Pregnancy during the COVID-19 pandemic
The Pandemic, by Lynn Ungar:
“What if you thought of it
as the Jews consider the Sabbath—
the most sacred of times?
Cease from travel.
Cease from buying and selling.
Give up, just for now,
on trying to make the world
different than it is.
Sing. Pray. Touch only those
to whom you commit your life.
And when your body has become still,
reach out with your heart.
Know that we are connected
in ways that are terrifying and beautiful.
(You could hardly deny it now.)
Know that our lives
are in one another’s hands.
(Surely, that has come clear.)
Do not reach out your hands.
Reach out your heart.
Reach out your words.
Reach out all the tendrils
of compassion that move, invisibly,
where we cannot touch.
Promise this world your love–
for better or for worse,
in sickness and in health,
so long as we all shall live.”
On day 3 of social distancing,
my midwife sent me the poem above as she delivered heartbreaking news: Due to COVID-19, the CHA Cambridge Birth Center had been closed for labor and delivery for the foreseeable future. Instead, all low-risk expecting mothers are being funneled into hospital care. I was stunned and disappointed. During pregnancy, you’re often told to prepare for the unknown, but this pandemic was beginning to raise too many question marks for comfort.
I felt selfish for being upset when I still had so much to be grateful for – the health my growing snowpea and my family; the medical system that could support me here if I were to fall sick; the shelter and warmth that protected me; the food (and toilet paper) that we had secured; the connections that I could access virtually; and the feeling that I wasn’t alone.
And yet I also knew that the frustration, disappointment, and fear that I was feeling deserved to be acknowledged if I hoped to stop dragging them around along with the 20 pregnancy pounds that I had already gained. To be honest, I was a little angry – angry that during my last few months of freedom, I had been sentenced to home arrest; angry that I was becoming detached from the bond I was forming with my growing baby by the stress that was beginning to dominate my thoughts; angry that my birthing choice had been taken from me less than a month after I had set my hopes on laboring and delivering at the birth at the center at my last second trimester appointment.
More importantly, I was angry at the patriarchal medical model of birthing. Instead of trusting our ability to birth naturally, the medical model of birthing is one in which:
We are funneled into a setting where pregnancy is treated as an illness;
We are taunted with the threat of unbearable pain to ensure that we follow hospital protocols – and if that doesn’t work, we’re confronted with the threat of a call to Child Protection Services (I’ve actually heard of this happening!);
We are judged first by the color of our skin and income level, and, especially if we fall into a minority status, we are assumed to be manifesting our complications if we speak from our bodies’ intuition (why else would Black women be 2-3 times more likely to die from pregnancy-related causes than white women?);
Provider protection from medical malpractice holds more weight than creating a childbirth experience unattached to the baggage of birthing trauma;
Failing to read the small print is a slippery slope to a C-section and financial disaster;
The business of birth as usual is an extension of sexual violence, rape culture, parochial abortion laws, and the other myriad ways that women are disempowered from control over our bodies (and why didn’t they teach us this in school?!).
At least, that’s how I felt in that moment. But I’m just an angry, hormonal pregnant woman, so what do I know about my baby and my body?
Of course, these are issues that go far beyond the scope of COVID-19. The purpose of the birth center’s closure is noble as they want to ensure that Cambridge Hospital’s labor and delivery team is fully staffed during this era of high healthcare worker demand. But it did make me wonder… why are low-risk pregnant women being pushed into the same building that houses so many COVID-19 cases?
Beyond the local area, hospitals are pressuring women into early inductions before too many cases of COVID-19 hit. Other hospitals are forcing birthing mothers to choose between their doula and their partner to be present during labor and deliver (assuming they are asymptomatic and haven’t recently been traveling). What’s worse, other hospitals have acted against World Health Organization (WHO) and Centers for Disease Control (CDC) guidelines to ban ALL support people. Rather than take away our right to a positive birth experience, wouldn’t it make more sense to provide resources and encouragement for some of us to shelter at home to birth in an area where we can feel safe and supported?
But here we go with the unknowns again. Are pregnant people more susceptible to being infected and ill from COVID-19 than other populations? CDC doesn’t know yet. Can COVID-19 be from pregnant or breastfeeding mothers to their fetus or breastfeeding newborn? There’s no evidence that of the virus in amniotic fluid or breastmilk, but it’s too early for CDC to tell. If a pregnant person has COVID-19, can it cause any harm to the baby after it’s born? Again, CDC can’t determine this. So how do we honestly assess the possible risk of COVID-19 in our birthing choices? We can’t yet, but our pregnancies go on.
What we do know is this: WHO says that all pregnant people – including those who have confirmed cases of COVID-19, those who are suspected of having COVID-19, and those who are simply scared of becoming infected with COVID-19 – should have the right to a “safe and positive childbirth experience,” which includes the following:
“Being treated with respect and dignity;
Having a companion of choice present during delivery;
Clear communication by maternity staff;
Appropriate pain relief strategies:
Mobility in labour where possible, and birth position of choice.”
Translated, we should have the right to choose an experience that can best support us. Home birth is one choice. Granted, it isn’t the choice for everyone, and modern medicine isn’t pure evil. In fact, the miracle of modern medicine saves countless lives each year when it comes to intervening early in complications. However, many of these complications that would make home birth a potentially unsafe choice can be predicted by high-risk conditions, such as preeclampsia, gestational diabetes, pregnancy with multiples, and breech or transverse fetal positioning.
But for low-risk pregnant mothers who were already down for the natural experience (and yes, I’m mainly trying to reassure myself here), home births may merit consideration – not only to potentially protect ourselves from potential COVID-19 transmission, but also to avoid the countless unnecessary medical interventions that often come as baggage with the hospital birthing experience.
There is evidence to show home births can in fact be a safe choice for low-risk expecting mothers – especially if we have assistance from a certified nurse midwife, access to a practicing OB/GYN, and an escape route to the hospital, just in case. As an example, a 2019 study published in The Lancet's EClinicalMedicine journal showed that there was no increased risk of perinatal or neonatal death for low-risk pregnant people who intended to give birth at home compared to those who intended to give birth at the hospital.
But still, what about all the other unknowns related to my home birthing experience – you know, like what if something DOES go wrong that could have been prevented if I had chosen to give birth at a hospital? Could I ever live with myself if my baby were hurt…or worse?
The truth is, I’m scared. Not so much about COVID-19 itself – I’m thankful that my pregnancy has seemed to improve my immune system’s functioning, not diminish it. Instead, I’m scared of the unknown. In some ways, it feels like a problem of privilege, but I am scared of birthing in a hospital. And I’m scared that I also wouldn’t be supported if I were to choose to birth at home. Beyond birthing and even beyond COVID-19, I’m scared of being sheltered at home indefinitely after having a baby, and I’m a little scared of motherhood itself.
On day 16 of social distancing,
I still don’t know what’s going to happen in my own birthing experience, let alone the experience of any other mother who is expecting right now. But I do know that I’m starting to relax into a new normal. I’m feeling reconnected to the activity of the baby growing inside of me, and I’m even feeling a little relieved to have mourned the loss of my ideal birth experience so early. Finally, I’m beginning to become comfortable with not knowing because this moment of uncertainty is all we have.