I’ve received quite a few private messages asking whether homebirth is a better option than hospital birth in the age of coronavirus.
Let me start by acknowledging that I don’t know. No one knows; our lack of testing means that we don’t know how prevalent the virus is in the population or how likely a person is to catch it from another person. We also don’t know if coronavirus poses special risks to pregnant women and newborns although for safety’s sake, we must assume it might.
Homebirth midwives are providers, too. They are at much higher risk than average of having and transmitting the virus.
Since I don’t know, I can only list the pros and cons as I see them.
COVID-19 INFECTION RISK
Pro: There is no question that hospitals themselves are very high risk areas for COVID-19 transmission. They are filled with people who are severely ill and doctors and nurses who have been exposed to the virus repeatedly. That said, it is important to remember that hospitals are always full of sick people, so strenuous efforts are made to isolate labor and delivery as well as the postpartum floors from the rest of the hospital. The safest place within any hospital is almost always labor and delivery and the postpartum floors.
Con: midwives are healthcare providers, too. Unless they have stopped seeing all their other patients, they are at much higher risk than average of having and transmitting the virus. Moreover, they are unlikely to have access to the personal protective equipment that would reduce their risk. Keep in mind that a pregnant woman could have the virus already and SHE could pose a significant risk to her baby.
Con: If you need to transfer emergently during labor or after birth, you will be exposed to EMTS and emergency room personnel, the people who have the greatest risk of having been exposed to the virus and potentially exposing you and your baby to it.
INTERVENTIONS
Pro: Homebirth dramatically reduces your risk of unnecessary intervention.
Con: Homebirth dramatically increases the risk of death for baby and mother due to lack of necessary interventions.
COMPLICATIONS
Pro: There are no pros. Homebirths do not reduce the risk of complications; they increase the risks that complications will lead to brain injury for the baby or even death for the baby or mother.
Con: There is no access to an operating room for emergency C-section, no access to blood transfusions for hemorrhage and no access to the people who can perform advanced resuscitation and intubation of a baby who is born not breathing.
Con: Complications can often be prevented with early recognition and intervention. Homebirth midwives boast that they are experts in normal birth; they leave unsaid the fact that they are NOT experts in childbirth complications and often don’t recognize when they are developing.
Con: In the US (but not Canada, the Netherlands, the UK etc.) there is a second class of “midwife” known as certified professional midwife. They are not real midwives, merely lay people whose “education” is typically only a correspondence course. They lack the education and training of ALL other midwives in the industrialized world and they fail to meet the international standards of midwifery. They are barely better, and in some cases worse, than no midwife at all. They have NO training in managing serious childbirth and newborn complications. That’s why their death rate in much higher than midwives in other countries.
ACCOUNTABILITY
Pro: There are no pros.
Con: Homebirth midwives in the US, particularly CPMs, lack both malpractice insurance and accountability. If something goes horribly wrong, there is no one to sue and no way to hold them responsible for their errors.
THE BOTTOM LINE
There is one undeniable pro to homebirth in the age of COVID-19. It almost certainly lowers your risk of exposure to the virus compared to hospital birth but ONLY if you don’t need to transfer to the hospital. Your risk is not low, however, since your midwife is at high risk of carrying the virus.
There are a lot of cons but none greater than the fact that in the US, homebirth dramatically increases the risk of neonatal brain injury and death.
On balance, it seems to me that the risks of homebirth outweigh the risks of hospital birth, but other women may reach different conclusions and make different choices and that is their right.
