Some pregnant people want to switch to a home birth as the coronavirus spreads, but midwives warn a sudden change in plans could be risky

Crystal Cox/Business Insider

"The biggest fear is, 'I want my partner with me.' That's really the biggest one," Klein said.

• As the coronavirus pandemic continues to be a top priority for hospitals, pregnant people are becoming anxious about their ability to give birth on their own terms, with their partners or a support person present.
• Some are also concerned about protecting their babies-to-be from the coronavirus in hospitals which are dealing with coronavirus patients.
• As a result, midwives say they are seeing an insurmountable rise in requests from to help people switch from hospital births to home births on very short notice.
• But midwives told Business Insider that suddenly switching your birth plan could be dangerous and home birth environments are also susceptible to coronavirus spread.
• Visit Business Insider's homepage for more stories.

On the morning of March 26, Risa Klein, a well-known New York City-based certified nurse midwife, received a frantic call from a woman who was 33 weeks pregnant, begging Klein to assist her with a home birth so she wouldn't have to deliver in the hospital where she originally planned to have her baby.

"She was just about choking on her words, telling me she was planning on delivering her baby in a Westchester hospital, but now is desperate for me to deliver a baby at home. And I hadn't spoken to her before," Klein said.

The woman lived in Westchester County, New York, and her hospital had announced that, in an effort to stop the spread of coronavirus, it has now banned spouses, partners, doulas, and anyone else from entering the hospital with people who've gone into labor.

It is one of many across the country enforcing similar policies that restrict the number of support people allowed or ban them entirely. In Denver, Colorado, if a support person runs a temperature during a screening, they cannot enter the hospital with a loved one who is in labor. In Massachusetts, Mount Auburn Hospital in Cambridge is considering changing its single support person policy to none, and in St. Paul, Minnesota, and New York, New York, only one person is allowed into the hospital along with the person giving birth.

As a result, pregnant people are anxious about their ability to give birth on their own terms and protect their babies-to-be from infection-ridden hospitals. In an attempt to regain control of their birth plans, they're reaching out to midwives about home-birth options.

In normal times, a home birth can be safe for people with a low-risk pregnancy if it is planned in advance, though not all midwives agree

Klein, a certified nurse midwife with nearly two decades of experience, only assists births in a hospital setting - and she believes it's even more important to be in a hospital during the coronavirus pandemic.

"Some midwives believe that home birth is where they want to to help the families," Klein told Business Insider. "And then somebody like me believes that it's safer for a woman to give birth with a midwife in a hospital, pandemic or no pandemic, because minutes matter.

"God forbid there's a problem with a baby or a mother, you have the teamwork of obstetricians, maternal fetal medicine specialists, the equipment that's needed. So I believe especially in a pandemic, it is safer for the mother and the baby to be in the hospital."

Sarita Bennett, a physician, certified nurse midwife, and the president of the Midwives of North America Alliance, has a different take. She believes planned home births can be a good option for a pregnant person who is healthy and has a low-risk of complications, primarily because they are less likely to be rushed into a risky medical intervention like a C-section.

"The management model in the hospital that has led to our poor outcomes is nothing more than a corporate business model, and I understand it. That's what you have to do. Whenever you flip burgers at McDonald's, everything has to be the same and you have to control the flow. I get it," Bennett, who trained and worked at a hospital as a physician before becoming a midwife, told Business Insider. "What you get in home birth is care where the care is individualized to the family, to the person."

Research is mixed. Home births have fewer high-risk medical interventions than hospital births, according to a 2017 study, but the researchers also found that the mortality rate was higher for a baby if home-birth complications did occur. On the other hand, a 2019 meta-analysis done by researchers at McMaster University found that home births do not increase the infant mortality rate if they are planned in advance and the woman is considered low-risk for complications.

Giving birth in a hospital does not necessarily increase the risk of contracting coronavirus

During the coronavirus pandemic, the medical community's stance on home births hasn't changed.

Maureen Phipps, chief executive officer of the American College of Obstetrics and Gynecology (ACOG), told NPR that we are "at a disadvantage" because "the reality is we don't have a lot of data related to outcomes in pregnancy in women who have COVID-19 or their risk of contracting COVID-19."

