In March and April of 2020, our home birth practice phone rang constantly and email inquiries through our website came in multiple times a day. This immediate change in demand for community birth care pushed midwives to adapt their practices to preserve shared decision-making and patient autonomy in a changing landscape while keeping themselves and their patients healthy. The surge in interest in home and birth center care, the uncertainty and urgency of preventing infections, and the strain on our healthcare institutions challenged midwives. Now, over a year into the pandemic, we can see how midwives have adapted to meet the expanding demand for their services and responded to meet the care needs of their communities. In doing so, midwives have further demonstrated their value as a solid resource for care to their communities and within health care systems.
The pandemic has further exposed long-standing health inequities and structural racism that exists within our health care system. Choosing where to receive care and/or give birth has become more complicated in light of the risk of exposure to COVID-19 in each setting and concern that institutional policies may worsen the ability to receive respectful care. One response to the pandemic has been the exponential growth of home and birth center practices.
ACNM supports midwives and models of care committed to:
- Ensuring parents and families are supported and their feelings are validated,
- Facilitating processes for shared responsibility and informed decision-making regarding the place of care and or birth, and
- Delivering evidenced-based, respectful, person-centered care1
Midwives are optimally positioned to provide accurate information for pregnant people to evaluate their options for care and birth based on their preferences and framing of safety and risk. Midwives are central to the health and protection of the family during pregnancy, childbirth, and in the early days and months once a baby is born.2 Researchers of well-designed studies regarding home and birth center birth have demonstrated outcomes to be similar for births across settings when there is an integrated system of care providing for timely transfer when and if needed.3,4
ACNM supports birthing at home and in birth centers for pregnant people and recognizes that optimal outcomes are achieved when:
- They have quality screening for perinatal and neonatal risk,
- Are attended by a midwife whose education meets or exceeds the International Confederation of Midwives Global Standards for Midwifery Education and are licensed within their state of practice, and
- Care is provided within an integrated, supportive system for safe, seamless, and timely transfer within the context of written practice guidelines.1
Respectful prenatal, birth, and postpartum care that strives for health equity is essential to the well-being of pregnant people, newborns, families, and communities. The pandemic has exposed many stressors to our system of care, but also has presented opportunities for collaboration across care settings with the reframing of priorities for how to deliver care. Providing care in the home and birth center settings can potentially limit exposure to multiple health care providers and support staff as well as to other birthing people.
In addition to following recommended distancing and masking protocols when giving care, midwives have needed to consider changes to their local health care system or infrastructure. During pregnancy, midwives have needed to have discussions regarding preferences for receiving care. Some pregnant people have wanted a combination of telehealth and face-to-face visits to decrease exposure. The demographics and priorities of those being served have expanded to people who may not have considered care in this context prior to the pandemic. Particularly with expanding interest, midwives have needed to clearly communicate expectations to all parties so they understand the increased agency and ownership of their care and whether it would best serve them.
In addition to navigating the increase in patient volume, midwives have needed to call upon the core competencies pertaining to care in the community and their ability to be fluid in this regard. Some home and birth center midwives have also been called upon by health care structures to provide support for families birthing in hospitals who need antenatal or postpartum support.
In alignment with ACNM standards, practices caring for people in communities across all care settings are instituting clinical practice guidelines that specifically address COVID-19 utilizing the most current understanding relevant to infection prevention and screening.5
You can learn more about how midwives are addressing the challenges and opportunities presented by the COVID-19 pandemic at the upcoming ACNM 66th Annual Meeting, May 23-25, 2021. We will discuss how one home birth practice pivoted to provide more comprehensive and accessible care.
References:
1.ACNM Patient-Centered Care for Pregnant Patients choosing home birth during the COVID-19 Pandemic, 8/2020
2. International Confederation of Midwives. (2020) ICM Joint calls to action: protecting midwives to sustain care for women, newborns & their families. Retrieved from: https://www.internationalmidwives.org/assets/files/news-files/2020/05/1call-to-action.pdf
3. Vedam, Stoll, Macdorman, et al. 2018. Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PloS one, 13(2), https://doi.org/10.1371/journal.pone.0192523
4. Scarf, Rossiter, Vedam, et al. Maternal and perinatal outcomes by planned place of birth among women with low risk pregnancies in high income countries: a systematic review and meta-analysis. Midwifery. 2018;62:240-255.
5. American College of Nurse-Midwives. (2011) Standards for the Practice of Midwifery. Retrieved from https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000051/Standards_for_Practice_of_Midwifery_Sept_2011.pdf
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