Coronavirus and home birth

Has the Coronavirus outbreak made you consider home birth? Or are you wondering what would happen to your home birth plans if you come down with it?

This article will look at the benefits of opting for home birth in these times, plus the possible issues that may arise, such staff shortages or you becoming ill. This is not medical advice but an exploration of the issues, a weighing up of pros and cons. I hope it will be read by parents-to-be, doulas, chairs of Maternity Voices Partnerships and clinicians. I’d like to send a huge vote of thanks to all health professionals who are on the front line at this challenging time.

One of the benefits of home birth is your own germs. Despite what people commonly think, hospitals are not places to go if you want to avoid germs. There are germs at home, but they tend to be the lower grade ones, ‘familial bacteria’, that are helpful or we have built immunity to. Hospitals on the other hand are full of sick people and one of the risks of hospital birth is picking up infections such as C dificile. Obviously, hospitals endeavour to keep really clean, but there are lots of bodily fluids around. At home, the only bodily fluids are your own.

The Coronavirus seems to spread easily which is why events are being cancelled, and there are suggestions about reducing the number of people you are in contact with. Giving birth at home reduces your contact to only the midwives who attend your birth, not all the other people (staff and families) on labour ward and postnatal ward, or the trolleys and staff who move from ward to ward.

Hospital birth is not just about giving birth in hospital, in a room someone else was in before you, but also about the postnatal stay, sharing a bathroom, lots of people, all opening and closing the doors. Hospitals may well limit visitors, which you may be glad about, but if you have other children, they may not be able to visit you.

Planning a home birth also massively reduces your chance of intervention. Overall, a planned home birth has only a 3% chance of emergency caesarean, compared to 11% with a planned hospital birth (from Birthplace study of low risk women). Planned home birth is also associated with less chance of tearing/episiotomy, haemorrhage, assisted birth, and need for epidural (8% vs 31%, same study). Intervention often leads to a longer stay in hospital, as well as potentially making you weaker and therefore more vulnerable, increasing your exposure and your chance of contracting Coronavirus.

If you are considering home birth for the first time because of Coronavirus, here’s an article I wrote about why planning a home birth is a good idea, even if you want to give birth in hospital, and you can find more information on home birth here and also here. Worried you are not prepared? You honestly don't need a lot - just a few extra towels, and some plastic sheeting or replacement shower curtain. If you want a pool these can be booked and delivered quickly. Ask your local doula or home birth group if there any local for sale, or to hire.

Even for women planning a hospital birth staying at home for as long as possible could reduce your chance of contracting Coronavirus. It can be difficult to then know when to go in, without leaving it too late and giving birth in the car. One of the benefits of planning a home birth is that if birth is going quickly and well, there is no need to go anywhere, but also that you have a midwife with you helping you to make the decision to go in if needed, and an ambulance with gas and air in it to take you.

There is an argument that hospital trusts, regional health boards, should be making strategic plans to increase the number of home births in response to Corona, to reduce the spread of the virus and also to ease the strain on the health service, and protect staff.

Women planning home births are concerned that the opposite will happen. Often what happens as soon as there is staff sickness, community midwives and home birth teams are called off home births and reassigned to labour or postnatal wards. If you are told there are no midwives to come out what do you do? You do not have to go in. The choice to give birth at home is yours to make. Generally, the hospital will do what it can to send someone out, but if there is no one then they may send an ambulance. If this is a worry for you then consider hiring an independent midwife. Independent midwives are amazing! Plus they have a much smaller client caseload so are less likely to pass on Coronavirus to you.

It is better to be proactive about this. Write to the head of midwifery now, and the Chief Exec, and ask them about their strategic plans. Let them know that you are planning a home birth and are aware this reduces your chance of contracting Coronavirus, and would not like to put you and your baby at increased risk if staff shortages mean home birth services are cut.

