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

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

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

鈥淚 called Katie, and she was just wonderful,鈥� Ms. McHugh says.听

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鈥檛 Ms. McHugh鈥檚 original plan, but she was comforted by how Ms. Bramhall and her colleague Meghan Sperry communicated with her 鈥渁s a person, not as a patient鈥� throughout her labor and the beautiful moment when she heard her baby boy Tully cry for the first time.听

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

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

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

Fear of COVID-19 infection is a common reason for this increasing interest in home birth听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听varies based on where the midwife is located, says Sarita Bennett, president of the Midwives Alliance of North America.听鈥淭hose who live in New York City are impacted a little differently than those in the Midwest,鈥� she says. 鈥淎ll of them though are seeing more interest in out-of-hospital births at home and at birth centers.鈥�

That trend is reflected in Ms. Bramhall鈥檚 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鈥檚 new birth center, set to open in September, is almost at full capacity for January.

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鈥檝e had to adjust to maintain that foundational element of trust.

鈥淎 very well-established and well-oiled practice had to be rebuilt from ground up,鈥� Ms. Bramhall says. 鈥淚t鈥檚 imperative that people stay connected to me and me to them. I have to know them the same way, to make accurate decisions.鈥�

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

鈥淲e鈥檝e had to require our clients to purchase a doppler, blood pressure cuff, and personal听weight scale, so they can do their assessments themselves over video chat ... so we get听accurate data,鈥� Ms. Bramhall says.

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

鈥淎t a birth when we arrive, everybody is masked up, we do a rapid-response test on everybody听and ourselves, and if everybody comes back negative, we can unmask and have a birth,鈥� she听says. 鈥淲e鈥檙e doing our best to balance our personal safety and the safety of our families, with听keeping this life-changing event as magical and joyous as we can.鈥�

Empowering mothers

Midwives provide women with individualized care during pregnancy, childbirth, and the听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.听

鈥淭he only people who are good candidates for out-of-hospital birth are people who are听full-term and healthy,鈥� Ms. Bramhall notes.

Certified Nurse Midwives can practice in all 50 states.听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听reach, says Dr. Bennett.

Michelle Ingram-Sanders, a midwife in Bedford, Indiana, just south of Bloomington, owns听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.

鈥淲e鈥檙e keeping an open mind and doing everything we can to protect ourselves,鈥� says Mrs.听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.听鈥淚f the visit goes a little long, I still have time for cleaning and prep,鈥� she says.

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

鈥淧regnancy 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鈥檚 hearts and minds,鈥� she says. 鈥淔ear on top of labor in a pregnancy can change an outcome, because fear will change any outcome in life if that鈥檚 the driving force.鈥�

Ms. Bramhall says the way to alleviate that fear is to empower the mother, by helping her find听strength she didn鈥檛 know she had, especially when the pain is so great, she doesn鈥檛 think听she can proceed.

鈥淵ou look in her eyes, and you make her see, that you see, that 鈥榶es she can.鈥� And you听hold that, until you get to that point where, 鈥榶es she did,鈥欌�� Ms. Bramhall says. 鈥淎nd that鈥檚听where her empowerment comes in.鈥澨�

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

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

Ms. McHugh has enjoyed that continued relationship after her second son鈥檚 birth.听

鈥淸Ms. Bramhall] has been very much a part of my aftercare and Tully鈥檚 aftercare,鈥� she says. 鈥淪he made sure that all of us as a family are doing OK, emotionally, spiritually, everything. She鈥檚 just been very wholesome in her approach.鈥澨�

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