Navigating Prenatal Care During COVID-19
Updated: Jul 14, 2020
It's been quite a process navigating midwifery over the past month and a half, as widespread social changes due to COVID-19 have been shaping how we all interact with one another. Midwifery care is traditionally incredibly personalized, centered around connection, relationship building and a certain degree of physical closeness that allows for integrating other modalities into supporting the pregnancy, like body work to relieve discomforts, palpating bellies to feel baby's position, and body balancing stretches to prepare for birth. As a midwife in the time of COVID, I've had to reconfigure how I support my clients in without being in close physical proximity to them. Let's just say it's been a lot easier to do than I originally imagined, and it's actually given many unexpected gifts that have re-grounded me into why I became a midwife in the first place. Here's how my practice has changed and the things I've learned so far...
Midwifery care is so personal. And covering myself with extra layers of plastic and cloth, in addition to the physical distancing requirements, had initially made this process feel much more impersonal. But I've been reminded that midwifery as a model of care still remains personal at its core. It can't help but to be personal and intimate and connection-centered. Because connection happens no matter how many layers or barriers are between us - and I'm really feeling that lately in more areas than just midwifery.
I love seeing my clients' beautiful faces in our virtual visits! And without having to be in the same room together, they can still show me the things they need to show me (like how much swelling is on their ankles, or where on their belly they're feeling baby kicks and wiggles). They can still ask me all of their questions, and I can still respond thoughtfully to each one. We still spend an average of 45-60 minutes at each visit checking in on how they're doing on every level; physically, mentally, emotionally and spiritually. We still laugh together, problem solve together, rejoice in successes together and shed tears together over the hard parts of the journey.
Though I'm not feeling their babies with my own hand by palpating my clients' bellies, I'm inviting them to feel and become more familiar and in tune with their babies - position, movement, sensations. It's as if these additional barriers to physical proximity have challenged us to create new doors. It's resigning the easy path that I'm used to traveling as a midwife, and asking the parents to take on leading the way. And it's brought me right back to where I started on my own journey to becoming a midwife -- family-centered, autonomous and individualized care. It's not up to me to reach over and determine baby's position. It's up to the parents to connect, respond and prepare in the ways that they innately know are appropriate for themselves and their family. I am here to provide options, counsel and guidance, but ultimately the family leads the way. This is, of course, their journey. Some experiences:
1. Virtual Visits: Initially I was pretty stressed about virtual visits. How would I monitor vitals? How would I be sure that everything was staying on-track? What I learned very quickly is that virtual visits have actually been pretty wonderful. I have been pleasantly surprised to learn that several of my clients already own or have access to a BP cuff, measuring tape and a fetal doppler. So, I've been asking folks to take their own vitals during our virtual visits. We still get to enjoy our 45-60 minutes of face-to-face time, where we discuss all the things we would normally discuss and I answer all of their questions. The connection and personalization isn't missing - it's alive and well!
2. Saving Travel Resources: I have a few clients who normally have to travel quite a distance to my office for our appointments, who now have the ability to save gas, time and childcare by not traveling to see me and doing virtual visits instead. This is pretty extraordinary and has expanded my parameters for who I'm able to serve and support in the greater San Diego and surrounding areas. I certainly don't mind a trek to attend someone's birth and provide postpartum care, but having the option to do partial virtual visits in the future (post-COVID) for folks who live farther away gives a whole new option for access to care for these families.
3. Masks at Births: Part of the reason most folks choose homebirth and midwifery care is because they are looking for a more natural experience. So, walking into someone's birth space donning a face mask can feel a little reminiscent of a hospital-like atmosphere. And to be honest with you, it feels really awkward for me. So much of my communication is non-verbal in birth, and removing half of my face from view makes me feel nervous that my lines of communication are hindered. Some families are also understandably put off by the mask, but I assure you, your same smiling midwife is still there! Wearing a mask is something I do to help keep you safe in a time of lots of unknowns - it doesn't change my practice style or the way that I care for you. One thing that I've decided against requiring is that my laboring clients wear masks while in labor. I just cannot fathom telling a laboring person to put on a mask while she's doing her best to breathe deeply - she and baby need all the oxygen they can get!
4. Labs & Home Visits: While virtual visits are working out great, there are still certain times where it's important for me to see my clients for in-person visits, and I do! If someone needs labs drawn, I will see them in-person to draw those labs. I will also see my clients for their regularly scheduled 36wk home visit and any other acute visits that require in-person assessment and care. During all in-person visits, I will be washing and sanitizing my hands and surfaces thoroughly and wearing a face mask to protect my clients.
5. I Miss Hugs: It's hard to know what to say after a baby is born when someone turns to me and asks, "Is it ok if I hug you?" when I normally I wouldn't even hesitate. Air hugs just don't land the same. I'm a hugger - though I'll definitely respect the boundaries of those who aren't huggers - and I find myself missing those little celebratory or reassuring moments. It all seems a bit surreal to walk into a birth space as intimate as someone's home, their bedroom or their bathroom even, and have to think about social distancing. So much of how I support in labor has to do with presence, reassuring touch and voice. How do I resist helping when I'm there to help? Moreover, how do I challenge myself to continue providing excellent support within the parameters of COVID boundaries?
6. Reframing: It's easy to get stuck in what we don't want. I don't want to midwife with the restrictions of COVID. I don't want to limit in-person visits. I don't want birthing families to be limited by strict policies if we have to transfer to hospital. There's lots that I have zero control over as a midwife... as a human. But one thing that's never changed is what I DO have control over - and that's the way that I respond and reframe. It's a lot like how I work with clients to reduce birth trauma. Pulling the uncomfortable parts off the shelf and exploring them before (or if) they even become real. Deciding in advance where I am able to make decisions and be in my power, so that I feel calm and confident even in the most unfavorable circumstances. Where can I see that I've been able to innovate and provide flexibility amongst rigid boundaries? How can I empower my clients to rely on their connection to their baby and their partner if they require a transfer to the hospital? How am I remaining fully present without being physically present?
7. Babies Keep Being Born: Honestly, friends... At the end of the day, babies just keep being born. No matter the circumstances - even with a global pandemic, a closed down state and stay at home orders - babies will continue to be born every, single day. Birth is as ancient as the beginning of time and there's something really sweet and miraculous about this extraordinary, but also super
ordinary, event. If you're feeling worried about your upcoming birth, just know that the blueprint for being born and giving birth is in your baby's DNA and your DNA, and it's a blueprint that's been lovingly passed down since the beginning of all humanity. You can trust that innate wisdom, because it is unrelenting in the most positive and beautiful way.
That was a little longer than expected, but I hope you were able to discover a little more about my process in caring for folks during this strange and wild time that we're living in. If you've got any questions about midwifery care or homebirth, I'm always happy to have a conversation! Be well and stay safe.