San Diego sees spike in home births during COVID years

In March 2022, Emily was pregnant with her first child and really wanted to become a mother. But she was far less excited about the idea of ​​giving birth in a hospital, especially in the age of COVID-19.

“It was not clear if there would be limits on the number of people in the room and it would likely be necessary to wear a mask,” she said.

Emily, who asked to be referred to only by her first name for privacy reasons, said the restrictions made her consider alternatives. She already knew that she wanted to have autonomy over her birth experience and avoid other medical interventions that might come with a hospital birth.

She then had a disturbing prenatal appointment. When Emily told her doctor that she wanted to go into labor without an epidural, the doctor laughed and said he heard this from many expectant mothers who ended up changing their minds.

It was then that Emily made the final decision to give birth at home.

“I know a lot of people work from home and have just found creative ways to do what they usually do at home in a different setting,” Emily said. “I think that inspired a lot of people to think, ‘Hey, can I have a home birth?’

Since the start of the pandemic in early 2020, home births have skyrocketed both nationally and in San Diego County. Countywide, home births are up 28% from the year before COVID-19 through the end of 2022.

To be sure, the 576 home births in 2022 are just a fraction of the county’s over 37,000 births last year. But the increase is significant – Emily said it was difficult to find a free midwife.

Some women give birth outside the hospital by accident – their babies are born too quickly and they don’t make it to the hospital on time. However, most plan to give birth at home and hire a certified midwife to come to their home during the birth and accompany them through the birth process. They have medical instruments to help if needed.

“She had oxygen tanks, she had everything she needed to get stitches if there were tears, she had medication in case of bleeding, any major complications that might occur,” Emily said of her midwife.

She added that the midwife is trained to respond to more than just minor complications, including cases where the umbilical cord is wrapped around the baby’s neck or if the baby needs help breathing.

A 2014 California law allowed midwives to oversee childbirth without medical supervision, but only for women without any pregnancy complications. The list of conditions that rule out home birth includes: gestational diabetes, breech presentation, or even twin pregnancy.

Hospitals are still the safest

Despite current trends, the American College of Obstetricians and Gynecologists (OB-GYN) believes that it is still safer to give birth in a hospital.

Midwives can transfer the woman to the hospital if complications arise. Emily said she was comforted by the fact that she lives a five-minute walk from the hospital. However, experts say being close to a hospital can be a false sense of security — five minutes can be too long depending on the complication.

“There are some birth complications that we just can’t predict ahead of time and it takes time to get into an ambulance and get to the hospital, and time can mean someone bleeds for longer,” Dr. Alice said. Sutton. , an obstetrician-gynecologist at the University of California, San Diego.

Studies show that between 23% and 37% of women who try to give birth at home end up in the hospital. But the most common cause is not a dangerous complication, but the fact that the mother is exhausted. Her labor has been delayed and she needs an epidural or other pain medication. Other causes are too low a fetal heart rate, postpartum hemorrhage, and breathing problems in the infant.

The most serious risk is the death of the baby during or after delivery, Sutton says, and that risk is higher with home births.

“And for a baby, these pre-transport moments are really vital, and if a baby is born in a hospital, then there is usually a neonatal intensive care unit or neonatal intensive care unit and pediatricians who are always available,” she said.

However, Sutton said she understands why women might not want to give birth in a hospital. Sutton herself is pregnant and plans to give birth with a midwife at UC San Diego.

“I think sometimes in the medical system in general and even in the hospital in particular, patients don’t feel like their intentions at birth, their plans or their wishes are not being followed,” she said. “Sometimes patients really hope for a minimally invasive delivery, but they don’t get it. And then it makes them worry about interacting with the medical system again in the future. So I think it’s very important that suppliers try to honor those intentions whenever they can.”

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Emily lies in the birthing bath in her bedroom during a home birth, October 2022.

Alicia Thembi gave birth in April 2021 and said the possible restrictions due to COVID-19 got her thinking. She wanted to hire a doula—a certified assistant who can help a mother during childbirth—but she wasn’t sure if she could have anyone other than her husband in the delivery room.

“So it was a red flag for me, it definitely bothered me a lot,” Tembi said. “And you had to wear a mask, of course. And you should have been tested for COVID right away.”

However, Tembi decided to give birth at the University of California, San Diego – in a maternity hospital with a midwife, where hospital doctors were seconds away.

“I think there is still this anxiety, what if something bad happens and you are not near the hospital?” she said. “At UCSD, if something out of the ordinary happens, you get rolled out down the hallway. Much better than going in an ambulance.”

High costs

Emily also considered going to a certified birthing center, but her insurance didn’t cover it. It also didn’t cover hiring a midwife to come to her home, but it was still cheaper. A home birth with a midwife costs about $6,000, while in maternity hospitals it costs $8,000 or $9,000. In addition, according to Emily, she already feels comfortable at home.

“Once I go into labor, I don’t have to think about getting in my car and going somewhere, I can just be here in this space,” she said.

Heather Lemaster is one of San Diego County’s licensed midwives whose business has flourished during the COVID era.

“COVID-19 has helped families really stop and go, wait a minute, I have other options, there are plenty of places I can have a baby,” LeMaster said. “And I think also maybe for some families that gave them just a different point of view. So just think, do I really want to come home with something I didn’t come with?”

LeMaster usually sees three to five deliveries a month, but says other midwives are doing double digits. She said that she usually arrives five to seven hours before the birth and tries to get inside so as not to spoil the mood.

“I really want them to feel like we haven’t even arrived, and then most of my families, either partners will catch the baby, or if there are little siblings or maybe a little teenager, sometimes they want to catch their siblings. and so I kind of help that too,” she said. “From that comes an empowerment that can’t be described in words.”

LeMaster said she saw several emergency transfers to hospitals, including for a mother’s tear that needed to be repaired in the operating room, excessive blood loss or bleeding, and when she suspected the placenta was blocking the entrance to the uterus.

“In general, I would say that a real emergency, where you didn’t see the signs in advance, when you don’t see the dominoes fall one way or the other, is extremely rare,” she said.

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A midwife measures Willow’s head after she was born at home, October 2022.

Important day

A month before the birth, a midwife came to Emily and brought a bath for childbirth. When the day came, Emily alerted the midwife and just relaxed. As her labor progressed, a midwife and doula arrived.

She had a long way to go – her labor lasted 37 hours and her baby was facing backwards, causing severe back pain.

“It was very painful, much more painful than I expected, but it was great because my doula and my midwife were able to respond to it with various exercises, movements, to try to encourage her to change position,” Emily said. . “There were times when her pulse would drop a little and my midwives were constantly monitoring me, monitoring her to make sure all her vitals were in order.”

She ended up not giving birth in the bathtub as planned, but was still able to get through the pain and stay at home. She created a soothing atmosphere for the baby in her bedroom with scented candles, soft lighting and Christian worship music.

“So the whole vibe was just really comfortable,” she said. “Warm, subdued light, just very relaxing.”

After a day and a half of labor, she pushed for four hours, after which her daughter Willow was born at home.

“There are a lot of unknowns before birth and that can cause a lot of fear,” Emily said. “And I found that being in my own home, in my own space, was kind of alleviating some of that fear. I’m here, I’m comfortable, I know this space.”

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