How midwives are supporting pregnant women amidst COVID-19

Amidst the COVID-19 pandemic, hospital visits are bringing greater and greater inherent risks, leaving many pregnant women searching for alternative places to give birth. As a result, many midwives are seeing an increase in clients looking to give birth at home or in birthing centers. According to the National Institute of Health, in the US, only about one percent of babies are born at home, but some prenatal care workers and experts predict that COVID-19 encouraging women to deliver outside of the hospital might cause a spike in the percentage this year.

Dorothy Lee, a Takoma Park resident who works as a midwife at BirthCare & Women's Health in Alexandria, VA, has seen an increase in clients coming to her practice who are already far along into their pregnancy. “We're not quite overrun, but there is a run of women who are looking for alternatives from the hospital,” Lee says. “The month of May is going to be very busy for us because I believe we took on about 10 new clients.”

Giving birth during the pandemic

Photo: Artwork of a masked midwife delivering a baby

Artwork of a masked midwife delivering a baby Photo courtesy of Shashi Arnold.

Even though many new clients are coming to her at the last minute, Lee believes many of them are not complete strangers to the idea of a home birth. Many of her pregnant clients have likely considered home birth but are now more serious about it as they wish to avoid the hospital.

“I think most of those women sort of contemplated doing a home birth at some point, but the social mores of this country… up until now, have been against home birth,” Lee says. 

Despite the fear Lee often sees around home births, due to mostly anecdotal complications, there is now greater reason than ever driving these women to her services. “Now with [COVID-19], all of a sudden women are like, ‘Oh, look at that. I thought about a home birth, maybe this is the time to do it,’” she says. “And so I think that’s the women that are coming to us,” Lee says. 

Lee’s practice has not changed its guidelines on what constitutes a normal pregnancy that the midwives can safely deliver out-of-hospital, even though they have accepted more clients since the start of the pandemic. 

“We don't deliver twins at the birth center or at home. We don't deliver breeches. We don't deliver people with preeclampsia, which is high blood pressure that comes because of the pregnancy,” Lee says. “We haven't compromised who we keep because of COVID-19. If they say they don't want to go to a hospital, that's their choice, but they can't stay with us if they're not in our protocols of a normal healthy pregnancy.”

While some women are turning to midwives like Lee to find alternative places to give birth, most are still going to the hospital to deliver their babies. Some women must deliver at the hospital because they have a high-risk pregnancy or need a caesarean delivery. Many others simply feel safer at the hospital or want to have the choice of getting an epidural at the hospital. 

Kelli Harkless, a midwife who usually helps with hospital births but is currently only seeing patients for checkups, understands why women fear delivering in the hospital, yet doesn’t think a home birth is the answer for every woman. 

“Out-of-hospital birth always has to be a very personal decision for someone anyway, and I think it probably pertains even more so now,” Harkless says. “I don't think the coronavirus means that everybody should be having home birth because there are a large portion of people who want an epidural, [and] they don't want to be able to feel all their contractions.”

For women that do deliver in the hospital, there are special measures in place to keep them protected from the virus, especially if a woman in the labor and delivery ward has COVID-19. “Generally if there's a woman in labor and she has tested positive for the virus, she's going to be on the same unit as the rest of the moms who will also potentially be in labor,” says Harkless. “They just have special rooms for them that are supposed to control the airflow… so that the airflow in that room is not getting to the rest of the hallway.”

Lee and Harkless are also working to keep their clients safe from the virus in their offices, and in Lee’s case, in the clients’ homes. First and foremost, they keep their workspaces and instruments clean by constantly wiping everything down with disinfectant. “We use a lot of bleach on instruments, and the table, and the doorknobs,” Lee says.

However, Lee and her coworkers have run out of their supply of bleach wipes and can’t acquire more, so they had to get innovative. “We don't have bleach wipes because they're gone, so we do a lot of making our own bleach solution and spraying it on paper towels and wiping things down. We're now starting to run out of paper towels.”

Additionally, Lee and Harkless always wear masks when with clients and encourage the clients to wear masks as well. “Everyone has to have a mask on, and that's including patients,” Harkless says. “We have the cloth ones on hand that we can give to people if they show up without a mask.”

Overall, both Lee and Harkless have seen that many pregnant women are worried about how to safely bring a baby into the world during a worldwide pandemic, so they are doing everything they can to support their clients in having the safest possible pregnancy and delivery.