Current as of October 15th, 2021
Subject to change
COVID-19 & Home Birth
In Colorado Springs
I am following the progression of the coronavirus (COVID-19) and watching for news from experts about how this could affect pregnant women and their babies. Though this is all so new, we are learning more almost daily. Here are the key things it's important for you to know:
According to the Center for Disease Control (CDC),
"Although the overall risk of severe illness is low, pregnant and recently pregnant people are at an increased risk for severe illness from COVID-19 when compared with non-pregnant people. Severe illness includes illness that requires hospitalization, intensive care, need for a ventilator or special equipment to breathe, or illness that results in death. Additionally, pregnant people with COVID-19 are at increased risk of preterm birth and might be at increased risk of other adverse pregnancy outcomes, compared with pregnant women without COVID-19."
(Covid-19 Vaccines While Pregnant or Breastfeeding)
One caveat to this is that there are large gaps in the data. For example, the CDC doesn't appear to show how many women were hospitalized because they were there to give birth, versus being hospitalized specifically for COVID-19. Many of these women may have been there to give birth and were asymptomatic (around 44% of women who test positive are asymptomatic according to this JAMA international study published in April 2021). It also doesn't seem to differentiate between healthy pregnant women and those with comorbidities such as diabetes or obesity at the beginning of pregnancy.
As of October 11th, 2021, there have been 128,771 cases of COVID-19 among pregnant women in the United States, and 180 total deaths associated. (Data on COVID-19 during pregnancy: Severity of maternal Illness, CDC) That's a 0.14% death rate among cases. So, although there is an increased risk of experiencing severe symptoms when pregnant, the absolute risk of death is low. Note: The JAMA study mentioned above shows a 1.6% death rate among the pregnant population, which is 22% higher than the death rate among pregnant women who are not infected with COVID-19, but this data includes women in countries that are less developed than the U.S., so this data may or may not be extrapolated to the population here.
There also seems to be some evidence for potential "vertical transmission," which means that mothers who test positive have some potential to pass the virus on to their newborns. According to the CDC, among 3,750 infants born alive to mothers who had COVID-19 at the time of birth, 3,431 (91.5%) infants tested negative, and 305 (8.1%) tested positive (14 were indeterminate). To be sure, the data comes primarily from 23 states, along with Puerto Rico and the U.S. Virgin Islands. Still, it's a fairly good sample size, with widespread demographics. The mortality rate among children, however, is extremely low, and very likely correlated with comorbidities.
"42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities." -NCBI
This same systematic review also noted that children with comorbidities were at higher risk of mortality (death) from COVID-19 than children without comorbidities. The American Academy of Pediatrics lists the childhood mortality rates on their website, and they note that:
"In states reporting, 0.00%-0.03% of all child [ages 0 - 17] COVID-19 cases resulted in death" -American Academy of Pediatrics
That said, it's important to note that numbers are ever-evolving, and the current evidence suggests that midwives do not need to transfer clients out of care unless their symptoms become moderate or severe, and/or they require hospitalization for their symptoms. However, I will watch my clients much more closely, put protocols in place to guard safety, and continue to be a guardian of the normal.
(For more information, check out Dr. Aviva Romm's article and podcast on this topic.)
What about the vaccines?
"The American College of Obstetricians and Gynecologists (ACOG) recommends that all eligible persons greater than age 12 years, including pregnant and lactating individuals, receive a COVID-19 vaccine or vaccine series. Individuals aged 18 through 64 years at high risk of severe COVID-19 are eligible for a COVID booster."
"COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant. If you are pregnant, you might want to have a conversation with your healthcare provider about COVID-19 vaccination. While such a conversation might be helpful, it is not required before vaccination. You can receive a COVID-19 vaccine without any additional documentation from your healthcare provider."
I have reviewed the current evidence, and since the vaccine has still only been out for a short time, I do not feel comfortable endorsing it for my pregnant and breastfeeding clients at this time. It is unclear whether there is a causational link between the various vaccines and adverse pregnancy outcomes, including miscarriage, preterm birth, and other concerns.
Is a home birth a good option for me during the Covid-19 pandemic?
First and foremost – I am here to help however I can!
If that means we spend an hour on the phone working through your fears and concerns, whether or not you choose to transfer to home birth care, then so be it. I am a midwife, here to be “with woman” in the best way I know how with what resources are available to me. There are a few things to think about on your end, though, and I hope I can answer some of these concerns right upfront.
4 Reasons to Consider Home Birth During the COVID-19 Pandemic
You can have the support people of your choice at your home birth. Most hospitals are still limiting visitors to two people per 24 hours if you test negative for COVID-19, and only one if you test positive.
The hospital is the epicenter of the pandemic, and you may be better off staying home, where you and your family are already colonized to any germs already present.
You do not have to fear anyone putting policy and procedure ahead of you and your baby’s needs. I offer all the same procedures and tests, and you are encouraged to choose those that you think best.
It’s as safe to plan a home birth with a trained attendant as it is to plan a hospital birth if you are low risk.
What if I wasn't planning on a homebirth before?
