Ask the Midwife: Should I Plan an Out-of-Hospital Birth in This Time of Coronavirus?

Dear expectant Mother,

Social distancing is imperative now. Many communities are being told to “shelter in place” and stay home. Even if you are young and healthy, and feel quite certain that if you do contract COVID-19, you will be just fine, someone you have contact with may not fare so well.

If you or someone you love is expecting a baby, it is even more important that you take precautions, i.e. social distancing, staying home to avoid contact with the virus.

Also, be sure to follow strict health and hygiene principals. For example, frequent hand washing for a minimum of 20 seconds with soap. I know everyone is saying this, but it is important. Wash your hands immediately after you’ve touched any potentially germ or virus infested surfaces. Money is very dirty. If you are pregnant, try not to touch anything dirty.

Questions From Moms

The question has come up, “Should I plan for an out of hospital birth in this this time of Coronavirus?” If projections are correct, in these coming critical weeks, hospitals will be full to overflowing. Doctors, nurses, lab technicians and midwives will find themselves overwhelmed. People with less-than-critical illnesses will be asked to refrain from going to the hospital.

It makes perfect sense for healthy, low-risk pregnant women to plan for labor, delivery and immediate postpartum care outside of hospitals. This decongests the hospitals and protects MotherBaby and Family from contagion.

In fact, the UK National Institute for Health and Care Excellence says: “NICE concludes that for low-risk women, whether having their first or subsequent baby, birth is generally very safe for both mother and baby, and they should be free to choose any of the four birth settings: the standard hospital maternity (obstetric) unit, alongside midwifery units (separate midwife-led units alongside an obstetric unit), a freestanding midwifery unit, or birth at home; and be supported in their choice.”

It is a mother’s human right to have her baby where she feels safe, with the support of a skilled birth attendant. Mother, YOU deserve to birth where you wish, with the midwife or doctor of your choice. If you choose a childbirth center or home birth, your midwives will help you develop a proper back-up plan, including transportation to get you to a hospital, should the need arise.

Considering Birth Attendants

You might think about or already be considering and asking, “Should I have a doula?” Doulas are wonderful, non-medical support for pregnant, laboring and postpartum/breastfeeding mothers. Doulas provide kind, evidence-based, continuous care for laboring women.

Doulas are not a replacement for midwives or doctors. PLEASE do not plan a home birth with only a doula in attendance. Doulas who attend home births without the presence of a midwife or doctor, are working out of their scope of practice. If an emergency should arise, a doula does not possess the medical skills necessary to assess the problem and act appropriately. So yes, have a doula, but also have a proper primary healthcare provider who is trained to keep you and baby safe during the labor and childbirth process.

We are hearing about “Free Birth” in which women do not plan to have a healthcare provider to support them in labor and birth. In my experience as a BirthKeeper for three decades, this is NOT a good idea. Every MotherBaby deserves skilled care in childbirth. Birth is life’s most significant event, the fulcrum of grace. Love yourself enough to plan for loving, respectful, skilled care in childbirth.

Finding a Midwife or Doctor

The Awakening Birth website has good information on your choices of healthcare providers for pregnancy and birth.

You may choose between a:

• Doctor/Obstetrician: hospital practice
• Certified Nurse Midwife: assists births in hospitals, or birth center, or home
• Certified Professional Midwife: practices at home and/or in birth centers
• Lay Midwife: may help women, but only at home

If Considering a Lay Midwife

Some indigenous women prefer to have a lay midwife from their own community who may have vast knowledge and skill handed down from generations of BirthKeepers. However, a person who decides she wants to be a midwife, has no training in skills, and little or no experience, may not be a wise choice for you.

When choosing a lay midwife, ask her questions to be sure you will be fully supported. Some sample questions for you to consider:

• If it becomes necessary to transport to hospital during my labor, or shortly after the birth, where do you usually take Mothers and Babies?
• Would there be a friendly greeting to lessen my trauma when I arrive at the hospital?
• If my vagina tears in childbirth, are you able to suture me at home? Would you give me local pain relief (i.e. Lidocaine injection) before sewing me?
• If my baby needs assistance breathing, are you certified in neonatal resuscitation?
• Do you bring oxygen to the birth?

Preparing for Your Birth

Whoever your midwife is, if you plan home birth be sure to ask, “What supplies should I be prepared to have on hand for my baby’s birth?”

Home, hospital or birth center, an important question is, “Who do you recommend I have with me at the birth? Since we are socially distancing ourselves, to prevent the spread of Coronavirus, it is best to plan for the minimum of people present at the birth, i.e. one or two skilled midwives, one doula, one close family member (your partner or mother are good choices).

Your preferred place of birth could be a hospital, a birth center (free standing our adjoining a hospital) or a home birth. Discussing these with your midwife or doctor is a good idea. You should feel comfortable asking questions, getting the answers you need is a wonderful part of prenatal care. If you are getting “Prenatal Scare” from your healthcare provider, its time to find someone you trust, who BELIEVES in your ability to bring your baby Earthside.

Yes, birth outside the hospital presents less chance for contact with germs and viruses that your body is unfamiliar with. In this time of COVID-19 causing a global pandemic, out-of-hospital birth, can be safe and comfortable. It is up to you, expectant mother, to make wise, well-informed choices.

For more relevant pregnancy and birth information, go to Awakening Birth.

Changes at Bumi Sehat

During this time of social distancing to prevent the spread of COVID-19, Bumi Sehat in Bali remains open for births, 24 hours each day/night and seven days a week. Essential prenatal check-ups are still being done at Bumi Sehat Bali, Papua and Aceh, come in and ask registration to guide you directly to the midwives.

We are sorry, prenatal and elderly yoga as well as childbirth preparation classes, and Youth Center classes, are all suspended until the wave of global pandemic passes.

This too will pass. One day we will all be back to hugging. Meanwhile, we can still LOVE one-another, serve one-another, bless one-another.