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The author at her property in upstate New York, at seven months pregnant.
Courtesy of Rani Molla

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The demand for midwives is surging. Here’s why I made the switch to home birth.

The pandemic uprooted my pregnancy plan. So I made the decision to have my baby outside the hospital system.

Rani Molla is a senior correspondent at Vox and has been focusing her reporting on the future of work. She has covered business and technology for more than a decade — often in charts — including at Bloomberg and the Wall Street Journal.

I’ve been told that pregnancy can be a singularly difficult experience, filled with physical and psychological stress, like preeclampsia, heartburn, and existential dread. Well, I raise you the coronavirus pandemic.

I am eight months pregnant, and in the past month and a half I’ve gone from planning a delivery at a Manhattan hospital to a home birth 175 miles away, where my partner and I have been building a home. I am not saying this is the right decision, but it is mine.

It is also a decision many others are making. City midwives are reporting a surge of interest that they cannot meet. At the end of March, Google searches in the US for “home birth” were at their highest level in five years.

One woman I spoke with, Meghan (who asked that her last name not be used to protect her privacy), is 34 weeks pregnant in San Francisco and switched to a midwife early last month after hearing from her sister and brother-in-law, both doctors, about the hazardous situation in the hospitals there.

“I don’t want to be kicked out of the hospital,” Meghan said. “I don’t want to be induced. I just don’t want to have these interventions that are Covid-related in my birth. And I also want to just be as comfortable and as positive as possible and not scared.”

My home birth decision was made for similar reasons, but there were also other factors.

On March 22 — the day after our canceled baby shower, and two days after New York Gov. Andrew Cuomo announced a stay-at-home order for the entire state — New York-Presbyterian, the hospital where my obstetrician delivers, said that partners would not be allowed in the delivery room. That meant I and many New Yorkers would have to give birth alone.

But I knew of the myriad World Health Organization-recognized benefits of having a companion by my side. It felt wrong to do otherwise. So much of pregnancy is biological and thus falls to women; not having my partner be able to support me through it seemed a bridge too far.

Many other pregnant people and their advocates felt the same way, as is evidenced by the more than 600,000 people who signed a petition to safeguard one’s right to having a birthing support person present during labor.

Cuomo has recognized families’ worries. Last week, he announced the creation of a task force that would help authorize birthing centers as alternatives to hospitals. These typically freestanding health care facilities focus exclusively on prenatal care and delivery, and have a more homey bent than hospitals. He also issued an executive order to reverse the no-partner rule that several New York City hospitals had instated.

But I was still afraid that hospitals might override it, or that rules could change again before my due date. I understand why they might — doctors are trying to keep patients, families, and staff safe. So far, it seems hospitals have been inconsistent with policies regarding allowing birth partners.

Like Meghan, I also didn’t know if I’d want to be in a hospital anymore, crowded as they were with coronavirus patients and health care workers trying to make do without enough. My body is already at the behest of forces beyond my control; I didn’t want the hospital system to be one more thing that was out of my hands.

So I made the decision to get back some agency.

Fears around childbirth multiplied once the pandemic hit

Mine has been a planned and uncomplicated pregnancy. I’m an adaptable person and had mostly been calm and upbeat. Then came the coronavirus. I’ve joked that I got a pandemic in exchange for being so sanguine about the birth of my first child.

Prior to the pandemic, I didn’t have many stipulations about how I was going to give birth, but knew two things: I wanted a natural birth, and I wanted my partner to be there to help me. I wanted it to be as straightforward as possible, and at the time that had meant delivering at a hospital I trusted.

Rani and her partner Ryan on a Long Island beach in October, one day after she found out she was pregnant.
Courtesy of Rani Molla

But as with most Americans, the pandemic has exacerbated existing stressors, and things have since become less straightforward.

I am without the support of other family nearby. My sisters live in other states and my mom thinks the coronavirus is a hoax, or at least greatly exaggerated, and that the government’s response in ordering people to stay home is a huge overstep. That is to say, I’m trying not to talk to her about anything Covid-related, which is hard given the times, so I talk to her less.

Then there is my job. To avoid stress, people tell you not to pay attention to the news. As a journalist, that’s more difficult. I, for one, have been charting the exponential curve of coronavirus cases and their mounting death toll for a living. That’s as the economy is collapsing and I fear for my own job, as journalists are being laid off due to plummeting ad revenue, even as readership hits new highs.

Add to that the continual sirens in the city that wracked my nerves. Every trip out of my giant apartment building to walk my dog felt like a Navy SEAL expedition to keep from touching surfaces or running into other people. Our close friends can see a refrigerated morgue truck from their apartment in Brooklyn. I grieve for the unclaimed graves on Hart Island and makeshift hospitals in Central Park. It’s all a lot to bear on top of the regular stresses of pregnancy.

