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I’m far from the only pregnant person whom the pandemic has sent down the rabbit hole of newly considering home birth. For weeks, midwives who assist home births have been swamped with new requests, intensifying in recent days when two major New York City hospital systems — where, combined, about 30,000 babies are born annually — banned partners or other support people from delivery rooms. Robina Khalid, a licensed midwife and co-owner of Small Things Grow Midwifery, says her practice typically takes 70 to 80 clients a year for prenatal care and home birth; in the past week, they’ve gotten over 100 inquiries, most of them from people later in their pregnancies. “All of these people who are writing us, I want to help all of them, but there’s only so much of me to go around,” Khalid told me Tuesday. “And you have to weigh it against the risks to the community you’re already caring for.” Many midwives, she says, have already had to cut down on the length and frequency of in-person prenatal visits to avoid exposure to COVID-19 and, like all health professionals, are carefully apportioning protective gear.
Being physically unable to meet the demand isn’t the only concern home-birth midwives have about their sudden popularity, as Khalid wrote in an open letter on March 18 on behalf of the New York City Homebirth Collective. “As somebody whose whole job is to try to help people give birth in the most empowering, autonomous, peaceful, loving way possible, it is legitimately heartbreaking to think about people having to give birth from such a place of fear right now,” Khalid told me. But she and the other members of the collective are slightly wary of anxious latecomers knocking on their doors. “Fear and panic do not lend themselves to an empowering home birth,” Khalid wrote in the open letter. She explained their thinking and gave advice to people facing giving birth alone in a conversation that follows in condensed form.
If I’m reading your open letter about the sudden interest in home birth correctly, there’s a capacity question, and there is also a concern that not everybody who is contacting you is well-suited for home birth. So it’s not just the numbers, right?
Even before COVID-19, when we would consult with people about whether or not we would work with them as clients, we would always ask, what brings you to home birth? before anything else. In general, to me, fear of the hospital being the only response is sort of a red flag. Because giving birth at home is not just avoiding fear of the hospital. It’s its own experience. You have to be wanting that experience. You have to want and trust that experience of giving birth without, for example, pain medication. Or where there isn’t access to an operating room immediately. It’s a very different model of care. There’s an element of it that is really autonomous, and you have to want that autonomy. That’s not for everybody.
One of the things that many of the home-birth midwives agreed upon when we started to get all these panicked phone calls is that part of what our care involves is really getting to know our clients over the course of their pregnancies, which is one of the ways we keep births safe. We really understand that person, and they really trust us. That becomes really difficult in a situation where people are coming to you because they’re scared of the alternative but they don’t really understand you as a medical professional who they trust, either. And it’s hard to develop that relationship over Zoom in two weeks.
How many additional patients do you think it’s possible to take, and under what criteria?
I can only speak for my practice, and we were already filled to capacity for the two of us. We just set up an automatic email for when people inquire that says we’re full through, for us it was to September. We’re only writing back to people who are due September or later. We also have that as a message on our voicemail now because it was too much to write to everybody individually. Another midwife practice that does not have an assistant to answer email just isn’t writing back, period, anymore. There’s just too many of them. Some midwives are taking maybe one, maybe two. There are some people who have considered an April or a May. For most of us, nobody has room before June, is the sense that I’m getting.
What I think is telling, interestingly, is that while the hits to the New York Homebirth site have gone up 300 percent this week, most of us are getting increased questions about April and May. Not so much the summer, and not so much the fall. Which to me is saying that most people are hoping that things will be back to normal in the fall.
Have you heard of folks refusing to go to the hospital because of COVID-19?
Another midwife told me that a week ago, a doula called with someone who was essentially pushing … We have no idea how the labor is going at that point or how that person’s health and care was about that point. We know nothing about that person. Part of keeping ourselves safe so we can take care of the people we already committed to take care of is to lessen the risk of transmission to us so we’re not taken out of commission. To go to a stranger in labor is not safe for anybody.
