Midwifery Care Plan during COVID-19 Pandemic
COVID-19 AND COMMUNITY MIDWIFERY CARE
We are making every effort to stay informed and educate ourselves on developments regarding Novel Coronavirus and COVID-19 infection as well as best practices in midwifery management in a community setting.
We are grateful that we can be of service at this time. And in order to continue to be available to provide essential midwifery care to as many families as possible, we are putting systems in place to protect you, the greater community, and ourselves.
Registered clients, please feel free to reach out with any questions or concerns you have.
Also, we know this is a strange and stressful time for everyone, but we still care about you and want to hear from you with your successes and smiles too! Social distancing and virtual appointments don’t mean we don’t want to stay in touch about the fun and meaningful parts of your pregnancy and early days with your baby. Midwifery practices are a little bit different, but our motivation and values are not changing. We are committed to bringing just as much heart, support and connection as we always do to your care.
On this page you will find our current recommendations and protocols for keeping yourselves and us, your midwives, safe and healthy.
AVAILABILITY AND APPOINTMENT SCHEDULE
We are making every effort to stay informed and educate ourselves on developments regarding Novel Coronavirus and COVID-19 infection as well as best practices in midwifery management in a community setting.
We are grateful that we can be of service at this time. And in order to continue to be available to provide essential midwifery care to as many families as possible, we are putting systems in place to protect you, the greater community, and ourselves.
Registered clients, please feel free to reach out with any questions or concerns you have.
Also, we know this is a strange and stressful time for everyone, but we still care about you and want to hear from you with your successes and smiles too! Social distancing and virtual appointments don’t mean we don’t want to stay in touch about the fun and meaningful parts of your pregnancy and early days with your baby. Midwifery practices are a little bit different, but our motivation and values are not changing. We are committed to bringing just as much heart, support and connection as we always do to your care.
On this page you will find our current recommendations and protocols for keeping yourselves and us, your midwives, safe and healthy.
AVAILABILITY AND APPOINTMENT SCHEDULE
- Any appointments and consultations not requiring physical assessments including interviews with prospective clients can be conducted via tele-medicine if desired.
- The following appointments must be scheduled in person:
- Initial visit at 12 weeks with labs as indicated
- 20 weeks, 28 weeks with labs as indicated, 32 wks, 35 wks preparation for home birth, 38 wks, 40 wks, 41+ wks
- All appointments in the first two weeks after the birth.
- Midwives are experts in providing care to people having healthy pregnancies, normal births, and healthy newborns in a community setting. We do not have access to higher level medical equipment and facilities including full personal protective equipment. Therefore, if a client is sick, it is in everyone’s best interest for the client to be seen in a medical setting for evaluation and treatment.
- Please let us know asap if anyone in your home is sick or believes they may have been exposed to someone with COVID-19. We can help you make decisions about how and when to seek medical care.
- We recommend that all pregnant people and everyone in their household quarantine at home and avoid contact with others as much as possible. The limited research that is currently available indicates that pregnant people are not at an increased risk of developing COVID-19, but pregnant people may be at an increased risk of severe or critical illness if they do develop COVID-19.
- All midwives and assistants in our practice are wearing masks for ALL in person contacts. We will use our discretion about the type of mask we use for each interaction with the goals of minimizing risk of virus transmission as well as conserving medical grade masks for situations when they are most needed.
- We request that anyone attending in person appointments wear a mask.
- Soap and water is very effective for destroying Novel Coronavirus. Wash hands, clothes, and surfaces frequently.
- Current research shows no evidence of transmission of the Novel Coronavirus from parent to baby during pregnancy.
- Breastfeeding is still recommended even if a birthing parent has mild illness. Breastfeeding is likely protective for babies, and is as important as always for maternal and newborn health and well-being. Babies can contract the virus from parents after birth, so if a breastfeeding parent is ill, they should wash hands and wear a mask during breastfeeding.
- We have coordinated with other local midwife colleagues for back up assistance in the event that we get sick or suspect we have been exposed to COVID-19.
