ideabug/iStock(NEW YORK) -- Expectant women today are facing a question they likely never expected to have to ask in their pregnancy -- how to give birth during a pandemic.
The question has led some women to look online for answers, specifically on home births. Searches on Google for information on home births have increased markedly as the novel coronavirus has spread in the United States and pictures of hospitals full of patients with COVID-19, the illness caused by the coronavirus, have consumed the news and social media.
Some pregnant women are also suddenly looking at other birthing options in light of restrictions many hospitals have placed on the number of people allowed in the delivery room and in hospital visiting areas in light of the coronavirus.
“People are sort of in panic mode, they’re afraid to go into the hospital with the fear of the unknown,” Michelle Rhude, certified nurse midwife and owner of Bella Donna Midwifery in Jacksonville, North Carolina, told ABC News' Good Morning America. “They’re saying, ‘I need to change my plan. I don’t know if they'll allow my husband or mother in the birthing room.’”
Women as far along as 37 weeks pregnant are calling for interest in trying to change their birth plan, according to Rhude, whose company provides home birth, birthing center and doula services, among other needs. The hospital system in Rhude's area has instituted a new rule that says laboring mothers may have one visitor accompany them, forcing women to choose between their partner or doula.
Besides the possibility of not having their support person during labor and delivery, women are also fearful of being around sick people, Rhude noted.
“They feel if they stay home [to] have their baby they’re not going to have that exposure,” she added. “And then it’s, ‘I’m not even going to have my person with me.’”
Rhude said her services and resources differ from hospital maternity wards, and women typically do their homework over the course of an entire pregnancy. Some even plan for years.
“It’s hard a lot of women coming to you last minute who have not done all the research,” Rhude explained. “We want to help every woman, we in this time of desperation, but is it has to be the best choice.”
Doctors too are expressing their concerns about the complications that could arise from women making last-minute decisions to give birth outside of a hospital.
"Obstetricians in the United States are concerned about home births because we don’t have a rigorous system in place where if things start to become abnormal we have an easy and safe way to transfer women to the hospital," Dr. Elizabeth Langen, a practicing OBGYN and clinical associate professor at the University of Michigan, told GMA. "Results for home births in the U.S. are not the same as they are in other countries."
"My concern is that if people are choosing to have a home birth who have a higher risk of complications than people who generally have home births, then we might see harm come to people because they’re choosing a riskier location of delivery," she added.
Here are more pressing questions answered about a home birth versus a hospital birth in the time of coronavirus:
How common are home births?
Home births are on the rise in the U.S., data shows.
Approximately 35,000 births, or just under 1%, per year occur in the home in the U.S., according to the American College of Obstetricians and Gynecologists (ACOG).
Who should not have a home birth?
Women who are in a high-risk pregnancy should not consider a home birth, experts say.
Other disqualifying factors for a home birth include: Being pregnant with more than one baby; having had a previous c-section birth; being breech (i.e. the baby's buttocks and/or feet are positioned to be delivered first); maternal medical conditions, like high blood pressure and gestational diabetes; and high-risk fetal issues.
What are the risks of a home birth?
Home births are associated with a “twofold increase in perinatal death” according to a 2017 position paper by ACOG. Home births are also associated with a triple risk of incidents of seizures and serious neurological dysfunction for the baby.
For the mother, the main risk factor in a home birth is related to potentially deadly bleeding.
The coronavirus pandemic also presents a unique risk because emergency services are backed up in some areas with COVID-19 patients, noted Langen.
"If women are attempting a home birth and something terrible happens, a mom is bleeding or a baby is not breathing, generally you rely on an ambulance to transport you to the hospital," she said. "But that might not be an option for you if there aren’t as many EMS workers available in your area to help transport you safely."
Are hospitals safe for pregnant women right now?
The safest place to give birth is "still a hospital, hospital-based birth center, or accredited freestanding birth center," according to coronavirus guidelines issued by the American College of Obstetricians and Gynecologists (ACOG).
"Even the healthiest pregnancies can have problems arise with little or no warning during labor and delivery," ACOG says in its guidelines. "If problems happen, a hospital setting can give you and your baby the best care in a hurry. And studies have shown that babies born at home are more than twice as likely to die around the time of birth than those born in hospitals."
ACOG also added that, "Every woman has the right to choose where she will give birth. But it is important to not take any risks that might put you or your newborn’s health in danger, especially as there is a high risk for getting COVID-19. Talk with your ob-gyn or other health care professional about your birth plan and any concerns."
Langen also said that hospitals realize giving birth is not an elective surgery that can be delayed and are therefore taking as many steps as possible to ensure deliveries continue on in a safe environment.
"We understand that labor and birth needs to go on," she said.
What questions should women ask before a hospital birth?
Langen stressed that doctors and hospitals are there to help expectant women, especially when it comes to answering any questions.
"We recognize that everything has been turned upside down and we want to keep you safe," she said. "Talk with your doctor about how to make that happen ... ask your provider about what is safe to do and how the hospital is going to keep you safe."
With some hospitals temporarily relocating labor and delivery departments, expectant women should also ask their provider any logical questions about where they should go for the delivery, according to Langen.
She said women should also ask their doctors about what they can do now to prepare themselves for the safest possible hospital birth.
"What we’ve tried encourage for our pregnant patients is really aggressive social distancing to minimize the chance that they’re symptomatic when they come in for delivery," Langen said. "If you are any time near where you might deliver, we think keeping you and your support person free from symptoms is really important."
What should women consider before choosing a home birth?
"The decision to have a home birth safely really requires that you and your midwife look at your whole pregnancy and your medical health and the baby’s medical health to make sure that home birth is a safe option," said Langen. "There are women for whom home births have higher risks than others so you want to make this decision based not on this virus now, but on the whole pregnancy and safety for you and your baby."
Women who do choose a home birth need to be prepared to have a certified birth provider -- whether that's a midwife, a nurse or a doctor -- oversee the birth, according to Dr. Sarp Aksel, an OBGYN in New York City.
"I don’t think there’s any such thing as a low-risk pregnancy because any pregnancy can turn into a high-risk pregnancy in a matter of minutes," Aksel told GMA last year. "Having someone [leading the birth] who is well versed and experienced in that is really important."
Any woman considering a home birth should have a well-rehearsed and documented contingency plan in place, advises Aksel, including plans for quick and reliable transport to a nearby hospital, if needed.
In the time of coronavirus, women also need to talk with their certified birth provider about the precautions the provider has taken for their own safety.
"You want to talk about what personal protective equipment does the midwife have access to and how many homes did she have to go in and out of because this is also going to be a dangerous time for midwives," said Langen. "They may not be able to socially distance if they’re going in and out of people’s homes."
"And if your midwife is sick, she may or may not have a lot of backups to help with your birth," she added. "Looking at the whole system and how safe it is for you as an individual is important."
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