Women & Infants Health Blog with Dr. Tessa Reinke
COVID-19 Fear Shouldn’t Force a Home Birth
By Tessa Reinke, MD (Family Practice, Surgical Obstetrics)
Even under normal circumstances, uncertainty leads to fear and anxiety. During this period of social distancing and quarantine secondary to the COVID-19 pandemic, those uncertainties can drive widespread panic, mistrust and misinformation. This, in turn, can cause us to alter our normal patterns of decision making.
The New York Times recently ran an article written by Dr. Harlan Krumbolz, a New Haven cardiologist, discussing that since the pandemic began, the number of patients’ with heart attacks seems to have substantially decreased, at times by as much as 40-60%. The concern Dr. Krumbolz raised in his article is that COVID-19, in addition to creating the very real fear of infection and death, “has instilled fear of face-to-face medicine… As a result, many people with urgent health problems may be opting to remain at home rather than call for help.” He goes on to plead with his readers not to avoid or delay care for important and emergency procedures, even as hospitals and physicians are delaying elective procedures and visits.
Thus far, our corner of the world has thankfully felt much less impact from the pandemic. Of course, we are socially distancing and small businesses throughout the area are closed or are struggling financially, but our emergency rooms are not overflowing with people sick from respiratory symptoms and most do not have personal stories of friends on ventilators or family members who have died with the virus. Even still, the uncertainty surrounding medical care in these pandemic times has led to increased anxiety in one of our most vulnerable populations—expectant mothers. Understandably, pregnant women and their support networks are worried about putting themselves and their soon-to-be born children at risk by accessing medical care both during their pregnancies and during the labor and delivery process. This has led to an increase in late-to-prenatal care pregnancies and less than safe delivery situations.
Deciding where and how her obstetrical care will occur is clearly a woman’s personal choice, but it should not be made without all the information available for a safe and healthy outcome. First, hospitals and clinics are equipped to care for both infectious diseases, such as COVD-19, and other medical issues concurrently without exposing those who are uninfected. For those seeking to avoid exposure to SARS-CoV-2 by not seeking prenatal care altogether, they are putting themselves and their fetuses at risk from any number of complications including diabetes, high blood pressure, and placenta problems. These problems, under proper prenatal care, can be managed and the delivery planned in such a way to avoid poor outcomes for both mother and child. Without advanced planning, the risks of harm greatly increase. In addition, women in labor are often taken to a different section of the hospital from those who could pose an infection risk and frequently do not even pass through the emergency room. There is little to no overlap between medical staff attending to a woman in labor and in the postpartum period and those attending to individuals sick with an infectious disease. Hospitals are adept at separating women and newborns from infection risk every day and that has not changed with this pandemic. In fact, it has become more stringent in many cases.
Second, there was a short period of time where hospitals were not allowing partners to be present during a woman’s labor and delivery. This has never been the case in our area. Several well supported scientific studies demonstrate that a laboring woman has a better experience and is more likely to have a safe and healthy delivery with a support person present. And the ultimate goal for any obstetrical provider is a safe and healthy delivery for mother and babe.
Third, delivering in a hospital labor and delivery ward or at an accredited birthing center is simply safer on average than delivering at home, both for the mother and the infant. Due to the physiologic changes associated with labor and delivery, problems and complications can rapidly arise in even the healthiest of pregnancies that threaten maternal and fetal well-being. The American College of Obstetrics and Gynecology Committee Opinion on home birth reports that about one in every three first-time mothers seeking planned home birth and between 4-9% of experienced mothers require transport to a hospital while in labor for lack of progress, issues with the baby’s heart rate, need for pain relief, high blood pressure, bleeding and problems with the position of the baby that cannot be dealt with in the home setting. These transports, under the best circumstances, are often urgent, rushed affairs leading to increased maternal anxiety, difficulties getting the woman’s support person to the hospital and other complications. Valuable time is lost, first assessing the issue at hand and the need for transport, then transporting the woman in labor and then reassessing her once she gets to the hospital – all of which can be avoided by choosing to deliver at an appropriately equipped facility. This is particularly true in rural settings, where the actual transport time may be significantly longer than the recommended 15 minutes or less. Indeed, planned home births, even those attended by licensed practitioners have twice the rate of infant death (3.9 events per 1,000 home births vs. 1.8 events per 1,000 hospital births) and three times the rate of infant seizures and other neurologic problems (ACOG Committee Opinion – Planned Home Birth, 2017) because situations arise during labor and delivery that cannot be managed outside of a hospital. These increased complications happen even in a carefully selected population of expectant mothers who are deemed lower risk. Complications and morbidity are significantly worse in unplanned or unattended out-of-hospital deliveries.
Although these discrete numbers may seem small, preventable harm in this population must be unacceptable to us when weighed against fear of the unknown. This is particularly true where the known exposure of SARS-CoV is very low in our region. Please consider the known risks of not accessing appropriate clinic and hospital based medical care during pregnancy and birth against the lesser known risks of exposure to COVID-19.
For more information:
ACOG Committee Opinion on Planned Home Birth: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/04/planned-home-birth
ACOG Statement on Birth Settings: https://www.acog.org/news/news-releases/2020/04/acog-statement-on-birth-settings