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Pregnancy in the age of COVID-19 can raise a number of complicated, unexpected questions. With hospitals preparing for a boom of coronavirus cases and anxieties over potential transmission in institutions caring for infected patients, more pregnant Mainers are considering home birth.
“I think people are desperate to stay out of the hospital, both because they are trying to avoid infection and reduce pressure on the hospital system,” said Holly Arends Murphy, a midwife at Birch Moon Midwifery & Lactation Care in Penobscot.
Susi Delaney, a midwife at Red Tent Midwifery, said that limitations on the number of people that can be present for a birth at the hospital may also contribute to the increased interest in home birth during the age of the coronavirus.
“Most hospitals in the state have a limited number of people that can come into the hospital,” Delaney said. “Some [women] may have been planning to have a partner along with a sister or a mother or a doula — several people who are there to support them in multiple ways.”
Though there are many advantages to home births, especially during the pandemic, there are steps that need to be taken in order to make sure they are done safely and confidently. Here are tips from experts about how to safely plan a home birth in the age of COVID-19.
Make sure your pregnancy is a good fit for home birth
Home births are not appropriate for all pregnancies. Expectant mothers with pre-existing conditions like high blood pressure or diabetes, as well as certain conditions specific to pregnancy — such pre-eclampsia and gestational diabetes — are likely safer giving birth in a hospital. And with other conditions like placenta previa or placenta accreta, a hospital is a must.
Midwives will evaluate whether your pregnancy is a good fit for out-of-hospital birth at the beginning of their consultations.
“Certified professional midwives work within a scope of practice focused on normal pregnancy and birth,” Delaney said. “We can only provide care for a singleton pregnancy, when somebody is expecting one baby, not twins. We cannot provide care for somebody whose baby is breached. We currently cannot provide care for someone who has previously had a Caesarean.”
In the same vein, though, Delaney said to reflect internally and make sure a home birth is what you really, truly want for your pregnancy.
“Really assess what [your] reason is for considering switching to a home birth,” Delaney said. “If it’s simply coming out of a place of fear, we really would encourage [you] to evaluate it further. Simply switching to home birth out of a place of fear does not help home birth to be safe.”
Check your insurance
Check to see if your insurance covers home birth or out-of-hospital birth. For example, MaineCare does not yet cover care with a Certified Professional Midwife, or CPM. If your insurance doesn’t cover home birth but you are still convinced that it is the right fit for you, be prepared for the out-of-pocket cost.
“Usually, CPMs charge a flat rate for prenatal to postpartum, somewhere between $3,500 and $4,000, maybe a little more or little less,” she explained. “For a lot of our clients who have private insurance, it’s actually less than their deductible so having their baby out of hospital is actually cheaper.”
You may be able to find a midwife who is able to work with your financial limitations. Murphy said that some midwives are doing care pro bono or at a significantly reduced cost to make sure financial barriers are not a limitation to home birth, in the midst of a pandemic or otherwise.
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Find a midwife
One of the most important steps for any home birth is to find a midwife that is a good fit for you.
“You really want to feel like it’s a good relationship,” said Christine Yentes, founder and midwife at the Holly No. 7 Birth and Family Health Center in Bangor. “Our skill sets are very similar amongst the midwives in the state of Maine [but] how we communicate, how we build those relationships might look different.”
Yentes said that proximity helps, too, though midwives have a range of service radii.
“Make sure you’re choosing somebody who is a licensed midwife in the state of Maine,” Murphy said. “That guarantees a person has a certain level of education and practice with a certain scope.”
Right now, many midwives are swamped with home birth requests, so you may not have as many options as you once did. Still, Delaney recommends shopping around by calling a few midwives before choosing the one that is right for you. She said to ask questions about their background, experience, back-up plans in case they get sick and how they manage problems during birth like excessive bleeding or long labors.
“Asking questions about these things help get a sense of what that midwife’s style of practice [is and] helps a person figure out if they feel supported and safe with this midwife,” Delaney said.
If you don’t have time to shop around, though, Yentes said not to sweat it too much.
“A lot of times women will talk with a lot of midwives, but I don’t think that’s happening so much for women transferring late into care,” Yentes said. “[Still], it usually works out well.”
Practice social distancing
You should be doing this already, but make sure you are practicing social distancing — as well as proper hand washing and sanitizing practices — for the sake of the health of your midwife.
If you are coming from away, your midwife may ask you to quarantine for a period of time. Murphy said she is requiring clients coming from Massachusetts and New York to quarantine for two weeks before she sees them in person.
Prepare your home
Prior to the home birth, your midwife will provide you with a checklist or things to do before the big day — among them, choosing and cleaning the space where you will be giving birth and providing a few simple supplies, like paper towels.
Yentes said not to worry too much about keeping your home environment perfectly sterile, though.
“I don’t think they need to wear masks or gloves or anything like that,” Yentes said. “It’s just general cleanliness.”
Find a sitter
Though kids are usually allowed to be present at home births at the mother’s behest, most midwives are limiting the number of people that can be present at the birth — not just for your safety, but for theirs.
The exact rules will vary by practice, but make sure you will have someone to watch your kids while the birth is taking place, just in case.
“We’re asking for children to be with a family member if possible just to limit any possible contagion,” Yentes said.
Be prepared for a transfer to the hospital
Though midwives say that transfers to the hospital for home births are uncommon, it is possible that unexpected complications will arise.
“When certain risk factors arise that indicate there is a greater possibility of needing intervention, we end up going to a hospital,” Delaney said. “If someone has high blood pressure or they’re very stressed, that can contribute to a baby’s heart rate not being normal.”
As part of standard planning, midwives will be prepared for such a transition. However, in the age of the coronavirus, expectant mothers should be prepared that their midwives may not be allowed to go with them into the hospital.
Yentes said that the rules may vary by hospital in Maine — Northern Light Mayo Hospital in Dover-Foxcroft, she said, called to tell her that they will allow midwives into birthing rooms in addition to a support person — so check what the situation will be at your local hospital so you are prepared.
Also, be prepared that if you or someone you live with tests positive for the coronavirus, your midwife will likely not be able to help with the home birth and you will have to go to the hospital.
“Unless that person was quarantined outside of the home, and the mother had no symptoms, we’re not going to go into a home where someone has the coronavirus,” Yentes said. “I have a lot of clients I need to stay healthy for.”
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