Your Midwife's Approach to COVID-19 Pandemic
Coronavirus COVID-19 is present and spreading rapidly across the globe and exponentially in the United States. As of March 27th, 2020 at Noon, the US has reached a total of 85,356 confirmed cases with 1,246 deaths. Specifically in Michigan, as of March 27th, 2020 at 3:00pm, we have 3,657 confirmed cases and 92 deaths. I do not offer these numbers to scare anyone, but I need to be transparent about why the below changes to my midwifery care and guidelines are needed. These are scary times and we all have to understand that this is REAL and we NEED to take it seriously!
There is a chance that pregnant people are more at risk of developing complications if the virus is contracted due to the well-known susceptibility of being more likely to develop respiratory infections during pregnancy caused by more suppressed immune systems and the physiological changes that occur. We still know so little about this virus and exactly how it is being transmitted, updates on the research are being given every day. At this point we know it’s a respiratory virus, it can be transmitted through respiratory droplets, aerosolized in the environment for up to 3 hours, and survives being on materials such as plastic, metal, and clothing for up to 3 days. We know little about the possibilities of vertical transmission from pregnant people to their unborn babies or during the birthing process. There are cases internationally of newborns contracting COVID-19 currently but it is unclear at this point if they contracted it while still inside the womb and/or during birth or just shortly after birth. We do believe at this point that it is not transmitted via breastmilk, amniotic fluid, or umbilical cord blood.
This situation is new and there is a huge lack of evidence. I am trying my best to stay current with data and new research. Health care providers and Midwives are in constant contact with one another on a national/international level, discussing best practices, guidelines, and protocols to keep our clients and ourselves safe. What is known is that it is highly contagious and can live on surfaces for hours or days depending on the surface.
Symptoms of COVID-19 are: please note there is a possibility of being ASYMPTOMATIC
Shortness of breath
If you or anyone in your household has these symptoms, please advise your midwife. Currently there are drive-up COVID-19 testing sites in Jackson and Ann Arbor, and I can only assume more will start popping up as testing abilities increase.
I have to apologize in advance for some of what I am about to suggest or ask, as it may not be very midwife like… The new guidelines and best practices are hurting this midwife’s heart but I cannot ignore the reality of how serious this pandemic is, and it is going to get worse before it gets better.
As your midwife, I am practicing social distancing as much as possible. The only time I am out is for essential midwifery clients or necessary shopping. I am regularly monitoring myself for symptoms and check my temperature every day. I am sanitizing my equipment and surfaces with Sani-wipes before and after client contact. I am spacing out in-person visits and offering virtual/telehealth visits whenever possible.
Before midwifery visits, please don't have visitors at your house. Take your temperature and others in the home. If you or others in the home have traveled within the last 14 days or have any symptoms including a fever, cough, shortness of breath, runny nose, sore throat, and/or body aches, please let your midwife know.
Midwifery care may look different and I may wear a mask during your visits and birth, and wear gloves for ANY physical touch or assessments. I may ask you and others present to wear a mask as well. For your birth, I suggest very limited people to be present and those that are must be screened for symptoms before attending. If anyone you plan to have at your birth has any symptoms of illness or they have been in contact with someone else who has, they need to be quarantined and cannot be in attendance. If you want others to be included in your birth, we can set up for FaceTime, Skype, or video. Any person present can pose additional risk.
Home visits will be reduced or postponed. I am available for texts, phone calls, video chat, and emails. We can also meet on FaceTime and/or video chat for prenatal & postpartum visits. An option I am strongly implementing to maintain social distance is to have virtual/telehealth visits. You can check your blood pressure with an electronic blood pressure cuff, listen to your baby’s heartbeat with a handheld fetal doppler, and I will teach you how to measure your growing uterus with a tape measure.
I will be modifying the set-up of my prenatal visits schedule based on WHO guidelines and the community midwifery guidelines. I will continue to offer the normal visit schedule, however many will be virtual/telehealth visits and necessary in-person visits will be time limited to 15-30 mins as needed for any physical assessments (the conversation and discussion part of the visit can be done virtually or by phone before the in-person appointment time).
Postpartum visits will be performed in-person at 24 hours, day 3, and 2 weeks. Virtual/telehealth postpartum visits will be at 1 week, 4 weeks, and 6 weeks. Additional visits and in-person visits can be requested and added as needed.
In case of hospital transport, I will not be able to stay at the hospital as I normally would. I will be sure that you are taken care of, records are transferred, and the situation is well articulated.
If I became sick or had known exposure, another midwife may attend your in-person visits or birth. Your midwife is trying to be mindful of what is needed for your prenatal, birth, and postpartum care, months ahead including purchasing potentially necessary medications, supplies, and equipment.
As a current client, or someone considering midwifery care and home birth during this pandemic, an addendum to my original/main Informed Choice for Midwifery Care and Home Birth may need to be signed that lays out new disclosures and agreements and understandings of the changes to care that need to be implemented.
PLEASE, PLEASE, PLEASE, Practice social distancing and STAY HOME!!!!! Generally, any person near you is a potential risk. Stay at home (its beneficial to go outside in your yard, for a nature walk or hike. Try to remain 6 feet away from others). Social distancing means no play dates, less physical contact with others than who are in your household. Postpone or space out non-essential visits and appointments including dental, chiropractic, non-urgent health care visits, etc. Avoid travel.
Wash your hands often for at least 20 seconds with soap (foamy soap may be less effective). Wash your hands after touching any surface that may be contaminated, and before eating. Consider wearing gloves and/or face mask when going out of the home. Avoid sharing drinks and food with others. Avoid touching your face. Avoid handshakes, hugs & kisses. Frequent sanitize high contact surfaces including doorknobs, handrails, faucet handles & light switches. Frequently wipe down surfaces including your phone, computer and/or tablet.
Reduce shopping trips for food & essential items. Consider shopping for groceries and essentials online, grocery pick up, delivery or curbside. Prepare by thinking ahead about things that you may need within the next 2 weeks-2 months. There is a shortage already of some items and shipping is delayed in general. Eat as many nutritious, natural foods as possible including fruits and vegetables. Keep hydrated and be sure to have extra water on hand if you drink bottled water. Aim for ample sleep, at least 7 hours nightly.
Also these supplements & foods support a healthy immune system and are safe in pregnancy: · Vitamin D – 4000 IU daily
· Fish oil (discontinue at 37 weeks)
· Vitamin C 1000-2000mg daily
· Garlic (always a great immune booster)
· Zinc – 12mg daily These times can provoke anxiety. Try to incorporate self-care and relaxation into your daily life. Some options are prayers, mediation, yoga, pilates, sunbathing (when we have sun here in Michigan), walking in nature. Magnesium, chamomile tea, and lavender oil can help with stress, anxiety, and sleep.
There may be more changes with this developing situation. I am trying to adapt the best practices to keep everyone healthy & safe. This document will evolve as there is so much uncertainty.
All the while please know that I love and care about the health and well-being of you, your baby, and your family. This is temporary, but necessary, and will last for an unknown period of time. Please stay healthy and reach out anytime if you have questions or concerns.
This article was inspired and structured by the words of Celeste Groenenberg, LM.