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Birthing plans do not go as planned during coronavirus pandemic

Birthing plans do not go as planned during coronavirus pandemic

From the Coronavirus collection: March 22 through April 15 series
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Olivia Dunn Jimmy Taylor are pictured with their baby daughter, Rosalind Olga Taylor, on March 26 in Albany. New parenthood has been bittersweet for Olivia and Jimmy — they're head over heels for their new baby girl, but heartbroken that their parents have not been able to hold or be near their first grandchild.

ALBANY — On her first night home from the hospital after giving birth, 35-year-old Olivia Dunn watched as her father hung a plastic bag of his homemade meatloaf outside her kitchen door and then circled the house to peer through the glass front door.

He didn’t come in. He only looked. His daughter and her brand new baby were sitting together in a chair in the living room of their Albany home.

After he left, Dunn cried. Her father had seen the baby in images texted to his phone and on FaceTime. But not in person until that day. And this — this outside-peering-in visit — was not how she imagined it would go.

But then, she also hadn’t imagined that a worldwide outbreak of novel coronavirus would cause schools to close or businesses to shutter or entire economies to screech to a halt. She hadn’t imagined that the doulas she hired to support her through pregnancy would be barred from the delivery room. Or that keeping her loved ones safe would mean keeping her distance.

“It was heartbreaking,” Dunn said by telephone. “I’m an only child and this is my first child, so it may be their only grandchild. I imagined my mother coming and sitting with me. It’s hard. You just want to share your family, you know?”

Rosalind Olga Taylor was born March 19 at 9:27 p.m. at St. Peter’s Hospital in Albany while the global pandemic raged around her. While her parents, Dunn and husband Jimmy Taylor, knew that birth plans are just that — plans, not guarantees — they never could have anticipated the fears and anxieties that expectant parents the world over now face.

Birth plans everywhere are being upended as a result.

Interest in home births is growing as fears of exposure and overwhelmed hospital staff grow. Hospitals in California are offering induced labor at 39 weeks to speed deliveries before things get worse. Bans on visitors, including partners and fathers, in New York City labor and delivery rooms has local health care workers worried they’ll soon see an influx of downstate visitors upstate. While partners are currently allowed into Capital Region labor and delivery rooms, doulas and other support persons are not.

But guidelines are shifting so fast that local mothers fear nothing is certain anymore — that it’s just a matter of time before some other new restriction alters their plans.

“The experience of being pregnant is one of complete uncertainty,” said Dunn. “You don’t know anything — if your baby will be healthy, if you’ll carry the pregnancy to full term, who your child will grow up to be … but this, this is so much more.”

Interest in home birth spikes

No one has been more aware of the rapid change in birth plans than doulas and midwives.

Betsy Mercogliano, an Albany-based doula and certified midwife, said her phone has been ringing off the hook with people asking if they should scrap their hospital plans and birth at home. Women are afraid they may become exposed to the virus as hospitals are inundated with COVID-19 patients and protective gear for staff is increasingly hard to come by.

But if exposure is your fear, midwives warn that home births may be no more safe.

“Let’s think this through,” Mercogliano said. “You’re due in two weeks. You don’t know me, who I have been exposed to. I don’t know you, who you have been exposed to. It might not be at all a smart thing for either one of us to be in each other’s space.”

Risk of complication during birth is something that should also be considered, they say.

You are not a good candidate for home birth if you have an underlying health condition, are overweight or obese, are really young or really old (in reproductive years, that is), or are carrying multiple babies at once, since all raise your risk for complications during childbirth. First-time pregnancies are also not recommended.

“I’ve had to talk a lot of people down from their fear ledge,” Mercogliano said. “I talk to them about the parameters for our home births, which are low risk, healthy and planned.”

There’s also a capacity and supply issue right now.

Midwives are being slammed with home birth requests, but many don’t have the capacity to absorb a large number of new clients, nor do they have enough protective gear, the New York Homebirth Collective wrote in an open letter issued last week.

The group is urging people to stick with their original birth plans as much as possible, if also because of the time it takes to develop trust with a provider or midwife.

“If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth,” they wrote. “Birth is a physiologic process that is greatly impacted by one’s environment and one’s emotional state. For most people, the two are inextricably linked. Home birth with a client who does not fundamentally trust their location of birth place is unsafe for both client and midwife.”

They also do not recommend birthing at home without a skilled professional nearby, and without any education or preparation. Many things can go wrong during labor, they write, and midwives are trained to respond to emergencies and spot the warning signs ahead of time.