- We are available to registered clients by email, phone and Zoom for any questions you may have about your health.
- Taking good care of your mental and emotional health as well as your physical health are as important now as ever. Reducing stress and taking good care of yourself is very supportive of normal, spontaneous labor and birth. We recommend doing what you can now to increase your enjoyment of your pregnancy, safeguard your health, and enhance your love and labor hormones!
- We recommend finding activities and practices that are enjoyable, calming, and supportive. Choose activities that feel right to you, such as getting outside, making art, exercising, reading things that make you feel good, enjoying physical touch and affection with your household members, minimizing social media exposure, playing, enjoying meals, meditating, talking to friends and family by phone, or whatever else helps you feel calm and content.
- Eat a varied and healthy diet of real foods as much as possible.
- Get plenty of sleep, plenty of water, and some movement every day.
- Apps like Calm, Headspace, and GentleBirth can be wonderful resources for calming and focusing the mind and relieving anxiety.
- Here is a short meditation you can do now and return to as often as you need to, for shifting the experience of fear and anxiety lead by Somatic Experiencing Practitioner Lael Keen.
- Dr. Aviva Romm is a midwife, physician and well respected expert on alternative and herbal medicines. Her web page and blog on COVID-19 are rich resources with lots of information and recommendations for maximizing health, and they are frequently updated. Click here to check it out.
- Acupressure or Acupuncture are wonderful tools for supporting pregnancy, encouraging timely labors and births, pain management, lowering stress and anxiety and increasing health and well-being. Here is a link to internationally recognized acupressure expert for pregnancy and birth, Debra Betts. Her website has specific instructions for how to find and use acupressure points at home. And here is a link for a series of points for lowering anxiety.
- Acupuncturist Alicia Masiulis made a self-massage/acupressure video with techniques you can do at home for labor preparation and anxiety reduction. Click here to watch.
- Many therapists are still available for phone or video sessions.
- Online childbirth classes are a wonderful way to meet virtually with other parents and prepare for your birth.
- In person appointments in your home are available as long as no one in the home has any signs of illness (fever, cough, shortness of breath, congestion, diarrhea, or vomiting) or any reason to believe they may have been exposed to someone with COVID-19.
- Please limit people at appointments to those who live with you.
- Prior to an in person visit, please wipe down high touch surfaces (door knobs, faucets, countertops, toilets, etc.) with either a soap and water solution, a solution containing 70% or greater concentration of alcohol, or a solution containing 10% or greater of bleach.
- Prior to an in person visit, please take your temperature and the temperature of everyone living with you. We can not do in person visits if anyone has a temperature of 100.4 or greater.
- Prenatal care can consist of a combination of virtual and in person visits.
- We will not be able to attend in person visits for clients who are ill, or where household members have potentially been exposed to COVID-19 (travel from a high infection area in the last 14 days, recent contact with someone with a diagnosed case of COVID-19, symptoms consistent with COVID-19). We can meet over Zoom, and can help you make decisions about whether medical attention and/or hospital birth are appropriate.
- We are wearing masks during ALL in person contacts. We request that anyone attending your prenatal visits also wear a mask in compliance with safety recommendations.
- You may wish to purchase or borrow some supplies and equipment to use at home to monitor your health, especially when care is happening virtually over Zoom. This might include: thermometer, blood pressure cuff (arm type, not wrist type), scale, fetoscope or doppler for listening to baby’s heart, baby scale for monitoring newborn weight loss and weight gain. We can teach you how to use these tools at an in person appointment or via Zoom.
- Normal fetal movement is a very good indicator of baby’s health. In most cases where fetal movement is normal, frequent listening to fetal heart tones is not necessary. Most pregnant parents have a good sense of what constitutes normal fetal movement for their own baby. You can use kick counts to confirm that fetal movement is normal if you wish. There is an educational handout in the Client Portal on how to perform kick counts.
- Currently, all normal supplies for home birth including birth kits from our supplier, Radiant Belly, are still available. Radiant Belly is experiencing shipping delays due to increased volume of orders, and they anticipate they may run out of some items due to supply chain issues. For this reason, we recommend ordering your birth kit and any other supplies you need as far in advance as is practical.
