Birthing in the Time of COVID

Strategies for Parents and Birth Workers during Pandemic 2020.

It’s easy to imagine how birthing in the midst of a pandemic can be unsettling, especially the closer you get to your due date. 

• Will there be a labor room for me at the hospital? 
• Will my home birth midwife get sick and have to miss my birth? 
• Will my partner be there for the birth?

In our daily lives of work, school, and gathering with family and friends, nothing is quite the same since the arrival of COVID-19; nor has it been the same for those who are preparing for birth. Early on, when cases started making their way into the US, hospitals began pro-actively enforcing rules for social distancing in the labor rooms. It is important to remember that this was around the same time hospital employees were reporting serious shortages of protective clothing and masks for doctors, nurses and other hospital staff. When exploring options that work for everyone there are no simple answers. Administrators did the math: Each person kept out of a birthing room equaled another gown, mask, or set of gloves that would be unused and available for hospital staff.

In an article from Wired we hear from Henry Chu, who arrived at Mt. Sinai Hospital with his wife in labor to find that no one was allowed into the birthing room except the birthing person and hospital staff:

“Outside the main entrance, I hugged her. She hugged the kids. I couldn’t even walk through the door. I watched her walk up to the reception, then someone escorted her away. It was such a weird feeling. It didn’t feel right . . . all I know is I will never be able to say that I was there holding my wife’s hand the day [our baby] was born.”

As time passed, and stories such as these became more frequent, birth workers began meeting informally to discuss how to support families during these trying times. At Zoom meetings, in online conversations, and on social media threads, birth workers shared information and ideas for supporting clients while observing the social distance guidelines. 

So much is unknown about current protocols for managing birth during a pandemic, and information about changes varies from day to day. Broadly speaking, here are some strategies to keep the virus out of birthing rooms that have been implemented in hospitals around the country: 

• One Person Rule – Many hospitals are enforcing a strict “one person” in the labor room rule. Those who were planning to have a doula could not have both partner and doula in the room. Most doulas reported taking a support role for the parents by phone.
• Once in the Room You Cannot Leave the Room – The requirement that “Once you are in the room you cannot leave the room until the baby is born” is put in place to keep support persons from bringing in germs from outside the birthing room.
• Hospital Guidelines Can Change Without Notice – Most hospitals suggested calling the hospital to let them know you are in labor and find out what to expect regarding changes in policies.
• Pre-Birth COVID-19 Testing – During COVID-19, some hospitals are testing the laboring parent for the virus and then having them wait six hours for the test results before admitting them. This option is important for parents to understand since in normal times, parents are encouraged to stay at home in early labor and arrive at the hospital in active labor, i.e., 5cm. If a hospital happens to have the 45 minute version of the test it would be a shorter wait, but for those having a second or a third birth, this could be problematic, especially if they have a history of fast births.
• Utilizing Induction to Guarantee a Bed – Many hospitals are managing the unknown of COVID-19, and its impact on birth, by recommending induction to all pregnant patients; allowing time to test them for COVID-19 and also guarantee them a bed. 

Many birth workers are feeling anxious about what birthing parents are facing–AND–we can only imagine the difficulty involved in trying to manage optimal health care during a worldwide pandemic. Add to that the huge demands that result in shortages of necessary supplies, and here we are . . . Birthing in the Time of COVID.

As parents began hearing about rapid changes occurring in hospital protocols, and the possibility that doulas or partners might not be allowed in the birth room, many began to explore options for birthing out of hospital. Emily Shugarman of the Daily Beast, in her article, “Pregnant Women Turn to Home Birth to Escape Virus,” writes:

While popular in many other countries, home birth is very rare in the U.S., making up just 1.6 percent of all deliveries. Laboring in a free-standing birth center, rather than a hospital, makes up another half a percent…

But providers say the current panic is changing the face of those seeking a home birth. Rachel Cook, an Olympia midwife interviewed for the article, indicated that her clients are usually mothers who had an earlier bad experience in a hospital, or women whose parents also birthed at home. But in a single day this week, she received three calls from women considering home birth—all of whom were first-time mothers, and none of whom had previously considered an out-of-hospital delivery.

Fortunately, birth workers in every birth environment, whether it be home, birth center, or hospital, generally tend to be solution seekers. They know well that birth invites us into the unknown. When a birth presents something out of the ordinary–something unexpected–it’s not all that surprising to seasoned birth workers. Uncertainty, a common attribute of birth, requires parents and birth workers to think on their feet and be ready to make a quick left turn, or sometimes even a U-turn. 

“For expectant mothers trying to navigate pregnancy amid the COVID-19 outbreak, uncertainty surrounding the virus’ impact on pregnancy is a growing cause for concern. In the midst of this, doulas are taking on an even bigger role in supporting mothers during and after pregnancy.” WCPO.com

In the end, conversations about how to care for families in the time of Covid left everyone with a wealth of ideas to try on, adapt, or toss in the bin of “left-over ideas.”

