low-risk pregnancies should seek consultation with a midwife as an initial step when seeking care. Despite their low-intervention approach, Dr. Winter says the care they provide is evidence-based and wants to be sure people know what to expect and feel comfortable without potentially pain relieving medication or quick access to c-section. “Sometimes education can help with that, but I don’t think anyone should have to do anything outside the bounds of what makes them feel comfortable,” she says.
For many midwives the education they provide isn’t limited to equipment, emotional health and maintaining an intentional mindset. Hoy is available for her clients on-call 24/7 until six weeks postpartum and also spends time with her clients reviewing informed consent and risk to ensure her clients know the difference between giving birth at home versus in a hospital and can make informed and educated decisions about their pregnancy and birth.
“When you’re comparing a hospital atmosphere with a midwife, it’s different of course, but we’re both looking for good outcomes,” she says. “As a midwife I’m also looking for a very good experience for the mother, and I think it can become an opportunity for incredible empowerment for both the mother and family.”
Most midwives agree that doctors and interventions are sometimes necessary but the midwife community seems desperate to address lack of consent, overuse of interventions to decrease the number of traumatic experiences during birth. “When you look at the research, we’re seeing a lot of trauma and the lack of informed consent is alarming,” she says. “Especially for moms that might have had difficult experiences in their life. You can provide a safe place for them at home.”
Hoy stresses the importance of informed decision-making as a part of exploring birthing options and pregnancy no matter where families give birth. “Whatever is good for you and makes you feel safe, then that’s what you should do, but be really clear about what you want. There’s midwives and doulas who are flexible and I just want people to get what they want.”
Midwives played an integral role in birth and maternal care throughout history, and while they’re services have been underutilized in recent years, many communities are seeing a revival in public awareness with more expectant families seeking their services.
Dr. Winter hopes that this wave of interest in midwifery and home birth won’t stop after the pandemic and that more people will reexamine the way they view hospital policies and their birthing options. “That conversation should not stop when COVID-19 stops because I think it’s important that people are aware of home birth and do their research to see that it is a great option for low-risk women and maybe people will consider it outside of these circumstances.”