The COVID-19 pandemic has had an unimaginable effect on everyone’s lives. But if you’re pregnant, the virus and the disease it causes, COVID-19 (particularly the current predominant Delta variant) have produced additional concerns. One worry that some moms-to-be have expressed throughout the pandemic is whether they should move forward with their plans to head to the hospital when it’s time to deliver, or if they should consider a home birth.
The good news is that you don’t have to make the switch from hospital birth to home birth in order to stay safe. Here’s a look at what experts are recommend, plus how to make the right choice for you.
Home births vs. hospital births during the pandemic
Women have been giving birth at home long before hospitals even existed. Today, the vast majority of babies are born in hospitals, but modern home birth can be a safe alternative, provided you’re prepared and have a top-notch support system.
The American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse-Midwives (ACNM) say home birth should only be considered for low-risk pregnancies. “If a mother or child is not low risk, then no matter what the world pandemic status is, the best place for the mother and baby is to be in the hospital,” says Jessica Arno, a certified professional midwife based in San Antonio, Texas.
A home birth should be attended by a physician or certified nurse-midwife, and the mom-to-be should have fast access to a hospital in the event of an emergency, experts say.
ACOG has additional guidelines for home births: Only moms carrying one baby (no multiples!), only deliveries between 37 and 41 weeks, only babies positioned for a proper vaginal delivery and only if your labor started at home. (In other words, you shouldn’t start laboring in the hospital and then finish at home.)
That might sound like a long list, but it’s there to keep moms and babies safe. “Home birth is always a calculated risk,” explains Mark Payson, M.D., Practice Director of CCRM Fertility Northern Virginia in Vienna and a member of the What to Expect Medical Review Board.
Proponents of home birth point to potential health benefits: Planned home births have been associated with fewer maternal interventions, lower risk of maternal infection, and third- or fourth-degree lacerations and tears. Being able to have more control over their birth experience is also appealing to some moms. Home birth risks include fewer options for pain control, the possibility of needing hospital transport in case of complications and increased risk of perinatal death.
“Most deliveries are uncomplicated. However, a significant minority of women and infants used to die in childbirth,” says Dr. Payson. “Modern hospital-based obstetrical care has turned [that] into a vanishingly rare event.”
Pregnant During a Pandemic
Should you switch to a home birth due to the pandemic?
ACOG maintains that hospitals or birthing centers are still the safest places to give birth.
In April of last year, the American Academy of Pediatrics (AAP) updated its recommendations on home births to emphasize that they, too, believe medical centers are safest for moms and babies. The majority of experts agree, for several important reasons.
If a complication comes up, you and your baby are already in the best place to receive care.
Home births can be safe for low-risk pregnancies. But even for healthy women, serious complications can arise that require being transferred to the hospital ASAP.
The problem is that getting to the hospital in the middle of a home birth could be harder during the pandemic, especially if cases of COVID-19 are spiking in your area. Ambulances and EMTs may already be overwhelmed, causing them to get to you slower than they normally would, notes James Greenberg, M.D., Chief of Gynecology at Brigham and Women’s Faulkner Hospital in Boston, Massachusetts and member of the What to Expect Medical Review Board.
“If a medical emergency does arise during birth at home, families should also be aware of the very real risk that emergency transport services could be unavailable due to the coronavirus response,” said Kristi L. Watterberg, M.D., F.A.A.P., lead author of the AAP’s policy statement published in the May 2020 issue of Pediatrics.
Being brought to the hospital mid-labor for a complication also means you’d start out in the emergency room. That could put you in close proximity to people seeking medical attention for COVID-19 symptoms, placing you at greater risk for contracting the virus, says Washington, D.C.-based labor and delivery nurse Juliana Parker, R.N. This is particularly true if you live in an area with high levels of COVID-19 transmission.
That’s not the case when you plan to give birth at the hospital. If you’re planning on a hospital birth, “when you go into labor, you don’t enter the ER. You enter through a completely separate entrance and get taken straight to labor and delivery,” says Parker.
Hospitals are taking extra precautions to keep patients safe.
The truth is, germs are always a concern in hospitals, not just during a pandemic. As it is when there isn’t a pandemic going on, your hospital room will be sanitized before you arrive. And maternity wards have adopted a slew of additional precautionary measures over the past year and a half to protect hospital workers and patients.
Home births should be planned in advance.
Safe home births need to be mapped out, says Leana Wen, M.D., a visiting professor at the Milken Institute School of Public Health and George Washington University in Washington, D.C. You’d need a licensed midwife (the AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board), and if your current provider can’t or won’t support a home birth, that might require changing medical practices. You also need to stock up on supplies, like plastic-backed sheets, sterile gloves and cord clamps.
“Home births can be safe, but you have to be very low-risk,” Dr. Wen explains in an interview with What to Expect founder Heidi Murkoff. “It’s not something you can just plan at the last minute.”
You’ll also need to think about where you’d go in the event of a complication or emergency. “You have to be super close to a backup plan,” says Dr. Wen.
In other words, it’s not the sort of thing you’d opt for if your due date was days away. “If you’re within four weeks of your due date, it’s unlikely you’d be able to switch practices,” Parker says. “You can try, but you’d want your new provider to have a chance to receive your records and learn about you.”
Making the right decision for you
Ultimately, it’s every woman’s choice to decide where she wants to give birth. But most experts agree that the potential risks of birthing at home are greater than the risk of birthing at a hospital during the COVID-19 pandemic. And that would only change “if the hospital was so overwhelmed that basic obstetrical care was unavailable,” Dr. Payson says.
If switching to a home birth feels like the best option for you, start by talking with your care team. Your doctor or midwife can help you weigh your concerns, recommends Dr. Wen.
Finally, no matter how worried you might be, try to keep your eyes on the incredible prize you’ll get at the end of this journey. Regardless of where you give birth or what the experience is like, in the end, you’re going to meet your sweet, beautiful baby.