… by Sandy Starkey | June 6, 2020
How do we, as pregnant women, find our way to homebirth midwives? Each of us has her own unique story, yet many of them overlap I suspect. In my case, when I was pregnant with my third child, I learned that my obstetrician, a beloved family friend who had delivered my first two babies, was retiring. “Congratulations!” he said heartily, upon hearing my news. “I am going to give you the name of another Doctor I know, Doctor P. You have such easy births; I know you’ll be just fine with him.” I was happy for my old Doctor; he deserved to retire. He had been delivering babies for forty years! Nevertheless, Dr. P, the man he referred me to, was not what I had expected. In fact, Dr. P gave me the creeps. To put it bluntly, at my first appointment, he stared at my breasts the entire time. It’s true, I am a large breasted woman (thanks mom), and I was also pregnant, so even bigger. But still…yuck. After I got home, I thought, maybe I imagined that. I’ll go to one more appointment, and if he does it again, that’s it. Well, let’s just say he failed to make eye contact once during that second appointment, and I was done with “Dr. P.” for good. Fortunately, I had just been present at my best friend’s homebirth, so I felt confident about switching over to a midwife. In fact, I felt not only confident, but relieved to meet Marina. Everything about her—her warm brown eyes, affectionate manner and the way she said my name repeatedly, with her Cuban inflected English—was the antithesis of Dr. P., who saw me as just a body part.
Meghan Perez was planning to give birth at a hospital on Long Island but has decided to use a midwife and deliver at home. Credit…Johnny Milano for The New York TimesThose of us who find our way to homebirth midwives feel blessed, and we should, because most American women do not get this chance. According to the CDC, only one percent of U.S. births take place at home, despite the fact that, as the Washington Post notes, “In many other countries, such as Sweden, Norway and France, midwives provide care for most expectant and new mothers.” Also, according to Elizabeth Armstrong, Princeton University Professor of Health and Public Affairs, “the evidence that home birth for low-risk women attended by a skilled midwife is no less safe than hospital birth has only been growing.” Nevertheless, in the U.S., homebirth hasn’t gained as much traction as it has in other countries, partly because some in the medical community have disparaged it, which has contributed to restrictive laws in some states on the licensure of nurse midwives, according to Suzanne Wertman, a consultant for the American College of Nurse Midwives who was interviewed by the Washington Post. This can drive some mothers away from homebirth, simply because of the cost, since “some midwifery practices may not be credentialed for coverage by certain insurance providers.” However, just as Covid 19 has shined a light on other disparities and inequities in health care, it has shown that midwives “are highly underutilized,” according to Wertman. She adds, “The pandemic is just exposing all of these weaknesses in the system.” In addition, it is very important to note that Homebirth patients should be low risk, without chronic conditions such as type 1 diabetes, obesity, and hypertension. These conditions are more prominent in communities of color, due to systemic racism, as the coronavirus crisis has highlighted. These inequities must be addressed in our health system first and foremost, so all women who wish to can have the option of a homebirth.
One silver lining to come out of the tragic Coronavirus Pandemic, especially on the East Coast, was a surge in homebirths and increased publicity for homebirth midwives. An April 2020 article in the New York Times entitled “Pregnant and Scared of Covid Hospitals, They’re Giving Birth at Home” describes the huge demand for midwifery services in the New York area. The author, Kimiko de Freytas-Tamura, quotes a midwife with thirty years of experience named Jeanette Breen, who says her midwifery practice has been “a whirlwind of activity,” and that they’ve even been getting late transfers, which they normally don’t accept. Breen went on to say that in addition to helping eight women deliver in the first three months of the year, she had fielded “more than 25 inquiries, nearly all of them women who had initially planned hospital deliveries with doctors.” Another midwife from Brooklyn, Tinisha Williams, said her practice had received 200 calls from pregnant women in one week.
The pregnant women interviewed in the New York Times article were most concerned about the health and safety of their babies, but they also worried about being separated from their partners during childbirth and not being able to bond effectively with their newborns in the tense hospital environment. One pregnant woman who was interviewed, Meghan Perez, said she and her husband had never seriously considered a home birth until the Covid 19 crisis hit. Then, as things became more intense and the hospitals appeared to be overwhelmed, they sought out a homebirth midwife. Meghan and her husband contacted an overwhelmed midwifery practice, Gaia midwives, and “were among 15 couples interviewed on the same day.” Perez told the Times, “When we were notified that they would take us on under their care, I felt like I was accepted to the college of my choice.”
The West Coast didn’t experience a hospital crisis like that of New York, but some California midwives nevertheless report a surge of interest in their homebirth practices. In a Los Angeles Times article entitled, “Pregnant Women Forced to Get Creative as Coronavirus Bears Down on LA Hospitals,” reporter Sonja Sharp interviews homebirth midwife Beth Cannon from Sherman Oaks, who tells her, “I’ve been getting at least five inquiries a day” about home births. People want to have their team, and they don’t want to be around the extra germs.”
I spoke to licensed midwife Dawn Dana from Ventura County, who told me that she took at least twenty calls from pregnant women inquiring about home birth because of Covid 19 concerns. She also received calls from supporting physicians, asking if she could take on low risk patients if the hospital went into crisis mode. Fortunately, this did not happen. Ms. Dana did add two new pregnant clients to her already busy practice, and she reports that both women were pleased with their homebirth experiences and were likely to choose a home birth over the hospital if they became pregnant again.
The East Coast women sought out home birth midwives in extraordinary circumstances. However, as with Ms. Dana’s new clients, the exceptional care they get is likely to persuade them to come back for their next birth. An article in the Washington Post quotes several midwives, who “cite the close relationships they develop with patients, and their emphasis on creating a comfortable, undisturbed space for childbirth as advantages over hospital births.” By assisting women in need during the pandemic and taking the burden off hospitals, midwives have once again shown us the critical role they play as health care providers. Ideally, as we work toward creating a more just society, with a health care system that benefits everyone equally, homebirth with trained, nurturing midwives will truly be an option for all women.
Armstrong, Elizabeth Mitchell. “Home Birth Matters—For All Women.” The Journal of Perinatal Education. 2010 Winter; 19(1): pp 8–11. Dana, Dawn. Personal Interview. 2 June 2020.
De Freytas-Tamura, Kimiko. “Pregnant and Scared of Covid Hospitals, They’re Giving Birth at Home. The New York Times. 21 April 2020. NewYorkTimes.com. Accessed 1 June 2020.
Schmidt, Samantha. “Pregnant Women are Opting for Home Births as Hospitals Prepare for Coronavirus.” The Washington Post. 20 March 2020. Washingtonpost.com. Accessed 1 June 2020.
Sharp, Sonja. “Pregnant Women Forced to Get Creative As Coronavirus Bears Down On LA Hospitals.” Los Angeles Times. 1 April 2020. Losangelestimes.com. Accessed 1 June 2020.