Pregnant Moms Scared of COVID-19 in Hospitals Need More Home Birth Options
Even in the best of times, the U.S. faces a shortage of obstetricians and other medical professionals capable of delivering babies and providing prenatal and postnatal care. As America deals with the coronavirus pandemic, this shortage only stands to worsen. Meanwhile, pregnant women face a huge new incentive to consider giving birth outside of hospitals. Will U.S. authorities make it easier to embrace home births and midwives?
“I’ve had more interviews [with prospective clients] in the last week than I’ve had in maybe January and February combined,” Ray Rachlin, founder of Philadelphia’s Refuge Midwifery, tells me when we talk on March 20. “The demand for home birth has increased dramatically.”
People have been wanting to avoid hospitals both out of fear of catching COVID-19 there and because they want to avoid new hospital restrictions, says Rachlin, who is a licenced midwife in New Jersey & President of Pennsylvania Association of Professional Midwives. Some hospital systems have been limiting or even banning visitors, including spouses, during deliveries.
“Over the past week, the Kentucky Birth Coalition has been flooded with contacts from people looking for midwives who attend home births,” Mary Kathryn DeLodder, a Louisville-based regional liaison for the group, tells me in a March 23 email. “Kentucky has pockets that do not have any access to home birth providers, and many of the midwives are reaching capacity. We desperately need more midwives to meet the current demand.”
“We’ve been contacted by people who are due anywhere from a few weeks from now to those due in the fall,” DeLodder adds. “Folks are planning ahead in case the current restrictions persist.”
Giving birth obviously can’t be put on hold for the coronavirus. But as the outbreak intensifies, overstretched medical staff, limited doctor’s office and clinic hours, and limited modes of transportation could prove logistical challenges for expecting families, even independent of any health risks.
In the face of the outbreak, the authorities have already been relaxing some protectionist rules around health care licensing and operations, such as those preventing doctors and nurses from working across state lines and those limiting the number of businesses allowed to make masks, ventilators, and hand sanitizer. Will we see similar momentum on home- and community-based health care for expecting moms and new babies?
For Years, The U.S. Has Needed More Birth Professionals
“There has been no growth in the number of obstetricians nationwide since 1980 despite increases in the number of women of childbearing age and the number of births,” noted an October 2019 report from the California Health Care Foundation.
In a March 20 letter to the White House, American College of Nurse-Midwives CEO Sheri Sesay-Tuffour said her group is “gravely concerned that the COVID-19 pandemic will place further untenable stress on the current maternity care system and workforce.” So it’s asking the White House “for emergency measures to temporarily lift the restrictive licensure requirements that limit access to the midwifery workforce.”
Midwives are not doulas, to be clear. The latter are more like birth counselors, providing information, emotional support, and physical assistance during pregnancy and childbirth but not direct medical care. Midwives are trained to care for women during labor and delivery, as well as provide prenatal and postpartum health care for women and newborns. Some are also permitted—depending on their license—to write prescriptions and provide general gynecological and “well woman” care.
Recent decades have seen a modest but measurable uptick in midwife-attended births, after they all but disappeared over the course of the 20th century.
“In 1900, almost all U.S. births occurred outside a hospital,” according to analysis from the Centers for Disease Control and Prevention. This proportion dropped to 44 percent by 1940 and to just 1 percent by 1969, where it hovered throughout the 1970s and ’80s. By 2004, out-of-hospital births accounted for just 0.87% of all recorded U.S. births.
But since then, non-hospital births have been making a small but steady comeback. According to a June 2019 paper published in the journal Birth, the number of home births increased 77 percent from 2004 to 2017 and the number of birth center deliveries went up by more than 50 percent. “In 2017, 1 of every 62 births in the US was an out-of-hospital birth,” authors Marian F. MacDorman and Eugene Declercq found.
States Put Up Artificial Barriers
The increase in non-hospital births comes as some states have loosened midwifery rules. Back in 2004, Missouri midwives could still be charged as felons; the state’s Supreme Court put an end to that in 2008. At the same time, some states have made it more difficult for midwives to practice.
Take Georgia. In 2015, the state said all midwives must have an advanced nursing degree and a Certified Nurse Midwife (CNM) license. Now, not only is it illegal to practice midwifery in Georgia without these credentials, it’s also forbidden to even call oneself a midwife.
“What the statute and regulations do, and the way the Board of Nursing is enfo
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