If you are already preparing for an unmedicated birth, or if you chose the hospital for financial, insurance, or other non-safety related reasons, then exploring out-of-hospital options is a great idea for you! Talking to me is free, and I am more than happy to answer any and all questions you have and I am willing to work something out with you to help your family get the care you desire.
If you initially chose to birth in a hospital because you believe it to be the safest possible location for you and your baby, that is an indicator that home birth may not be the best option for you. And that's okay! That doesn’t mean you shouldn’t look into home birth, it just means that there are some angles you may not have considered.
Call me anyway. I can help you sift through any fears or questions so you can clearly see your options. Who knows? Home birth might be just the answer to those fears!
What if I still want to give birth in the hospital?
If your trust is firmly in your OB/GYN or hospital-based midwife, you probably are safest delivering there, pandemic or no. Hiring a doula who can attend you virtually via Zoom or in-person (depending on your test results) is likely going to be a much more feasible and safe option for you.
Currently, all Colorado Springs hospitals are allowing one support person if you are Covid positive upon admission, and one additional person if your test is negative. For some great doula recommendations, visit my Local Resources page.
I would be happy to help you navigate what a hospital birth might look like, and help you ask good questions so that you can be further reassured by your current provider, or even help you realize that a home birth midwife really is what you want after all.
COVID-19 Appointment Policy:
My office mates and I want you to know that we are committed to caring for you during this time. We will not act out of fear, but we will be cautious and prudent so we are able to provide the best, safest care to you and your families within the most current guidelines and orders issued by local and state government officials.
We are currently required to ask anyone ages 10 and up to wear a mask within our office unless you are vaccinated.
We are all still seeing clients at the office, as converting to exclusive home visit care isn’t feasible for us at this time. Virtual and home visits are available on request, and we will work with you to achieve the safest level of care possible within the midwifery model of care.
For all appointments, we are:
- Requesting that clients mindful of social distancing, especially when other clients are present in the waiting area
- Expecting clients to notify us via text/phone if they have a fever and/or exposure prior to their appointment
- Washing and/or sanitizing our hands regularly
- Disinfecting all equipment/toys regularly
- Rescheduling or doing a virtual/phone visit if a client or anyone in their household has symptoms matching those of COVID-19 (or any other contagious illness)
We will only resume in-person visits 10 days after symptoms begin AND 24 hours fever-free. This applies to all persons living in your home.
Symptoms include (but are not limited to):
Fever above 100.4
Shortness of breath
Loss of smell/taste
Visit the CDC to see a complete symptom list.
If you have any of these symptoms, or if you test positive, call your midwife within 24 hours to come up with a plan for your care.
What is your late transfer policy?
28 weeks to 31 weeks, 6 days:
A non-refundable 10% Retainer Fee is due at the time of hiring, and monthly/weekly payments are calculated to ensure payment in full by 36 weeks.
To qualify for a late transfer, you must be:
- Eligible for home birth per Colorado regulations (see pg. 2, section 1.4).
- Pregnant with a single baby.
- If you are 34 weeks or later, the baby must also be head down.
- Able to provide complete records of prenatal care, including basic lab work.
- Strongly motivated to participate fully in all care decisions, educate yourself, and assume shared responsibility for your care.
- Strongly motivated to have an unmedicated birth in the safety and comfort of your own home, surrounded by the birth team of YOUR choice.
32 weeks or later:
If you are 32 weeks or later, and meet all of the above criteria, you will qualify for late transfer. However, I will require a non-refundable $1,000 Retainer Fee at the time you hire me, and payment in full by 6 weeks postpartum, to be paid in weekly installments or all at once.
Why isn’t there a discount in this situation?
This is my standard late transfer policy, as outlined in my Financial Agreement.
COVID-19, while a unique situation, really doesn't necessitate a change to how my practice works. A late transfer is a late transfer, regardless of the reason.
The bulk of my fee covers the cost, risk, and liability for your birth and immediate postpartum.
Prenatal, postpartum, and newborn care are included at an already greatly reduced cost in a global fee model.
Whether or not my fee is paid in full, my cost of doing business remains the same.
Office rent, supplies, fuel and mileage, EHR fees, licensing and registration fees, CEU’s, and more all still have to come out of my pocket, no matter how much is put in.
No matter how healthy you are, the overall risks of home birth in this situation are increased.
Part of what makes home birth safe is a strong relationship of trust built up over time with my clients. This may be harder to establish during a short relationship. Especially if a client is not already strongly motivated to have an unmedicated birth, or has never felt safe about birthing outside the hospital.
It is unfair to current clients who have already put in the time and money to prepare for a home birth.
I owe it to each one of my clients to treat everyone as equally as possible. If finances are a concern, please schedule a free consultation so we can discuss barters and/or alternative payment schedules. I am willing to work with you to make a home birth possible in your situation.
Midwives need to make a living wage.
Call me anyway!
If the above arrangements aren’t accessible to you, and you have an alternative plan in mind, I am all ears. If I can help you, I will. If I cannot, I will refer you to someone who can. There are lots of options in Colorado Springs, and one of them is bound to be right for you and your family! Thank you for understanding.