Mollie Birney wasn’t planning to give birth at home unless something went wrong. But with coronavirus sweeping the country and the fear of hospitals soon being overrun with patients, things have gone more wrong than she could possibly have imagined. Birney – now in her third trimester – is preparing to deliver in the bedroom of her Los Angeles apartment.
Birney, a clinical coach, had been thinking about using a nearby birthing center as an alternative to hospital when cases of Covid-19 were first reported in the US in January. But she has since switched to a home birth.
“The deciding factor for us is largely the virus,” she said, noting that delivering in a birthing center would mean contact with many more people and potentially greater risk of exposure. “I might be rearranging deck chairs on the Titanic here, but if rearranging makes me feel better, then I’ll do it.”
Pregnancy is always hard, even in the best of times. But as hospitals across the country prepare for a surge of coronavirus patients, some in the worst-affected areas are taking extreme precautions to contain the spread of the virus, including barring family and doulas from the delivery room.
New York’s governor this week said women in labor would be allowed to have a partner in the delivery room with them in public or private hospitals, despite the added risks. But nearly a million women are expected to give birth in the next three months and doctors’ offices are being flooded with phone calls from concerned patients, unsure of whether to continue with prenatal appointments (doctors generally say yes), what plans they should make for delivery, and what would happen in the event they come down with Covid-19.
Research on pregnancy and the coronavirus is limited given its first appearance in China just months ago, and the Centers for Disease Control (CDC) advises pregnant women to follow physical distancing guidelines. So far scientists have found no evidence that mothers who test positive for Covid-19 can transmit it to their fetuses in utero. Pregnancy and childbirth do not seem to aggravate the typical course of symptoms.
Once the baby is born, the CDC recommends a temporary mother-infant separation for mothers who have Covid-19, and offers guidance on breastfeeding precautions.
“Be extra neurotic and extra overprotective and extra hygienic with your hand-washing and face-washing,” said Dr Harvey Karp, a longtime pediatrician and author of several blockbuster parenting books. “You have to plan for all contingencies.”
Ruthie Ackerman, a writer, writing instructor and content strategist in New York, is due to give birth in August. But in the era of coronavirus, she faces an exhausting set of decisions in a city that’s become the center of US cases.
It’s not just a question of whether she should keep going to prenatal appointments, using public transportation to get there. After major New York hospitals, including Ackerman’s, announced that they were completely restricting labor and delivery wards, meaning all visitors including partners would be barred from entering, Ackerman had questioned whether to scrap her birth plan and flee the state entirely.
Others have fewer options. Jennifer Wright, who is 19 weeks pregnant in Winchester, Virginia – a small city in the rural Shenandoah Valley – lost her job at a local small business that sells shampoo and body care products recently when she was deemed non-essential amid the coronavirus shutdown. She had to get on Medicaid to afford her prenatal visits, and while she would love to make a nuanced birth plan weighing the risks presented by coronavirus, right now she has more immediate concerns.
Wright has been quarantining with her three-year-old son. And though her boyfriend still has his job at a nearby restaurant, she’s worried he might lose it any day. “I’m struggling to keep food on the table and diapers and wipes for my son in the house,” she says. “I could really use a financial blessing. I have rent and bills due.”
Jada Shapiro, the New York-based founder of Boober, a platform pairing parents with maternal care providers, and the childbirth education center Birth Day Presence, has had to reinvent her practice practically overnight.
“Covid is definitely making isolation for new parents worse right now, especially when people can’t have their own family members come over and help them,” she said.
Shapiro is trying to help surround them in the only space that’s safe – virtual space – and she has met with a lot of interest. A recent webinar in which she interviewed a top obstetrician had 500 signups within a day of being announced, with people registering from as far away as Hawaii. “The silver lining to this horrible situation is we’re able to help people wherever we are,” Shapiro said.
But Audrey Stewart, a member of Birthmark Doula Collective in New Orleans, whose client base consists mostly of women of color who are lower-income, worries about equity in access when so many of her clients don’t have reliable internet connections or a steady phone plan. “I really do worry about people who are already vulnerable on the margins slipping through the cracks,” she said.
Stewart has also seen a huge rise in interest in home births. “It’s definitely happening several times a day that someone toward the end of their third trimester is calling,” she said.
Louisiana already has one of the highest maternal death rates in the country, and the risk is increased almost fourfold for black women. Given the increased risk of adverse outcomes for Stewart’s clients in particular, many feel it’s too scary to go into the hospital at a time when many are barring all but a single support person.
“Our clients are mostly really aware of the disproportionate risk they face when giving birth, so I think the thought of going into the hospital feels extra scary right now,” Stewart said. “We’re already operating in a state of crisis,” she added of her state’s high maternal mortality rate, “and now we’re layering another major crisis on top of that.”
Stewart seeks to accommodate those seeking home births when possible. But other health authorities have cautioned against making last-minute plans to have a home birth.
“The leading data seems to suggest that there are slightly higher infant mortality risks for home births, and there is a large risk of hospital transfer,” said Emily Oster, the Brown economist and author of parenting books. The risk of hospital transfer is about 30% for first-time moms in the US, according to Oster’s data.
“If you plan a home birth at the last minute, any risks like this are probably larger than they’d be for more advance planning. The Covid risks to pregnant women and infants seem to be small.”
Birney, who is about 10 weeks out from her due date but has a standing relationship with the home birth midwife she would use, says she doesn’t only want to weigh statistics when she makes her choice.
“I have to make my best educated choice … There’s only so much we can control.”
