An Open Letter to the Birth Community Regarding COVID-19 and the Increased Interest in Homebirth From The New York Homebirth Collective March 18, 2020 © Robina Khalid
The care homebirth midwives provide is rooted in a genuine conviction that, for low risk individuals, birth at home is the safest option. This is not simply a philosophical attachment to the idea of “natural” birth. The evidence associated with planned homebirth with a licensed provider demonstrates a reduction in medical or procedural intervention while maintaining excellent outcomes for infants and birthing parents. (Cheney, 2014; Scarf 201). Physiologic birth has been repeatedly shown to carry benefits including but not limited reduced morbidity for both parent and infant; an effective respiratory transition for the baby; less genital tract trauma; reduction in likelihood of chronic disease related to cesarean birth/delayed breastfeeding; and decreased incidence of postpartum depression (Buckley, 2015).
During this time of unpredictability surrounding the global COVID-19 pandemic, many pregnant people are feeling understandable anxiety about what it will look like to give birth in, and bring life into, such a world. Many are grieving that what they hoped would be a time of joyful and loving anticipation has become one of fear and uncertainty. There is also rightful anxiety about giving birth in a hospital housing COVID-19 patients, as well as anxiety about hospital policies to contain the virus, such as limits on the number of support people, the wearing of masks during labor, and potential for separation from their babies. Some may be wondering if avoiding the hospital altogether is a solution to these worries and concerns. We empathize with the weight of these concerns.
We homebirth midwives are first responders committed to caring for clients in all situations including disasters and crises of all kinds. We believe homebirth remains a safe and viable option during these times. We as a community have been working closely together to develop protocols and support systems that allow us to continue to provide a high caliber of care without interruption as much as possible.
Part of what keeps our care safe now, in the time of COVID-19, is to prioritize our resources. Most of the homebirth midwives in NYC have full practices and do not have the ability to take on a meaningful amount of new clients at this time. We are not an institution that can absorb a large influx of birthing people. We also do not have access to the protective equipment that institutions provide to their providers. We are reliant on the market to order supplies – a supply chain that is rapidly dwindling.
In order to keep providing high quality, safe care, our own health and ability to serve one another in times of need are also resources we need to prioritize. Midwives, like any health care provider, put their own health and the health of their families in jeopardy every day to take care of clients no matter the circumstance. The nature of our jobs is that we cannot socially distance. The reality is that some of us will become ill during this time. Without an institution behind us to take care of our clients if we are ill, we need to rely on each other. Therefore, we have a responsibility to maintain a manageable client load so that we may support each other and keep homebirth accessible to those who have been planning for it.
That planning is in fact a significant factor in the safety of homebirth. The careful screening of clients before and during their care, as well as the developing of a relationship of trust over time, helps ensure the best outcomes for parent and baby. This not only involves medical screening in order to make sure the birthing person remains low risk throughout their pregnancy. It not only involves partnering with the birthing person to promote well being through nutrition and lifestyle. It also, importantly, involves facilitating emotional preparedness. Throughout pregnancy, we process fears and anxieties about giving birth. We develop strategies for coping with the intensity of labor and birth without analgesic medication. Clients are advised to take childbirth education classes to fully understand the physiology of normal birth. Many secure a doula. All of this work and emotional preparation make homebirth safe.
People choose to have a homebirth because they seek autonomy in their pregnancy and birth, because they believe home is the safest place to give birth, or because they desire to experience all that homebirth offers, from the intense and challenging to the joyful and transcendent. Fear and panic do not lend themselves to an empowering homebirth. This is true generally and it is true now during what is unequivocally a scary time for so many of us. If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth. Birth is a physiologic process that is greatly impacted by one’s environment and one’s emotional state. For most people, the two are inextricably linked. Homebirth with a client who does not fundamentally trust their location of birth place is unsafe for both client and midwife.
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.
In sum, we believe that the anxieties and fears birthing people hold surrounding birthing in hospitals during a pandemic need to be addressed by the systems those people originally entrusted with their care: the hospitals themselves. It does not serve birthing people to birth in a place they do not trust is safe. Pressure needs to be placed on the hospital system to provide creative and humane solutions to these understandable anxieties. Given the evidence that having a doula improves outcomes for both parents and infants, guaranteeing entry to doulas as an essential and irreplaceable member of the birth team is one measure to allay these anxieties. Reducing the length of postpartum hospital stays and allowing early (6-12 hour) discharge with appropriate medical postpartum care may be another.
If pregnant people still feel compelled to investigate their options for out-of-hospital birth, they may explore the myriad resources provided by nyhomebirth.com. If after diligent and thoughtful research, the autonomy and safety of homebirth remains appealing, pregnant people are always are welcome to contact individual practices, with the understanding that most practices book up far in advance.
References Buckley, S. J. (2015). Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. The Journal of Perinatal Education, 24(3), 145–153 https://doi.org/10.1891/1058-1243.24.3.145 Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of care for 16,924 planned home births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health, 59(1), 17–27. https://doi.org/ 10.1111/jmwh.12172 Scarf, V.L., Rossiter C., Vedam, S., Dahlen, H.G., Ellwood, D., Forster, D., Foureur, M.J., McLachlan, H., Oats, J., Sibbritt, D., Thronton, C., Homer, C.S.E. (2018). Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery 62:240-255. https://doi: 10.1016/ j.midw.2018.03.024