They and other childbirth experts recommend that people who are nervous about giving birth in the hospital contact their providers now to talk about the possibility of an early discharge and ways to minimize interactions with hospital staff. They also recommend trying to labor at home for as long as possible.

Albany Medical Center, St. Peter’s Health Partners and Ellis Medicine — the area’s three largest health systems — insist it remains safe to deliver at their hospitals. Staff are monitored every day for symptoms, and visitors are screened for both symptoms and travel history, they say. Patients who are confirmed or suspected to have COVID-19 are kept from others, they note.

“The health and safety of our patients is a top priority, and expectant parents should rest assured that it is safe to deliver their babies at Albany Med,” spokeswoman Sue Ford said, echoing sentiments from the other hospitals.

Visitor restrictions

Dunn learned one week before her due date that the doulas she had hired to coach her through pregnancy and delivery wouldn’t be allowed into St. Peter’s.

Hospitals across the Capital Region have restricted labor and delivery visitation to just one support person in an effort to reduce density and keep asymptomatic carriers of coronavirus from exposing patients and staff. New York on Friday told hospitals, including those in New York City, that they must allow at least one support person during labor so long as they are screened and asymptomic for COVID-19 symptoms.

“I was just devastated,” said Dunn, noting that she wasn’t about to choose her doula over her husband.

She had hired the doulas — who are trained to provide physical, emotional and informational support during pregnancy and childbirth, but unlike midwives do not deliver babies — largely for the emotional support.

“At 27 weeks I had to go in for surgery to have a cyst removed from my ovary, and it was scary and traumatic,” she recalled. “So part of my thinking was the doulas would be the support team I didn’t have through the surgery. It was going to make the birth something natural and special, as opposed to my last trip to the hospital.”

She labored at home for as long as possible with their support, until finally she had to leave. The doula who was with her that day, Liz Addeo, said watching her client leave for the hospital without her was one of the hardest things she’s ever done.

“It was heartbreaking,” she said. “I’d been working with her for three months. When you establish a relationship with a client like that it becomes very intimate and you want to see that birth through. Not being able to experience that moment was really hard.”

Doulas were initially upset at being turned away under the new and growing hospital visitation restrictions. They and their clients view themselves as health care professionals, and feel they should be admitted as such.

Their tone, at least publicly, has shifted on the issue in recent days as they acknowledge the strain that many hospitals are currently under.

“We understand the hospitals have to do what they have to do to keep everyone protected,” said Deshaya Williams, an Albany doula who specializes in postpartum support. “We’re trying to do Skype or FaceTime or texting the partner while the birthing person is in labor, but it’s difficult without being physically in the room.”

As long as they can’t be there, local doulas still want to support their clients during labor and delivery. They’re offering to FaceTime or call or text — whatever the laboring person is comfortable with.

During Dunn’s final hours of labor in the hospital, her husband and doulas exchanged texts regularly.

“I think just having them there, even by text, made us more comfortable,” she said.

Social, emotional support

Doulas and midwives are trying to shift their work to virtual settings as much as possible, though this is difficult for a field that is inherently hands-on.

With in-person childbirth classes canceled at most area hospitals and practices, the Family Life Center in Albany is attempting to fill the void by moving its childbirth education work online.

Jessica Allen Hayek, a birth doula with the center, taught her first online class Tuesday night from a makeshift classroom on her porch, featuring birthing balls, instructional posters and a model pelvis. Her classes will focus on the birth itself, while her colleagues’ will focus on breastfeeding, infant care and other topics, she said.

“There’s something really magical about sitting in a room with five expectant families that are all going to have their babies around the same time and that energy is something you can’t get over the computer screen,” she said. “But people feel better when they have information. And we want to give them information in whatever way we can. Our goal as educators and doulas is to try and empower people and to give them peace of mind.”

Doulas, midwives and childbirth experts across the region are urging expecting parents to become empowered in any way they can during these uncertain times — to sign up for online classes, to call their providers and ask questions, and to become comfortable with having to be flexible about their birth plans.

At the very least, they say, signing up for a class or hiring a doula may give them the social and emotional support that may be lacking during this time of social isolation.

The lack of social support has been one of the harder aspects of new parenthood for Dunn and Taylor.

“It is both a weird and a wonderful time,” Dunn said. “We’re having the most blissful, exciting time of our lives in just the most scary time that I’ll ever probably live through. It sort of just heightens the importance of family and of love.”

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