However, a statement on ACOG's website says the organization "believes that the safest place for you to give birth is still a hospital, hospital-based birth center, or accredited freestanding birth center." Complications can occur in even the healthiest of pregnancies, ACOG said in a statement, so being in a place equipped to deal with those potential issues is the safest option.

"Every woman has the right to choose where she will give birth. But it is important to not take any risks that might put you or your newborn's health in danger, especially as there is a high risk for getting COVID-19. Talk with your OB-GYN or other health care professional about your birth plan and any concerns," ACOG's statement says.

Klein said that some of the pregnant people contacting her are voicing concerns about contracting the coronavirus in a hospital setting. But she believes that fear is unfounded: hospitals may be under-prepared to treat people with COVID-19, but they are taking safety measures to protect people in other wards.

"It's very well-controlled on labor and delivery floors. People are wearing masks, the appropriate PPE," or protective medical gear, Klein said.

The controversial no-visitor policies are an example that hospitals are taking serious precautions, she added. "Even though it's very emotionally-draining and women are going to have to be stressed, unfortunately asymptomatic partners had been coming in and testing positive, and then they run the risk of infecting their partner and their newborn."

Dr. Iffath Hoskins, an OB-GYN at NYU Langone Medical Center and the chairwoman for ACOG in New York, told Today.com healthcare workers are taking every precaution to keep all patients safe, pregnant women included. "We know that pregnant women have decreased immunity so we're very, very careful with these patients through the pregnancy," Hoskins said.

What's more, home-birth settings are still susceptible to the coronavirus.

If home-birth midwives travel from home to home, or if a pregnant person's family member has left the house or is asymptomatic, coronavirus has a chance to spread to these homes, Klein said.

If you are near your due date, midwives do not advise suddenly switching your birth plan

Although Bennett is a proponent of home births, she said that pregnant people attempting to switch their birth setting due to the coronavirus pandemic should rethink a swift change of plan.

Bennett said she wouldn't assist a last-minute home birth if the only reason for it was a fear of contracting coronavirus in a hospital.

"Being scared of the hospital is not really the best reason to have a home birth. You need to have a home birth because you understand it's safe and be committed to it," Bennett said. "So for me, that's the dividing line. I'm not here to rescue people and I'm not here to do their work for them."

By "work," Bennett is referring to measures pregnant people need to take to optimize their health for the best home birth possible without complications.

"If that means you stop smoking cigarettes, you stop drinking, whatever it is. It's individualized," Bennett said.

She also said people who choose home births "have to be willing to understand that there's no 100% guarantee of anything and that sometimes things happen and it's nobody's fault. [They] have to be willing to accept the reality that they can't blame people for the decisions they make. [Home-birth midwives] can't go out there on the line for people and then have them sue us."

There's a shortage of midwives, so switching to a home birth may not be so simple

Those who want to switch to home births last-minute will have to reckon with the shortage of home-birth midwives in the country.

Bennett said laws that make midwifery illegal in certain states have contributed to the lack of midwives available. Even if a pregnant person were to find a midwife in this climate, Bennett cautioned against switching to one out of desperation, rather than complete education and trust in home birth.

"Those are their options. Continue on with the current [hospital] system and accommodate it, or remove yourself from it and do the research, do it well, and take responsibility for yourself, because that's what this is really about."

According to Klein, even if a person is only early in their pregnancy and has ample time to switch birthing locations, it's not a good idea.

"I don't believe that any gestation period makes it correct for a woman to change her mind," Klein said. "Desperation and emotions because she can't have her husband or partner with her in the room should not be a reason to choose home birth."

Although it's not ideal, Klein recommended pregnant people who had planned for hospital births use technology like smartphones and iPads to digitally get the support they crave from a partner, midwife, or doula.

"The biggest fear is, 'I want my partner with me.' That's really the biggest one," Klein said. "Yes, it's a milestone. Yes, it's phenomenal. And at least you'll get that story [of giving birth]. It's just that the birth story lies in a new way. We have to be creative during these times, and it's really about sending a mother and her newborn home safe."

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