As coronavirus lingers, home births surge. How midwives are adapting.

Why We Wrote This

More women are considering home births amid the coronavirus. The trend has changed how midwives operate – and how some expectant moms view midwifery. 

Courtesy of Katrina McHugh
Katrina and James McHugh of South Royalton, Vermont, stand with their children, Cathan (far left) and Tully, who was born at home on March 25, 2020, with the help of midwives. Home births are rising due to COVID-19.

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Katrina McHugh was planning to have her baby in the hospital, but then the pandemic hit.

At her 36-week checkup, her doctor recommended a home birth due to Ms. McHugh’s concerns about safety. She gave her the phone number for Katie Bramhall, a local midwife with more than 30 years of experience. When contractions came, Ms. Bramhall joined Ms. McHugh at her home, located up a remote dirt road in South Royalton, Vermont. Hours later, they heard the beautiful sound of baby boy Tully cry for the first time.

Throughout the country, midwives have seen an increase in requests for home births, as hospitals continue to grapple with COVID-19 cases and more families choose to have pregnancies and deliveries outside traditional hospital settings.

As a result, midwives have had to adapt rapidly, while maintaining the core principles of safety and trust. Ms. Bramhall’s practice now uses videoconferencing for remote appointments, and she asks clients to purchase their own doppler, blood pressure cuff, and weight scale for assessments. Rapid-response COVID-19 tests are administered before births.  

“We’re doing our best to balance our personal safety and the safety of our families, with keeping this life-changing event as magical and joyous as we can,” says Ms. Bramhall. 

Katrina McHugh was planning to have her baby in the hospital, but then the pandemic hit. 

At her 36-week checkup, her doctor recommended a home birth due to Ms. McHugh’s concerns about safety. She gave her the phone number for Katie Bramhall, a local midwife with over 30 years of experience.

“I called Katie, and she was just wonderful,” Ms. McHugh says. 

But because the COVID-19 crisis was unfolding so quickly, that first appointment ended up being done by phone. Contractions came a week later, and Ms. Bramhall joined Ms. McHugh at her home, located up a remote dirt road in South Royalton, Vermont. This wasn’t Ms. McHugh’s original plan, but she was comforted by how Ms. Bramhall and her colleague Meghan Sperry communicated with her “as a person, not as a patient” throughout her labor and the beautiful moment when she heard her baby boy Tully cry for the first time. 

“They spoke to me like they had known me for years, even though they had just met me,” she says, adding the comfort of home was reassuring even in the toughest moments. “They just made me feel very calm and comfortable.”

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

Throughout the country, midwives say they have seen an increase in requests for home births, as hospitals continue to grapple with COVID-19 cases and more families choose to have pregnancies and deliveries outside traditional hospital settings.

Fear of COVID-19 infection is a common reason for this increasing interest in home birth as well as a desire to ensure partners can attend the birth, which some hospitals restricted at the height of the pandemic.

Evidence of the trend so far appears anecdotal. The level of demand varies based on where the midwife is located, says Sarita Bennett, president of the Midwives Alliance of North America. “Those who live in New York City are impacted a little differently than those in the Midwest,” she says. “All of them though are seeing more interest in out-of-hospital births at home and at birth centers.”

That trend is reflected in Ms. Bramhall’s practice, Gentle Landing Midwifery, based in Lebanon, New Hampshire. She usually sees three to four births per month, and that has nearly doubled through July. Ms. Bramhall had to double her staff in early April to accommodate the increase.

She says she expects this trend to continue; her practice’s new birth center, set to open in September, is almost at full capacity for January.

Courtesy of Katrina McHugh
Midwife Katie Bramhall holds Tully McHugh, who was born on March 25, 2020, in South Royalton, Vermont.

Ms. Bramhall, who is also president of the Vermont Midwives Association, says midwifery is centered on relationships built over a period of months, and with COVID-19 they’ve had to adjust to maintain that foundational element of trust.

“A very well-established and well-oiled practice had to be rebuilt from ground up,” Ms. Bramhall says. “It’s imperative that people stay connected to me and me to them. I have to know them the same way, to make accurate decisions.”

Among the adjustments was adding health privacy law-compliant videoconferencing into their system for remote appointments. 

“We’ve had to require our clients to purchase a doppler, blood pressure cuff, and personal weight scale, so they can do their assessments themselves over video chat ... so we get accurate data,” Ms. Bramhall says.

The top priority is safety, which is why Ms. Bramhall purchased 10-minute rapid-response antibody tests for COVID-19. 

“At a birth when we arrive, everybody is masked up, we do a rapid-response test on everybody and ourselves, and if everybody comes back negative, we can unmask and have a birth,” she says. “We’re doing our best to balance our personal safety and the safety of our families, with keeping this life-changing event as magical and joyous as we can.”

Empowering mothers

Midwives provide women with individualized care during pregnancy, childbirth, and the postpartum period. Those who offer home-birth care are trained and equipped to provide the same standard of care as a hospital setting, with ultrasounds, labs, and all the necessary tests. That said, it is not right for every case. 

“The only people who are good candidates for out-of-hospital birth are people who are full-term and healthy,” Ms. Bramhall notes.

Certified Nurse Midwives can practice in all 50 states. Certified Professional Midwives, like Ms. Bramhall, are specially trained for out-of-hospital births. While they currently can only practice in 35 states, efforts are underway to expand their reach, says Dr. Bennett.

Michelle Ingram-Sanders, a midwife in Bedford, Indiana, just south of Bloomington, owns Mother Nurtured Midwifery and has practiced for 10 years. She usually has four to six clients per month, and that has grown to eight during the pandemic. Her main focus has been staying healthy, she says, so she can still serve her clients.

“We’re keeping an open mind and doing everything we can to protect ourselves,” says Mrs. Ingram-Sanders, also president of the Indiana Midwives Association.

She has worked remote appointments into her practice, though some are in person when the mother is at term. She is allowing more time between visits to sanitize equipment. “If the visit goes a little long, I still have time for cleaning and prep,” she says.

Allaying the mother’s fear as much as possible has always been important in midwifery, and the coronavirus has only underscored that, says Ms. Bramhall. 

“Pregnancy and birth and making a family is such a huge transformation for everybody involved; add the fear of a public pandemic, and that makes that transformation even more imperative in people’s hearts and minds,” she says. “Fear on top of labor in a pregnancy can change an outcome, because fear will change any outcome in life if that’s the driving force.”

Ms. Bramhall says the way to alleviate that fear is to empower the mother, by helping her find strength she didn’t know she had, especially when the pain is so great, she doesn’t think she can proceed.

“You look in her eyes, and you make her see, that you see, that ‘yes she can.’ And you hold that, until you get to that point where, ‘yes she did,’” Ms. Bramhall says. “And that’s where her empowerment comes in.” 

Amid the heightened demand, midwives emphasize the importance of maintaining safety and strong relationships.

“We refuse to go beyond our capacity, because safety is the only game in town,” Ms. Bramhall says, adding that the midwife must have time to build the trust that is so crucial. “We will not compromise relationships.”

Ms. McHugh has enjoyed that continued relationship after her second son’s birth. 

“[Ms. Bramhall] has been very much a part of my aftercare and Tully’s aftercare,” she says. “She made sure that all of us as a family are doing OK, emotionally, spiritually, everything. She’s just been very wholesome in her approach.” 

Editor’s note: As a public service, all our coronavirus coverage is free. No paywall.

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