Home Birth During Covid-19
Home birth during Covid-19 is a choice many women are considering as they search for safe and alternative birth options.
Pregnancy is an amazing time as your baby grows inside your body and you prepare to welcome a new person into this world and into your family.
As your due date draws nearer there can naturally be some apprehension and uncertainty of what is to come during the birth.
This is even more so in 2020 as women seek support and care during pregnancy and birth during the Covid-19 pandemic.
Juliana Brennan is a private midwife, director of Mamatoto Midwives and a mother of three. She shares with us an amazing insight into the world of private midwifery and home birth during Covid-19.
How are you at this time?
Well, a bit more settled now, but like everyone else there was so much upheaval and concern over the health of all our community, my family and especially my elderly parents.
My biggest fear was not knowing much about the virus, the panic buying, children being taken out of school, social isolation and my son is in year 12…what is this going to mean for him?
I am glad we have had some restrictions lifted but I am still very much practicing social distancing to keep myself, my family and my clients safe.
What is it like for you as a midwife at the moment?
I’ve always been very busy and my practice is consistently booked out every month, however now I have been inundated with enquiries from women wanting home birth – even from women with very serious risk factors which normally excludes them from homebirth.
These women have reached out because they were only allowed one support person in labour at the hospital and they really wanted that extra support person as well as their partner.
Also they are fearful of contracting Covid-19 from the hospital setting…after all that’s where the really sick people will be…in hospital! So I have referred many women on to other midwives as I am already booked out until the end of October.
Many of my hospital shared care/hospital support clients who are experiencing an uncomplicated pregnancy have changed over to a homebirth. This is because they couldn’t have the support they wanted in the current hospital setting, but also they didn’t want themselves and their families possibly being exposed to Covid-19.
It’s a tricky situation as you really have to want to have a homebirth, and feel safe at home to be safe for a homebirth. Merely wanting to avoid a hospital for birth isn’t a good enough reason to have a homebirth.
I will still be careful in choosing my clients who are suitable for homebirth, both physically and emotionally.
What’s it like for prenatal clients who want to home birth during Covid-19?
We have moved most of our education and appointments to an online format via Zoom. Women we are meeting for the first time we would only see online. Our clients needing a check up we would see first online, then they would come into the clinic for a 10 minute visit for a check of blood pressure, baby’s growth and heartbeat.
My clinic in Clifton Hill, where I work alongside natural therapists on the first floor, was closed down. Below us is a hairdresser that also closed down.
My sister came to the rescue and allowed me to use her clinic in Kew. She stopped seeing her clients face to face, so her offices were free for me to use. I must say, I really like the space. My colleague Danielle works out of one office and I work out of the other…so we are both doubly lucky to be able to say hello to one another’s clients and of course catch up in between clients!
My new clinic room in Elwood at This is Life also closed down, so the lovely midwives from Mama allowed me to use their rooms…but now the Elwood clinic has reopened, so I am back there seeing my Bayside clients on a Saturday morning.
My clinic room in Chirnside Park at Koru Natural Therapies has remained open, so I have still been able to see my clients there too.
Of course adhering to the strictest hygiene, washing down beds, tables and changing linen in between clients and of course lots of handwashing!
Overall my prenatal clients all decided to self isolate as much as possible. Especially from 37 weeks…this was my recommendation. Many women were anxious I may have to change their birth plans if they were planning a homebirth, but I reassured them if they were willing to self isolate and so was I, then we were at very low risk of contracting Covid-19.
What changed significantly for the hospital system was the decision to allow only one support person in hospital. This meant one of my clients wanting a vaginal birth after two c-sections (VBAC2C) chose me to support her in hospital instead of her husband! What a responsibility!
For others it meant dropping women off at the emergency department and staying in close contact via phone or Zoom. Not ideal, but I completely understand the issues surrounding social distancing and protecting clients in hospitals and also hospital staff.
I do think two support people should be allowed in birth suites from now on…as Australia seems to have the infection under control much more so than other countries.
Have you adjusted your postnatal care?
Postnatally I am still happy to do face to face appointments, as long as clients and their families don’t have a cough, fever, or sore throat.
If they do, I arrange testing for them and wouldn’t visit if they had symptoms. This actually hasn’t happened…probably largely because my families all isolated fairly strictly prior to their births.
What is home birth during Covid-19 like?
For my clients it is self isolation from 37 weeks of pregnancy then the birth at home is the same.
My recommendation for women that have a fever in labour be transferred to hospital. Usually we would transfer anyway, after eliminating other reasons for fever such as dehydration.
This guideline has been debated amongst my colleagues; some feel we should still keep women home if they have Covid-19 symptoms if they don’t seem too unwell. My concern is leaving four hours after the birth and not being able to supervise all the time as well as the unknown effects of the virus on the unborn baby. In hospital the woman and baby would have constant supervision and care.
It is definitely an issue for me if hospital transfer is required. I did have one first-time mother needing a hospital transfer in labour…and of course I had to hand her over to the hospital staff. I kept in very close contact with her partner and he called me regularly to ask for my advice. It still isn’t the same as being ‘with woman’ and it saddened me deeply…as I am her main care provider and I develop a strong bond with my clients.
How are you navigating any possible Covid-19 pregnant or birthing woman?
The first thing to do is arrange testing and to self isolate until the results come back. If the woman presents with symptoms in labour I do have full PPE available.
So far none of my clients have had respiratory symptoms, so I haven’t had to worry about it. I think self isolating since 37 weeks has made all the difference.
What are the pros of a home birth during Covid-19?
Well staying out of hospital is definitely a positive!
If hospital is needed, not being able to take your primary care provider with you due to the one person support policy is a real issue. Continuity of care leads to good outcomes in birth, but Covid-19 is a real threat and hospitals have to enforce the rules!
What is birth like for healthy and well women at this time?
They are being exposed to hospital environments, then discharged home very early, with NO follow up except phone calls from maternal and child health nurses (MCHN). Some MCHN refused to visit, some GP’s wouldn’t do contact appointments.
Thankfully one of my colleagues was able to offer postnatal face to face care to many of these women which meant breastfeeding could be fully supported and of course she could weigh babies and make sure they were thriving. My own clients had the same care as they would have had before Covid-19.
What are the main challenges birthing women are facing with these new protocols?
Women who wanted two or more support people have had major issues adapting…many women choose to have private midwives at a hospital birth to advocate for them, and then facing this loss often meant changing to a home birth.
What are the main challenges for Independent Midwives in during this pandemic?
Making sure we don’t contract the virus! Keeping our clients safe! Hospital protocols around one support person.
Nurtured Birth would like to thank Juliana for her contribution to our blog.
If you are considering an independent private midwife for your pregnancy and birth, Juliana Brennan is very experienced and deeply caring.
Juliana can be contacted at Mamatoto Midwives for a comprehensive choice of maternity care options.
Juliana Brennan
juliana@mamatotomidwives.com.au
0419 253 778
At Nurtured Birth we love supporting independent midwives and working alongside them to enrich the continuity of care we know through research it results in better birth outcomes, improving mothers experience antenatally and postnatally.
We love it when our clients thrive therefore we have developed our practice to compliment maternity care by offering a range of pregnancy care options with pregnancy massage, osteopathy, doula support, childbirth education, naturopathy, pre & postnatal yoga, mothers groups too.
All this is our heartfelt vision to enrich, nurture, nourish and support a mama’s pregnancy, birth and beyond.
Written by Sharon Clarke, massage therapist at Nurtured Birth
Spectacular capture at the top by Bree Downes
