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Like many other states, Maine’s healthcare system has faced unprecedented challenges in the face of COVID-19. One of the perhaps unexpected side effects of the pandemic, though, is that more pregnant Mainers are considering home birth in the age of the coronavirus.
“People giving birth are really the only healthy people going to hospitals, and that’s just magnified now,” said Holly Arends Murphy, a midwife at Birch Moon Midwifery & Lactation Care in Penobscot. “If we can move healthy people out of the hospital to do a healthy thing like have a baby, [we] leave the beds in the hospital for people who really need them.”
According to the Maine Centers for Disease Control and Prevention, scientists do not yet know whether a pregnant woman, her fetus or a newborn child are more at risk for COVID-19 infection than the general population, nor are they sure whether COVID-19 can be transmitted in utero from the mother to the fetus (though newborns in Connecticut and Louisiana have died due to the virus, the latter after being born to a mother who tested positive for COVID-19).
Still, the increase in inquiries for some midwives in Maine has been drastic over the past few weeks. Murphy said that last week, over a two day period, she received eight new inquiries for home births. In a normal year, she might conduct 20 home births total.
Midwives attribute the influx to both an increase in fears surrounding the coronavirus, the limitations that hospitals have placed on the number of visitors that can attend a birth as well as the rush of Bostonians and New Yorkers self-isolating in Maine that Murphy said are having their babies here.
“If I have someone coming up from Massachusetts or New York, I’m asking people to quarantine for two weeks before I see them in person,” Murphy said.
Quarantine requirements are not the only adjustments that Maine’s midwives have had to make over the past month or so. Between telehealth visits, expedited fights for insurance coverage and shifting emergency protocols, midwives say that even home-based health care has transformed in the age of the coronavirus.
Social distancing in home births
Like everyone, midwives are practicing social distancing, self-isolation and self-quarantine.
“Even though I’m seeing people for prenatals, outside of that, I’m not going places,” said Christine Yentes, founder and midwife at the Holly No. 7 Birth and Family Health Center in Bangor. “I don’t think I’ve been to the grocery store in two weeks. I’m really trying to limit my interactions with the public at large.”
Most midwives have shifted to primarily telehealth visits rather than in-person visits in order to reduce the potential for infection. Remote visits aren’t just a change for midwives, though. They also require that patients conduct certain simple measurement and monitoring tasks that would normally be performed by the midwife.
“I and other [midwives] have put together self-assessment packs with dopplers and blood pressure cuffs and [have been] dropping them on people’s door steps so we can do those telehealth visits,” Murphy said.
There are certain elements of care that cannot be administered virtually, though, particularly after the third trimester.
“Some of the assessments we do during prenatal visits are check blood pressure, feel the baby’s position, check heartbeat and measure the growth of the uterus,” said Susi Delaney, a midwife at Red Tent Midwifery. “A few of those are difficult to do accurately consistently without having good training.”
For that, midwives are still conducting home visits, though they are extra careful about the potential for exposure.
“Initially, we meet virtually before I come into the house, using a HIPAA-compliant telehealth platform to maintain confidentiality,” she explained. “I sit in my car, have my laptop up and chart answers and conversation. I also have been providing education to clients on ways they can reduce their essential exposure.”
Building relationships remotely
Part of the unique challenge for midwives working remotely is not being able to form in-person connections with patients.
“A lot of our care is based on building relationships,” Murphy said. “That’s challenged right now, to tell you the truth, when I have people who come in late or I can’t be in the same room with. We are adapting.”
For her practice, Murphy said that holding more frequent telehealth visits is important, and that she welcomes texts and phone calls about whatever emotions or physical sensations are coming up for her clients.
“It’s a challenging time to be in the world and it’s an even more challenging time to think about bringing someone else into the world,” she said.
Yentes said this is also a concern for postpartum care. She said that monitoring both healthy development for the baby and health of the mother with issues like postpartum depression is challenging when they are limiting the amount of in-person exposure they can have with their clients.
“We’re still going back for the postpartum visit that we do at the home, but we’re leaving a scale and sling so we can do tele-postpartum visits as well,” Yentes said. “It’s not the same as in person. You really pick up more in person than you do over the phone. We’re still trying to give the best care that we can while keeping everyone safe.”
With the increased urgency and demand for home births in light of COVID-19, midwives have also been ramping up their ongoing fight to have insurers cover care by a Certified Professional Midwife, or CPM.
“I think many more would [pursue home birth right now] if their insurance would cover it,” Yentes said.
Yentes said that even before the pandemic, midwives had been fighting for new rules and regulations at the state level to require insurers to cover out-of-hospital births. She said there have been talks of expediting the new rules given the increased interest in out-of-hospital births and need for easing pressures on the healthcare system.
“We were supposed to have a public hearing, but we obviously can’t do that right now,” Yentes “It’s out of our hands. Most of us midwives would be ok if they expedite them so we can get passed and insurance could be behind women making those choices.”
Given that the state is “up to its neck right now” and there may not be motions on expediting the process in the near future, Murphy said that some midwives are currently working within potential clients’ financial limitations.
“A lot of midwives are doing care pro bono or at a significantly reduced cost,” she said.
Home birth in the age of the coronavirus
Like hospitals, midwives are also limiting the number of people that can be present for in-person appointments, as well as the birth itself.
“Normally, we let more people come to prenatals or to births, but we’re limiting the prenatals to just being the mama and two people can be at the birth center or at the home birth,” Yentes said. “We’re [also] asking for children to be with a family member if possible just to limit any possible contagion.”
Delaney said that the exact rules will vary by practice.
“Each practice has established their own guidelines,” Delaney said. “For my practice, I’ve asked only the essential people to be there. We’re trying to reduce our exposure, too.”
Midwives are taking extra steps to make sure everything is extra sanitary, too.
“I completely redid all my equipment,” Delaney said. “Instead of having things loose in a bin, everything is in Ziploc bags so it’s really easy for me to sanitize everything that’s been utilized.”
Midwives say that one of the biggest new challenges is not being able to go with patients in the event of a hospital transfer — a rare occurrence, but a possibility all the same. Depending on the hospital, midwives might not be allowed in if the mother has to be transferred to the hospital.
“All those great protocols we’ve had in place to provide support have had to be adapted,” Delaney said. “We can provide virtual support if a client needs to be transferred in most cases.”
Yentes said a few hospitals have contacted her about their special requirements.
“[Northern Light Mayo Hospital in] Dover-Foxcroft called me and said if we had to transport somebody to that hospital, they would still allow a midwife in and they wouldn’t be considered the support person,” Yentes said.
Still, though, Yentes said that births in the age of coronavirus — so far, she has helped facilitate three “beautiful,” “awesome” births — add a touch of normalcy to unprecedented times.
“There is still normalcy within the unprecedented,” Yentes said. “The babies are still coming out, they’re still nursing, they’re still doing everything they’re supposed to do. That’s kind of reassuring. Here’s something that’s happening that’s still normal.”
Watch: What does returning to normal look like?