Suggest increasing home births is a solution. More home births = fewer interventions = fewer hospital staff needed. Raise it with your local Maternity Voices Partnership, for them to ask.

So what if you are planning a home birth but may have been exposed to the Coronavirus?

are no greater risk of contracting it than the general public. Home birth is a great way to self isolate.

If you come down with Coronavirus the good news is that it is very unlikely that it can be passed to the baby in the womb.

“Only one case of possible vertical transmission (transmission from mother to baby antenatally or intrapartum) has been reported in the literature. Expert opinion is that the fetus is unlikely to be exposed during pregnancy. A case series published by Chen et al tested amniotic fluid, cord blood, neonatal throat swabs and breastmilk samples from COVID-19 infected mothers and all samples tested negative for the virus. Furthermore, in a different paper by Chen et al, three placentas of infected mothers were swabbed and tested negative for the virus.” Coronvirus COVID-19 virus infection in pregnancy, RCM & RCOG 2002 page 4

If you have Coronavirus, or are suspected of having it, whether showing symptoms or not, the advice from RCM and RCOG is to have a hospital birth. They are suggesting this for two reasons: your oxygen levels can be monitored, and your baby can be continually monitored.

“All women should be encouraged to call the maternity unit for advice in early labour. Women with mild COVID-19 symptoms can be encouraged to remain at home (self-isolating) in early (latent phase) labour as per standard practice.
If birth at home or in a midwifery-led unit is planned, a discussion should be initiated with the woman regarding the potentially increased risk of fetal compromise in women infected with COVID-19 (as was noted in the Chinese case series of nine women).2 The woman should be advised to attend an obstetric unit for birth, where the baby can be monitored using continuous electronic fetal monitoring. This guidance may change as more evidence becomes available.” Same report as above.

Deciding where to give birth is rarely made on one issue alone, but a weighing up of the pros and cons. Here the pros are being in hospital where you can be continually monitored, and the cons are all the cons of hospital birth, plus increased chance of contracting the virus or passing it on to others.

Continual monitoring is being offered. The report says that the fetus is unlikely to be exposed during pregnancy, but the reports from China suggest a potential higher level of babies having difficulties in labour. This is based on really low numbers (9/18 mothers), and could have had other causes. The cons of continual monitoring are a greatly increased chance of ending up with interventions such as caesarean, and more difficult and stressful birth, due to less freedom to move and increased worry about the trace. There is strong research to show that continual monitoring is no better than intermittent monitoring at indicating a baby is not doing well. See obstetrician Dr Kirsten Small’s website, Birth Small Talk, for articles on the pros and cons of continual fetal monitoring.

If you have a home birth the midwife will still be closing monitoring your and your baby. She will use intermittent monitoring to check on the baby's wellbeing. She will be watching and listening and if she has any concerns, she will recommend transferring you in.

If you are ill, where would you rather be? Giving birth in your own home, your own bathroom, your own toilet sounds much preferable. And afterwards, to be in your own bed, with your partner and/or mother/friend around 24/7 to care for the baby, and for you. Compare that to being left overnight in an isolation side room, just you and baby. Obviously, it depends how ill you are with it. If you are not sure if you have it, or have only mild symptoms, you may make a different decision to if you are very poorly with it. That’s why it makes sense to make the decision that is right for you, not a blanket policy.

As with many things in life, and definitely in birth, there is rarely one right answer, one choice, that fits everyone. You have to make the best decision for you and your baby, depending on your individual circumstances. Use the professionals’ knowledge and skills and then make your decision. All of us who plan home births know that there are things that come up that mean changing your home birth plans. We also know that planning a home birth has many advantages.

I hope that this gives you food for thought. For many women the idea of home birth anyway is not appealing. That’s fine. This is not for them. But if you are planning a home birth I hope you have found this practical and reassuring.

I am a doula and antenatal teacher in Bedfordshire. I have an awesome Pregnancy Retreat Day at the beginning of April.