How To Create A Birth Plan During Uncertain Times
Changes at doctor’s offices and hospitals are forcing Black moms-to-be to seek alternative ways to welcome their newborns
DeAndra Stevens is expecting her first child this spring. In the past week, more than a dozen packages were shipped to her home. Armed with gloves and hand sanitizer, the 33-year-old Baltimore resident opened each package carefully, and then made her way to the sink to wash her hands. Such is a baby shower in the age of coronavirus. The in-person event had to be canceled, but the gifts help her feel the support of friends and family from afar.
The doctor’s office where Stevens goes for twice-monthly prenatal visits recently barred visitors. The waiting room, usually crowded with family members and small children, will only have patients now. The hospital where she will deliver has announced that birthing people can have only one support person with them. Her original plan was to have her mother and her child’s father with her. She considered a doula as well. But because of the hospital’s new policy, she’s decided her support will be the child’s father.
We have not reached the peak in Covid-19 hospitalizations and deaths, so Stevens is aware the policy could change again. “If I can have no one in the delivery room aside from the care team, I’m preparing myself for that,” she says. “My biggest fear has always been having to go it alone.”
Stevens is on blood thinners and is predisposed to blood clots, so her pregnancy is considered high-risk. Her job with an investment firm has been made more stressful by current economic uncertainty. She is one of many pregnant people preparing to bring new life into the world at a moment when nearly everything about our lives has been upended.
She is also Black, and for expectant Black families, this new health crisis is layered on top of an older one. Black women are three to four times more at risk of pregnancy-related deaths than White women, according to the Centers for Disease Control and Prevention. In recent years, a flood of news coverage has outlined the issues fueling the crisis in Black maternal health. For pregnant people, quarantine and other social distancing measures mean being separated from their extended families and communities at precisely the moment they need them most.
For expectant Black families this new health crisis is layered on top of an older one.
Information about the virus is limited. There is no evidence that pregnant women are more susceptible to contracting Covid-19, and it’s unclear whether the coronavirus is transmitted to a fetus in utero, according to the most recent data. But because the virus is easily transmitted on surfaces and through the air, hospitals and doctors are taking precautions that fundamentally change the experience of birth.
In New York City, where 776 people have died from coronavirus, two private hospital systems tried to bar birthing partners completely last week before New York state officials intervened with an executive order to prevent this from happening. Families need to educate themselves and determine what level of risk they’re comfortable with, Dr. Joia Crear-Perry, president of the National Birth Equity Collaborative, says. “If there is no protective equipment at the birthing facility for the support, they may consider them not going,” she says. “Asymptomatic carriers in clinical care settings are infecting people.”
These changes have an emotional impact, and any feelings of loss should be acknowledged. “First we have to allow those birthing people to grieve what they had hoped and planned their delivery to be,” Crear-Perry says. She lives in New Orleans, another outbreak hotspot. During a recent webinar about birth justice and coronavirus, Crear-Perry compared some aspects of the pandemic to Hurricane Katrina. The isolation, the sense of being left alone to fend for oneself, and the opportunities to dig deep and generate new ways to resist and survive were all characteristic of the 2005 disaster as well.
Technology provides alternate ways to connect during pregnancy, labor, and postpartum. Apps such as Zoom, Skype, and FaceTime are becoming the go-to methods for communication as isolation and social-distancing become the nation’s new normal. Crear-Perry says some U.S. hospitals are looking for donations of iPads with videoconferencing capabilities for expectant families. In a video posted on Instagram, Florida-based veteran midwife Jennie Joseph encourages pregnant people, and the birth workers who assist them, to practice with their preferred technology ahead of time and have extra battery packs on hand. “Doulas, let’s be really proactive in how we provide support,” Joseph, the founder of Commonsense Childbirth tells viewers. “You can still support, even if you are not able to be physically present at the delivery.”
Tchaiko Omawale, a 42-year-old filmmaker in Los Angeles, is confident that her doula will be with her early next month when she expects to go into labor. Omawale and her partner have planned a home birth, something that many pregnant people — newly leery of hospitals — are now pursuing. That’s always been the couple’s plan, and it’s meant thinking through how to keep everyone as safe as possible in their home. Together, they’ve decided on a step-by-step approach: Upon arrival to Omawale’s home, the midwife and doula will remove their shoes and will change into fresh clothing immediately (the clothes they wore for their commute will be placed in a plastic bag). Next, they’ll wipe down their phones and disinfect all items needed for labor and birth. And of course, they will wash their hands frequently. Omawale has masks and gloves on hand for them, too. “That makes me feel the most comfortable,” she says.
“I’m excited for my body to take over from my mind. I can just imagine when the baby’s in my arms, and the only thing I’m responsible to do is sleep and feed the baby.”
This pregnancy is Omawale’s fourth, but the first to reach full-term. She has fibroids and has seen an obstetrician throughout her pregnancy in addition to working with her midwife. She is hopeful and excited, but also acknowledges her fears. “I’m deathly afraid of having to be transferred to the hospital,” she says. “I probably wouldn’t be able to bring my support system.”
In addition to thinking through the logistics of the birth, Omawale is preoccupied with the larger political context in which the coronavirus crisis is unfolding. Growing up, her parents worked for UNICEF and in public health, and she spent her childhood in Jamaica, Mozambique, Thailand, Sierra Leone, and Yemen. She says the way the pandemic is being mishandled reminds her of her time in war-torn countries. “When you have a government that actually works, it saves people,” she says. “We’re in a situation that’s broken. There’s a level of powerlessness that’s anxiety-inducing.”
She speaks freely about the swirl of emotions she’s contending with, and she dislikes when people tell her that being upset is bad for the baby. “My midwife doesn’t make me feel bad for being angry,” she says. For Omawale, having space to be angry at failed leadership helps her eventually get to a place of calm.
As her April due date approaches, Omawale looks forward to learning the baby’s sex and breastfeeding. “I’m excited for my body to take over from my mind,” she says. “I can just imagine when the baby’s in my arms, and the only thing I’m responsible to do is sleep and feed the baby. How amazing it will be to look into this baby’s face.”