In recent weeks, doctors, midwives and other health professionals in Baltimore have reported a surge in interest in home births. Many of these expectant moms fear that going to the hospital could expose them to the coronavirus.
Patty Maizelswas sitting in the waiting room of her obstetrician’s office when someone coughed.
In her belly, a baby fluttered, occasionally strumming her abdomen with fingers and toes. Outside, the coronavirus pandemic was taking hold. Maizels could see its creep.
It was during that visit to the Greater Baltimore Medical Center, just three weeks before her due date, that Maizels decided she would deliver at home.
In recent weeks, doctors, midwives and others health professionals in Baltimore have reported a surge in interest in home births. Many of these expectant moms, like Maizels, fear that going to the hospital could expose them to the coronavirus. Some are frustrated by restrictions on visitors or nervous about being separated from their children should they test positive.
The sudden trend is reigniting a debate between home-birth advocates and the medical establishment. Organizations like the American Medical Association call hospitals and birthing centers the safest place to deliver. But a small minority of women are increasingly pursuing the opposite.
Home-birth advocates say the virus proves the point they’ve been making for years: that while hospitals cater to sick people, labor is a condition of health, something that for most people is safe and comfortable at home.
After the pandemic passes, women may increasingly ask: “Do I need to be in a hospital to have a baby?” says Eugene Declercq of Boston University’s School of Public Health, who has studied maternal choice for decades.
Former Baltimore health commissioner Dr. Leana Wen recently gave birth to a daughter in a hospital and sympathizes with the worries of expectant mothers. Pregnant women are considered medically vulnerable people. Should they test positive for the virus, many hospitals separate them from the newborns, an agonizing prospect. “I would be devastated,” she said.
Still, Wen, an emergency physician and visiting professor at George Washington University, cautions against making a last-minute change of birthing plans because of the virus. Moms need consistent care, and such a disruption can be dangerous, she advises.
“If you were not planning to have a home birth to begin with, you should not be going for a home birth now," Wen said. But she advises women who were already planning to have a home birth to stick with their original birthing plan, too.
Midwives and others who work with expectant mothers report a flood of new calls in recent weeks. Some calls they attribute to the closure of Special Beginnings, a birthing center in Anne Arundel County that recently announced it was going out of business. Other calls are women like Maizels, who are opting to avoid hospitals because of the pandemic.
Certified professional midwife Paige Barocca has been overwhelmed by new business. One or two calls a week have spiked to three or four a day, she says.
Deanna Kopf of Birthwise Midwifery in Glyndon has gotten nearly new 40 calls since mid-March, quadruple what she’d usually expect. She hasn’t taken on all of the callers as new clients; some women, for example, don’t realize that delivering at home means going without epidural.
And switching course late can cause trouble: Midwifery places an emphasis on time spent with clients. “It makes it harder when people transfer late like that,” Kopf said. "It can also make things less safe if you don’t have that trust.”
Brittney Riddick of Columbia is a doula, trained to support moms during labor. She has had so many inquiries from clients wanting to switch to home births she set up an automatic email to reply to them all. She notes that most hospitals are limiting visitors during the pandemic, forcing moms to choose between having their doula and their partner in the delivery room. Moms, in turn, feel the coronavirus has “thrown a wrench in the ideas of how they were wanting to birth.”
To Maizels, 43, the fear of contracting the coronavirus outweighed everything else.
An asthmatic, she’d caught swine flu during a previous pregnancy. The illness that led her to cough up blood and go into lung failure during labor. Her daughter spent 10 days in the neonatal intensive care unit with a respiratory virus that did lifelong damage.
After that pregnancy, Maizels suffered postpartum depression that only lifted when she took up Olympic weightlifting and powerlifting. She regularly lifts more than 300 pounds. Lifting is a family affair: Her daughter, Kensie, was breaking state records by age 8.
Maizels’ athleticism gave her the confidence she could power through a delivery without an epidural. Her last child had come before nurses even had time to administer one. “I knew what to expect. I knew that I could handle it,” Maizels said. And she comes from a line of tough women: Her grandmother gave birth in a German potato field, then went back to work afterward, she says.
With just weeks left to go, Maizels reached out to Bayla Berkowitz, a certified nurse midwife and founder of Charm City Midwives. After labor, Charm City Midwives would examine the baby and make two postpartum visits. That would save Maizels more trips to the doctor’s office afterward.
