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Since the moment the term “pandemic” was used and a National State of Emergency was declared a few months ago, the world as we knew it changed.  Access to adequate healthcare in America was already limited due to myriad reasons, but when you factor in a global pandemic, the cracks in our system really began to show—hospitals transformed into COVID care facilities overnight, both ill-prepared and unequipped to handle such a sudden surge in patients.

But what would you do if you were pregnant and scheduled to give birth at one of these hospitals? Or got pregnant during this pandemic?  What resources are out there for women and partners in pregnancy? We were very lucky to interview Midwife, childbirth educator, Doula trainer, and Lead Pregnancy Educator at LOOM, Jessica Diggs. As a provider of support, knowledge, and resources to birthing people and their partners, Diggs was able to share some powerful insight on the phenomena of birth in the age of social distancing.

Are there mothers that you are working with who have contracted or been exposed to COVID-19? In this case, did you still perform an at home birth using the recommended and mandatory safety precautions or did you have to make other arrangements for them? If so, what precautions and alterations did you make to your procedure?

At the moment, I have not had anyone present with the virus before labor. However, my current guidelines state that if there is not enough time left in the pregnancy to safely quarantine and recover from the virus then their care will be transferred to another provider and they will need to give birth in a hospital setting.  The recommendation comes from an understanding that COVID-19 has potential respiratory complications that can be exacerbated during labor and the early postpartum period. Like any other factors that increase the risk for complications during or immediately after labor, once a client moves from low-risk to high-risk, then the safest place for them to give birth is at a hospital.

Who or what inspired your journey in OB?

Witnessing the birth of my baby sister at the age of 9 definitely played a significant role in normalizing birth for me, but even then I do not recall being fearful of the experience. I’m pretty sure I was the only one in the room who was quite giddy the whole time. My poor laboring mom surrounded by an anxious partner, her crying middle child and her foolishly giddy oldest child! 

Many people have been told by their hospitals to prepare for an at-home birth with little to no warning time. How does this affect your normal bonding process with the mother and partner, as well as the time spent preparing for the at-home birth?

Late transfers into care can always present some difficulties since they have not received the full benefit of midwifery care—the space to build rapport with the midwife in preparation for their home birth. From a clinical standpoint, their records and labs are thoroughly reviewed and ongoing conversations to normalize home birth occur. It definitely shifts my process from a gradual intertwined curriculum regarding safety, emergencies, pain management, and my scope to one that focuses only on those things. With time being limited, we do not always have the space to truly normalize all of those aspects regarding birth in general and how they are handled during a home birth.

Many hospitals have denied loved ones entry to attend the birth with the mother—has this ruling changed at all?  If this happened to you, what actions would you take given the current circumstances?

Here in Los Angeles, hospitals are allowing ONE support person to be present with them throughout the laboring process. For a few weeks, that support person had to leave once the baby was born but that has since changed (a week ago) and they are now allowing support people, like partners, to stay during the postpartum period.

We have been prepared to be denied entry in the hospital this whole time. From a safety standpoint, I do not disagree with this precaution, nor do I wish to be in the hospital setting during a pandemic. With this in mind, I have had frank conversations with my clients about what a transport would look like and the actions I will take to keep them safe and offer as smooth of a transport as possible. These actions include calling ahead to have them prepared for the client, asking to receive the client through L&D versus the ER, providing a hardcopy of records and a worksheet of the labor progress to best understand what happened at home.

What is something (a lesson, mantra, mindset, etc)  you’ve learned through your work in quarantine?

My mantra throughout this time has been, “Give them grace, they are operating in their trauma response right now!” For my work,  “Trust birth!”