- We highly recommend that you hire a doula to be part of your birth team, especially if this is your first birth and/or if home birth is new to you. Doulas are excellent providers of education, resources, hands on support and emotional support. They can join you earlier in labor than your midwives can (especially at the moment while we manage higher client volume), help evaluate labor progress, and help notify us when it is time for us to join you. A doula does not replace your midwives, but rather is a wonderful addition to the team. We are still available for support and education, as always! But we recognize and appreciate the important role doulas play in supporting birth and bringing calm, reassurance and connection to clients, especially during these difficult times. We are compiling a list of available doulas who have home birth experience, agree to follow strict social isolation in their own life to reduce risk of exposure for our clients and us, and agree to follow our requirements for use of PPE and any other safety precautions we ask of them at births. Contact me for details.
- We are still attending labors and births at home as long as everyone in the household is free of symptoms and have no suspected exposure to Novel Coronavirus.
- We will not be able to attend births at home for clients who are ill, or where household members have potentially been exposed to COVID-19 (travel from a high infection area in the last 14 days, recent contact with someone with a diagnosed case of COVID-19, symptoms consistent with COVID-19).
- Before the midwives come to your home in labor, please wipe down high touch surfaces (door knobs, faucets, countertops, toilets/handles, etc.) and ask anyone in the home who has been out recently to shower and/or change into clean clothes.
- Doulas are welcome and encouraged at births as long as they have no symptoms of illness or suspected exposure.
- We request limiting people attending the birth to midwives, one doula, and household members only.
- We request that everyone attending your birth wear a mask when in close proximity to us, including partners, doulas, family members and children. The birthing person is recommended but not required to wear a mask. This practice helps us minimize the chance of us spreading the virus to other families we come into contact with.
- You are welcomed to use a birth tub for labor and birth, however, there are some questions regarding potential increased risk of virus transmission during water birth, or from tubs being inadequately sanitized between births.
- Hospital policies regarding whether or not midwives may enter the hospital with clients during a transfer are changing rapidly. It is likely that in the event of a transfer, we will not be permitted to enter the hospital with you as we normally would do. Also, we may need to make the difficult decision to not accompany clients into the hospital even if permitted in order to reduce our risk of exposure and therefore the risk to all of our other clients and their families. This represents a major departure from our standard practice, and it is difficult for us to contemplate. However, during this unique time, we must consider the health of the whole community. In the event of a transfer we will still provide records and give report to the receiving care team, and we will still be available for support and guidance via phone or video throughout the rest of the birth.
- If we have two clients in labor at the same time, we will do our best to call in a backup midwife to assist you.
- Appointments after the first week can be a combination of virtual and in person visits.
- Prior to an in person visit, please take the temperatures of everyone in the household and wipe down high touch surfaces.
- In the event of illness in the birthing parent or baby, please contact us asap. We can help make decisions about when and where to seek treatment or testing.
- Breastfeeding and skin to skin contact is still recommended even if a birthing parent has mild illness. Breastfeeding is likely protective for babies, and is as important as always for maternal and newborn health and well-being. Babies can contract the virus from parents after birth, so if a breastfeeding parent is ill, they should wash hands and wear a mask during breastfeeding.
- We are reviewing and compiling information on the Novel Coronavirus, COVID-19 infection, and midwifery best practices from a number of reputable government and professional organizations daily. Below are links to some of these for your reference if you wish to read more. Be mindful of how much information is helpful to your sense of well-being, as well as when it increases anxiety. We encourage you to be educated but also to take care of your mental and emotional health.
- CDC - Pregnancy and Breastfeeding
- World Health Organization - Pregnancy, Childbirth and Breastfeeding
- ACOG - Novel Coronavirus Practice Advisory
- NACPM - Resources and webinars specifically for Certified Professional Midwives in out of hospital practice
- California Association of Licensed Midwives (CALM) - Resources, education, documents for CA Licensed Midwives