Of all I have heard, or read, these are the ones I chose as “keepers”:

SOLUTIONS FOR BIRTHING FAMILIES TO CONSIDER

1. Evaluate your birth location with pros and cons list, if you are not a high risk birth. One mother said, “I can afford to give birth at home…why not provide the hospital bed to someone else during this pandemic since I am not high-risk?”
2. Explore and honor feelings of fear, panic, or isolation. There are many places to get help if you are feeling regularly overwhelmed by your emotions. One source mentioned on a call, with great online resources, is PSI (Postpartum Support International) with support for all stages of pregnancy and postpartum for both parents. Help is available; you deserve it. 
3. Entertain a discussion of what resources you have if things don’t work out the way you are expecting. We are stronger than we know. What difficult moments have you lived through in the past that you made it through? What might you learn from the past that will help you now? Consider packing items that calm you such as earbuds and a music-maker.

SOLUTIONS FOR BIRTH WORKERS TO PONDER

1. In this time of face masks, let’s learn to smile with our eyes. Most people are feeling tense. Speaking in a friendly voice is more important than ever since a mask hides most of our facial expression. Let’s learn to “smize” — to let our smile show through our eyes.
2. Be open-minded about online or phone support. Remember that 98% of what we do does not require hands.
3. Using the lens of psychology, some say it is likely that these little ones arriving during the Time of COVID will have something to teach us. We can all agree that these are babes of a new era.

AND NOT TO FORGET . . .

1. Who are your support people? A great question for parents AND birth workers. Who will drop what they’re doing to help you if COVID-19 throws a wrench in your plans? Reach out now and say, “I will be calling you.” Find out who you can count on and then count on them.
2. The importance of phone chargers at birth is especially critical now. The last thing you need is a dead phone. For those who need it, a helpful Post-it note reminder helps: Do you have your Charger?
3. When worry seems to follow us, distraction can be provide a window of rest. It is okay to put the worry down for a bit. Listening to music, dabbling with pencil or ink doodling, or organizing photos might be just the medicine we all need.

During this pandemic, its fair to say that we all find times when we are wishing we could read the future to find out how this all turns out in the end—longing for certainty. Utilizing the breath can create space in the midst of crisis, or moments when it feels like fear is closing in. In those times . . . try this:

Breathing in slowly and deeply—we release our outward breath while consciously releasing any tension in our body . . .

Feeling deeply into the release . . . and repeat

Trying this two or three times in a row–deep breath and deep release–creating a tiny window of rest in the not-knowing. 

In addition to the challenges for birthing families, we know that COVID-19 is affecting each and every person around the world in some way. In this time of unprecedented challenge, it is helpful to remember that we are stronger than we know.

A final thought in COVID-19 coping arrived to me in the form of a story. I’d like to invite you to consider this fable, passed through the ages–from generation to generation–arriving here in this moment just for you. The story is said to originate from the great Zen masters of old whose stories helped their students to see things from another point of view.

GOOD LUCK, BAD LUCK — WHO KNOWS?

An elderly, hard-working Chinese farmer and his son, had a single horse. They used the horse to plow the field, to sow the seeds, grow the crop, and transport it to the market. The horse was essential for the farmer to earn his livelihood.

One morning, the horse broke the fence and ran away into the woods. When the neighbors found out that the farmer’s only horse had run away, they came to solace him, by saying – “Your only horse has run away just before the planting season. How will you till the land? How will you sow the seeds? This is unfortunate. This is bad luck.”

The farmer replied – “Good luck, bad luck. Who knows?”  The wise farmer was unwilling to label this incident good luck or bad luck.

A few days later the farmer’s horse returned from the woods along with two other wild horses. When the neighbors found out the news, they said –  “Now you have three horses! You can till the land much faster with three horses. Maybe you can buy more land and sow more crops and make more money. Or you can sell the other two horses. Either way, you will be a rich man! This is good luck! “

The farmer replied – “Good luck, bad luck. Who knows?”  The wise farmer once again was unwilling to label this incident good luck or bad luck.

Next morning, the farmer’s son started training the wild horses so they would help till the land. While attempting to mount one of the wild horses, he fell down and broke his leg. It was just before the sowing season and the son would not be able to help the farmer with his broken leg. The neighbors came once again and commented – “This is really unfortunate. This is bad luck.”

The wise farmer repeated – “Good luck, bad luck. Who knows?” The wise farmer was still unwilling to label this incident good luck or bad luck.

A few days later, the king’s men started to visit each village in the kingdom. A war had started between their kingdom and a neighboring enemy state. The king’s men were enlisting the eldest son from each family to join the army so that they could defeat the enemy state. When they came to the farmer’s house they saw the son with the broken leg. He would not be of much use in the army and hence they didn’t take him. He was the only eldest son in the entire village who was not forcibly taken by the king’s men to fight the war. The neighbors, some of them with teary eyes, came once again to the farmer and commented – “Your son breaking his leg was really fortunate. He is the only one who was not taken. What a stroke of good luck.“

The farmer calmly replied – “Good luck, bad luck. Who knows?” Again, the wise farmer was unwilling to label it as either good luck or bad luck. 

“As human beings, we have a tendency to interpret any and all events as either good luck or bad luck. Often we do this unconsciously. However, most events that are beyond our control are just events.” Tushar Vakil 

As we move through whatever challenges COVID-19 brings our way, perhaps the farmer’s attitude of “wait and see” is just the medicine we all need. In the meantime, take care and be well.

Kathie Neff, Childbirth Educator, Doula and Birth Story Listener
CCE(BFW), CD(DONA), Lifestyle Educator(KP), CLEC(UCSD)