And when you’re just birthing in place [unassisted], you don’t have any support or education or what to expect. For many people, it’s not a viable solution. They run the risk of not knowing what physiological birth is like, not knowing what’s okay and what’s not okay, and potentially overstressing a hospital by showing up when something is going wrong.
You wrote in your statement, “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.” But the hospitals have changed, right, from when people made their decision? We don’t know if there are asymptomatic patients, if providers have been exposed, or there’s not enough protective equipment.
We hear that. At the same time, if people don’t trust the space of home to give birth in, people are going to end up needing to transfer to the hospital. Not for emergencies but for things like failure to progress or diagnoses like that, which then overstresses the hospital system and us. Because people aren’t questioning their long-term choices, to me that says that the baseline is still that the hospital is the safest place. One thing we all should be thinking about in light of this is whether we should be questioning our tacit acceptance of the idea that the average pregnant person needed to be cared for in a space that houses sick people to begin with.
It certainly shows the fragility of the hospital system.
In our country, the hospital system is not that safe, as we’re learning from the lack of PPE [personal protective equipment] that we have. I think that there needs to be more pressure exerted on the powers that be in terms of changing these kinds of policies, because the truth of the matter is that right now, pregnant people are bearing the brunt of a systemic failure. What’s happening is that health-care providers are totally understandably scared because of the lack of PPE on their units. So they’re trying to control what they can control without necessarily a whole lot of evidence behind those recommendations. There’s fear driving those choices, and then that’s creating a potentially traumatic experience and probably a physically unsafe experience for a lot of people. There’s that petition going around, but I think people should also be making calls. I know there’s a lot going on right now, but these recommendations go against the World Health Organization and the New York State Department of Health. They really shouldn’t be happening. From what we understand how to decrease transmission to health-care workers, partners of pregnant people are not the problem.
What are the harms that you worry will come from these partner bans?
It will overstress an already-taxed nursing staff who are also scared and trying to function as best as they can, who are maybe getting floated to other places. Nurses can’t provide one-on-one care. They are caring for many clients at the same time. If clients don’t have a partner, it increases the burden on nurses, which increases the likelihood of transmission because there’s more face-to-face time with the nurses. The other thing is that we know this will increase interventions and poor outcomes because somebody is not with the patient at all times. We know that support increases the Apgar score of the infants. We know there’s something about decreased stress levels that has physiological consequences.
The hospitals who do allow partners will become overextended with people showing up in labor that they haven’t previously cared for. Or it’s going to force people to leave New York to go elsewhere, which is going to increase the spread of COVID, which is exactly what we don’t want to happen. And then the other question for me is that we know that New York state is the epicenter, we know our system is going to get slammed, we know that anaesthesiologists are going to get pulled to intubate people, so what happens to those who are alone and have no access to any kind of pain relief [such as an epidural]? The fallout of this decision is so myriad. I really feel for people who are working in the hospitals. I worked in a hospital for years. I think that all of the fear and panic is really understandable, but I don’t think there was a lot of thinking through the consequences of the choice. Partners are people who are living with, eating with, sleeping with these pregnant people and are likely not an additional risk than the person themselves.
Do you have any advice for the people who aren’t going to be able to switch their plans and are going to have to give birth alone?
I think the thing that we need to remember above all else is that birthing people are strong and resilient. Even in times of fear. Even in times of war. Even with no resources at all, people find the strength within themselves to do this thing. I think that right now is a less than ideal time to be expecting your baby. It’s a really complicated time. I understand people’s anxieties and fears. I think that at the end of the day, they have to lean into the support they have before they get to the hospital. To labor at home as much as they can with the people they love. And to just know that hopefully, especially with use of technology, they can have people with them virtually. And ultimately, they can do this and this can still be a hugely important, beautiful, special happy moment in their life. To remind people that babies, no matter what context they’re born in, are a really beautiful reminder of the inherent hope of our lives.