In other words, the decision of where and how to have a baby has changed drastically in the past few months. The plan had been to give birth at a hospital in New York City and then spend my four months paid leave upstate, where we have basically been retrofitting a metal garage to have plumbing and heat. That plan has been accelerated in the pandemic.

In March, I asked my doctor, whom I had sought out and trust, whether she thought hospitals would be safer in New York City — which was already being inundated with coronavirus cases and where obstetricians have been called in to help — or upstate, where case numbers were lower but hospitals had fewer overall resources. She said she didn’t know.

Already, she had suggested that my by now biweekly appointments would be done via video chat — which to me seemed okay for work meetings but not for something as intimate as my prenatal checkups. That’s when I began thinking about alternative plans.

Before coronavirus, I considered home birth to be a fine option. I’ve had friends who have done home births, which involve engaging the services of a midwife, a medical professional who does all of your prenatal exams and oversees your labor outside of a hospital setting. I asked my doctor about the option and she said that since I have a low-risk pregnancy, it would be fine.

Meghan, like me, had already been committed to a natural birth and saw a home birth as best allowing her to be able to do that. “I feel like having that other layer of fear laying over things — is this nurse scared to be here, was she exposed, was she in the ICU last week, do they have proper masks, how many times have they worn that mask? — I don’t want to think about that while I’m giving birth. I just want to think about giving birth,” she said.

Midwives, though, have cautioned against using the coronavirus and the related fear of hospitals as the overriding reason to switch to home birth. “Fear and panic do not lend themselves to an empowering homebirth,” midwife Robina Khalid explained in an open letter on behalf of the New York City Homebirth Collective. “If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth.”

Midwives are rightly worried about spreading resources too thin and maintaining a manageable client load. “​Part of what keeps our care safe now, in the time of Covid-19, is to prioritize our resources,” Khalid wrote. And midwives, like other health care providers, are struggling to find protective equipment. “The nature of our jobs is that we cannot socially distance. The reality is that some of us will become ill during this time.”

This leaves many pregnant people caught between an overtaxed hospital system and overtaxed midwives. The birthing centers Cuomo hopes to fast-track will be a welcome alternative for many. But just over a month away from giving birth, I have already made my decision.

When I mentioned my worries to a friend upstate a couple of months ago, she recommended her midwife. She told me she would only consider having another child if she could do it with this person — a recommendation worth a thousand Yelp reviews. Fortunately, this midwife had an opening for me.

I met with the midwife, told her my concerns, and asked her all of my questions, like how far into my labor could I expect her to come over, how long would she stay, and how would we get the baby’s vaccinations afterward. She was smart, thoughtful, and seemed like someone I could trust. It was the first time in a long while that I felt I could let go of just a hint of worry.

Preparing for home birth in an uncertain world

One thing that is important to my story: We had the means to leave the city and hire a midwife, while many others do not. The ability to travel and the luxury of having access to a second home is not one most Americans have. And my insurance largely covers out-of-network medical care, including midwives. Instead of our rental apartment or our unfinished garage-home, we were able to stay at my grandma’s house, which is located nearby in the northern Catskills. My grandmother died two years ago, right before my partner and I were married. While she will never see her grandchild, her house has helped him immeasurably. It feels nice to think of her still taking care of me.

It’s been more than a month now since I’ve moved upstate, having little physical contact with the outside world. I meet with my midwife every other week, and the personal attention is exactly what I need right now. She checks the baby’s heartbeat and tests for protein and glucose in my urine. We both wear masks. She palpates my stomach and can feel that my baby is already facing head down, ready to enter this strange world. If I were in Brooklyn, presumably a pared-down version of these appointments would be done by my obstetrician over a computer screen, which would be fine but certainly not the same as a warm hand on my belly. We’re currently gathering a list of supplies to have on hand for the delivery, like plastic sheets, extra towels, and flexible straws for my drinking comfort.

It’s also become clear that all my pregnancy and coronavirus fears are not going to be abated by a midwife and a move to the woods. I’m still overwhelmed, tired, and depressed. It’s hard to parse what part of that’s from pregnancy and what’s the enormous weight of the outside world during this remarkable point in time.

I find myself reading any incremental study on how susceptible pregnant women and babies are. So far I don’t seem more at risk, though the prospect of having coronavirus while pregnant obviously wouldn’t be pleasant. Cases in babies appear to be rare, but any case is heartbreaking, as would having to be separated if I became infected.

Meanwhile, I still have more work than ever and what feels like fewer resources with which to do it. Not to mention, I’m weighing the ethics of having my sisters visit me. And then I think of my mom, whom I see in the angry — and probably fearful — faces of those protesting stay-at-home orders. I don’t know when I’ll let her see the baby.

I try to remember that I am one of many who are scared and uncertain right now. Nearly 4 million people give birth each year in the US, and they are all fighting their own battles in their own situations.

Like many of them, I do not know if my decision is the best one. But it is my decision, which is incredibly valuable when so much about the world is uncertain.

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