Amanda Houseknecht of Matthews originally planned to deliver her baby at Atrium Health Pineville, with her mom, the baby’s father and her doula by her side.
But as the number of COVID-19 cases in Mecklenburg surged, so did her fear. All Houseknecht could think about was all the people she and her baby would be exposed to in the hospital: nurses, medical assistants, pediatricians, lactation consultants and more.
Then the hospital notified her she could have only one person with her in the delivery room. To prevent the spread of coronavirus, Atrium Health and Novant Health have restricted women giving birth in their hospitals to just one visitor.
“I was going to have to choose between the baby’s father or my doula,” Houseknecht said. “Of course, the baby’s father wanted to be in there, but he was not prepared to assist me in labor because we were no longer in a relationship. That meant I was going to have to labor without support. And that terrified me.”
So Houseknecht hired a midwife, and on March 29, she gave birth to a beautiful, healthy baby boy — Walker Brian — in her living room.
Birth plans upended: In Charlotte and across the country, expectant moms are grappling with tough decisions as the coronavirus pandemic upends their birth plans. Some are laboring at home for as long as they can to minimize their time at the hospital. Others are inviting family members or doulas into their labor rooms over FaceTime or Skype. And a growing number, like Houseknecht, are choosing to avoid the hospital altogether and have their babies at home.
Two Charlotte-based midwives told The Ledger their phones are blowing up as women fearful of picking up the coronavirus in the hospital explore the idea of a home birth.
“I normally get two to three calls a month, and I’m hearing from six or seven people every day, including some who are in their final weeks,” one midwife told The Ledger. “Some are women who have never considered a home birth before, but they just want to avoid the hospital.”
Medication-free labor: The midwives say they’re almost fully booked, even though they are rigorously screening candidates before taking them on.
Home birth is not appropriate for expectant women who have gestational diabetes, high blood pressure, twins or other factors that put them at higher risk. And, of course, the mom-to-be has to be comfortable having a medication-free labor and delivery.
“Fear of coronavirus is not a good reason to choose a home birth,” one midwife said. “If you’ve never given any thought to how to handle the pain of labor, you’re not a good candidate.”
Many midwives operate illegally: Home birth is rare in North Carolina, partly because the state has tough restrictions on midwives. Under state law, only midwives who have a nursing degree can get a license, and they must have a supervising doctor’s consent in order to attend a home birth. Doctors rarely consent.
It’s illegal for other types of midwives to supervise a home birth in North Carolina, so many certified professional midwives — those who meet national standards but don’t have a nursing degree — operate underground. It’s rare, but midwives in North Carolina can be charged with a misdemeanor for assisting a home birth. (It’s not illegal to have a baby at home, just to assist with one.)
The American College of Obstetricians and Gynecologists says hospitals and accredited birth centers are the “safest settings” for birth, noting that home birth is associated with a more than twofold increased risk of perinatal death. In the organization’s most recent COVID-19 guidance, it maintains that hospitals are safe places for delivery.
Midwives request emergency order: The North Carolina chapter of the National Association of Certified Professional Midwives has asked Gov. Roy Cooper to consider an emergency order allowing them to practice legally during the crisis.
By helping more low-risk pregnant women deliver at home, midwives could take some of the pressure off of hospitals facing an influx of COVID-19 patients, said chapter president Meredith Bowden.
Cooper’s press office did not respond to an email from The Ledger asking whether the governor was considering the proposed emergency order.
Doulas go digital: Charlottean Katie Lanier, 30, briefly considered a home birth after she learned her doula couldn’t be with her at Novant Health Matthews, but she and her husband, Josh, ultimately decided they felt safer at a hospital.
Fortunately, their doula, Andie Nantz, said she could support them virtually.
After discussing the best way to include her, Josh bought an iPad case with a strap. When the couple went to the hospital to be induced last week, Josh wore the iPad hanging from his neck, so Nantz could see what was going on via video chat.
“It was definitely awkward,” Nantz said. “You can’t make eye contact through a camera. And I was talking to the shower curtain a lot.”
Still, Katie said Nantz was a big help, breathing with her through contractions, suggesting different laboring positions and even telling Josh to pull the emergency cord to call the nurses because the baby was coming.
“I had moments of doubt, and Andie was able to say, ‘You can do this,’” Katie said. “Even though she wasn’t able to physically comfort me, she still helped in an immense and impactful way.”
The ‘perfect’ delivery: Houseknecht, 29, was also happy with her birth experience. She labored at home for about 23 hours before delivering her baby boy in a birthing pool in her living room.
Houseknecht’s mom, the baby’s father, his mom, her doula Sarah Cowherd and her midwife were all there for support. Houseknecht said she was glad she and her baby were exposed only to those people in her house rather than the 20 or more she would have encountered in the hospital.
“Now that I’ve had a baby at home, I can’t imagine birthing any other way,” she said. “I got to listen to my body. And my son came out eyes wide open, looked me right in the eye and started nursing. It was perfect.”
Michelle Crouch is a freelance writer and a regular contributor to The Ledger.
This post first appeared in the Charlotte Ledger Business Newsletter. It is reprinted with permission.