The challenges of supporting pregnant women during Covid-19, from a midwife

More parents-to-be might are considering home birth during the pandemic.
More parents-to-be might are considering home birth during the pandemic.
Image: REUTERS/Callaghan O'Hare
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As Covid-19 has spread around the world, people struggling to breathe have overwhelmed healthcare systems. That’s putting people who normally need the medical attention, such as cancer patients and people on dialysis, at greater risk. Many can’t avoid hospitals and doctors’ offices, where the chance of being exposed to the virus is higher.

Pregnant women are placed in a particularly difficult position. Many fear that giving birth in a hospital could expose them or their newborns to the virus. Hospitals are taking safety measures: Many have restricted the number of people who can be present during and after the birth, and some require new parents to wear masks around their newborns. But still, a growing number of parents-to-be are looking to give birth at home.

Home births can be just as successful as hospital births, but some public health advocates worry about safety trends when many women are pushed to avoid institutional care at once. During the 2014-2015 Ebola outbreak in Liberia, Guinea, and Sierra Leone, the UN Population Fund predicted that more than 120,000 women—more than 10 times the number of people who died from Ebola—could have died from a lack of maternal care.

Successful home births rely on knowledgable guides like midwives and doulas, which are expensive and not accessible to every parent. And certain birth complications will force a hospital visit. Covid-19, public health experts fear, may be putting women at risk if overwhelmed medical systems push them towards unsafe home births.

Below is a Q&A with Kate Dirks, a midwife at a healthcare facility in Atlanta, Georgia that is one of the busiest birthing centers in the US. This interview was originally broadcast on The Women, a podcast about women on the front lines of the Covid-19 pandemic hosted and produced by journalist Rose Reid.

This transcript, which has been condensed and edited, is an exceptional insight into how the virus has changed the circumstances around giving birth for both new mothers and healthcare workers—and how things could be different in the future.

Rose Reid: How has your practice changed with the coronavirus in the past month?

Kate Dirks: One of the truths about this last month has been this feeling of uncertainty and this feeling like we can’t be sure of what’s coming next. The practice has had to become really nimble. We’re actually changing guidelines and changing our philosophy and our response to the pandemic on sometimes what feels like an hourly basis.

Obstetric care for pregnant women was one of those things—it’s essential, right? Babies are going to keep coming. These are overwhelmingly healthy folks that are being forced in a way to stay in this overwhelmed healthcare system.

Other changes we’ve had to make are, of course, how we operate in the clinic around personal protective equipment, or PPE, which I know folks have heard a lot about. Before, let’s say a couple of months ago when I would walk into a clinic, and this is very much the heart of midwifery, there would be a lot of smiling and laughing, and perhaps a hug for patients that I know and who are getting close to delivery. Perhaps a comforting touch on the shoulder for difficult times. Lots of emotional interaction, facial expression—all this stuff was how I’d interact with patients and families.

Now in the clinic, every day we are walking in and masking, covering our faces with a surgical mask. Things feel different, your face is covered, you’re having to rely a lot more on the expressiveness of just your eyes, and your voice.

No more hand-shaking, no more hugging, no more touching. You feel far apart, like you’re on opposite sides of this clinic room. And that’s been a huge shift in the clinic. Certainly that’s had an effect.

And again, this is really important. I’m not arguing against this. Because we saw in New York and other places that women are often asymptomatic carriers, and certainly the pushing phase of labor is definitely a time where things are aerosolized and there is risk for healthcare providers.

I do try to make sure that I can make eye contact with women when possible, depending on their laboring position or where they are.

RR: Do you think that all these changes that are being made to protect against the spread of the coronavirus can be done without any less care for new moms and for women who are giving birth? Or are we forcing all new moms to make a concession for the overall public good?

KD: I think the reality is that we are asking mothers, women, families, newborns, to make a trade-off for the public good. I think across the board, there have had to have been difficult choices that are all coming from a good place of attempting to limit the spread of Covid-19. But the reality is, it can’t be the same experience as it was before.

This is especially true for women of color, native women, black women, brown women. Women from communities who historically have been treated so inequitably, across the country, are at least four times as likely to have poor outcomes in childbirth and maternal care. And these inequities are going to be unfortunately magnified by the virus.

RR: What do you think about the shift of women, with good research, thinking about the option to give birth at home or give birth in a different birthing center?

KD: I really understand why women want to avoid the healthcare system right now. Our home birth midwives at our birth center are overwhelmed by requests for transfer, a lot of times very late transfer. And the truth is, it’s great, and it’s understandable, but it’s not always possible and our midwives know this. They’ve had to have some really difficult conversations with people just because they don’t have time to form the relationship.

Home birth midwives, unfortunately, are almost across the board out-of-network for insurance. So we’re talking about a really big cost to folks. People that are relying on Medicaid or don’t have that kind of money are excluded from the ability to birth at home.

I think we would really be doing a disservice if we didn’t allow this painful, outrageous period of time not to make some fundamental changes to our system. One of the changes I think we really need to consider is why the majority of women in this country—healthy women, women who have no risk factors, women who are great candidates for out-of-hospital birth—why is it that all women must birth in a hospital in this country?

The virus and the pandemic have illustrated some real issues with a very patriarchal, top-down healthcare system that doesn’t always have the well-being of women first and foremost.

It’s one of the reasons I really love being a hospital midwife, because you do need an advocate in that setting to help you take back some of that power, some of this feeling that if you do what you’re told, and everything will be okay, and if you don’t do what you’re told or you ask too many questions, then bad things will happen to you.

Listen to this full episode of The Women.