Most midwives and health professionals agree that home birth is meant only for women with low-risk pregnancies. Those with complications like gestational diabetes typically need to deliver in the hospital.
The reemergence of home births, considered the norm in the United States through the early 1900s, is a somewhat recent development. Until 2015, only certified nurse midwives could deliver babies at home in Maryland, and even they had to collaborate with an obstetrician-gynecologist.
Barocca, who successfully lobbied Maryland’s General Assembly to license lay midwives, is now working to get insurers to cover their services.
Home deliveries make up only about 1% of overall births, although that number has been rising since 2004, according to the National Center for Health Statistics. The trend has been made more visible by celebrities like Gisele Bündchen and “Hairspray" star Ricki Lake. Lake also produced the 2005 film “The Business of Being Born," which is critical of hospitals.
Dr. Robert O. Atlas, chair of Mercy Hospital’s obstetrics and gynecology department, has heard multiple cases of moms telling his staff they will deliver at home rather than risk exposure to the virus. “OK, good luck with that,” he thinks. He points out that hospitals like his are taking stringent measures to isolate COVID-positive patients.
“I think that patients should feel comfortable delivering in the safety of a hospital,” said Dr. Claire Weitz, division head of maternal fetal medicine at GBMC, where Maizels was scheduled to deliver.
Lisa Groff Reuschling, director of clinical women and child services at GBMC, declined to comment on Maizels’ case, citing privacy concerns. But she said she was not aware of patients delivering at home instead of the hospital.
At GBMC, new moms are limited to one visitor throughout their stay, and everyone wears a mask and gets their temperature checked. The hospital has set aside two labor and delivery rooms where air pressure is controlled to keep contaminants from spreading, as well as a special operating room to isolate moms who test positive for the virus. After labor, positive moms have the option of quarantining in their rooms with their newborns, with protective equipment in place.
Additionally, staff work with parents to get them out of the hospital soon after labor.
“Providing a safe environment for moms and babies: That’s our No. 1 mission,” says Groff Reuschling.
In the course of his career, Atlas has seen cases where mothers died because of hemorrhaging and other complications after a home delivery gone wrong. Some studies show home births are associated with twice the number of perinatal deaths and triple the risk of seizures in babies. Citing such statistics, the American College of Obstetricians and Gynecologists calls hospitals and birth centers “the safest settings for birth.” The American Medical Association agrees.
Ultimately, Maizels couldn’t prevent one stressful visit back to the hospital.
On April 14, contractions began, and then stopped. Her cervix dilated, then closed back up. Hours later, the kicks and hiccups had gone quiet. In the morning, Maizels poked and rubbed her belly, expecting the baby she’d nicknamed “Flutterbug” to push back. Nothing.
At Berkowitz’s urging, she and her husband headed to GBMC, where doctors checked the baby’s heartbeat. Fine, they said. The baby had likely just exhausted himself after a so-called “stalled labor” and was resting. A few hours later, the kicks and pokes were back up to speed.
During that trip, Maizels was encouraged to see staff and others wearing personal protective equipment and taking other precautions to prevent the spread of the coronavirus. But by that point, she was firm in her resolve to deliver at home. “I still wasn’t going to take the risk,” she said.
It would be a few more days before she saw her mucus plug, a sign that labor is imminent. She texted Berkowitz.
On April 18, Maizels sat on top of the bed she’d covered with a shower curtain and a sheet. When the pain intensified, she moved to the bath, emerging when it was time to push. Despite the lack of an epidural, advocates of home birth say it can be more comfortable than a hospital birth, as women have the opportunity to move around their homes or into the tub as they wish.
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“It can be really empowering to say, ‘This is my baby, this is my body, this is my birth experience and my life, and I get to choose how it goes,’" Berkowitz says.
In the end, Maizels stood up, a knee on a side table, breathing through the pain.
Within three pushes, Flutterbug was out of her body and in the arms of his father.
For a moment, Maizels stood there, heart pounding as if she’d just run a marathon. She watched as her husband tended to the newborn, suctioning out his nose and wiping him clean. When he asked whether she wanted to hold the baby, she could only nod. After nine months of pregnancy, here he was, her seventh child who until just recently had fluttered in her belly 100 times a day. She kissed his head and held him against her skin to warm him with her body heat.