In This Issue—Protecting and Supporting Mothers and Babies During the COVID-19 Pandemic and Beyond

Abstract

In this column, the Associate Editor of The Journal of Perinatal Education explores the experience of women giving birth during the COVID-19 pandemic. Women's fear related to giving birth in the hospital is the impetus for a discussion of out of hospital birth and midwifery care. The Associate Editor describes the articles in this issue.

No one predicted the COVID-19 pandemic. Almost overnight, in the midst of the tidal wave of confirmed cases, hospitalization and ICU admission, the maternity hospital policies changed. Initially, hospitals across the country restricted all visitors including family and doulas. Mothers were separated from their babies. Everyone, including the laboring woman wore masks. In a rapid fire attempt to decrease the risk of health-care providers and women and babies contracting the virus, the unintended consequences of these restrictions were not considered.

A hue and cry went up, not just from women and their families, but from nurses and doulas and midwives and childbirth educators. And, from State Governors. In the midst of the shut downs of schools, businesses, theatres, and restaurants and the mandate of social distancing, government leaders somehow realized that women laboring and giving birth alone was just not right! State by state issued orders that women should be allowed one, but only one, support person in labor … a restriction that weeks earlier would have seemed excessive but now was happily applauded. The Center for Disease Control, the American College of Obstetricians and Gynecologists, and the Society of Maternal-Fetal Medicine issued statements supporting limiting labor support to one person.

Women were still fearful. Being alone or having to choose between a husband or doula were not the only fears. They worried about going into a hospital largely caring for very sick people, where almost all units were now COVID-19 units. How do you feel safe when you are hearing Codes called in adjoining units? There began to be increasing concern about mothers being routinely separated from their babies and being discharged well before breastfeeding was established. Social distancing once home brought its own set of worries. Women were going home with even less day to day support than is typical in the United States.

Women's fears are real and it is reasonable to think that during the pandemic women's increased fear related to being in the hospital, the loss of some labor support, and health-care providers desire to move women quickly through labor and out of the hospital might very well result in an increase in inductions of labor, augmentation of labor, and the cesarean rate. We know that strong support increases breastfeeding success. Will we see fewer breastfeeding babies at 3 and 6 months? Will we see an increase in the already too high incidence of postpartum depression and posttraumatic stress related to birth?

The pandemic has changed a number of things that might affect women's childbearing experiences in the future. It was not a surprise that right from the start, women across the United States began to question the need to go to the hospital to give birth. They questioned whether the hospital is the safest place to give birth. There was a tremendous increase in women reaching out to birthing centers and midwives who attend planned home births. What women are learning is that planned birth outside the hospital is actually a safe option for healthy women. The Cochrane review of planned hospital versus planned home birth determined that for healthy women attended by experienced midwives and with availability of medical backup if transfer to hospital is needed, there is no advantage of hospital birth over home birth (Olsen & Claussen, 2012). Birth Settings in America: Outcomes, Quality, Access, and Choice (National Academies of Sciences, Engineering, and Medicine, 2020) is an excellent resource for digging into the issue of out of hospital birth. Interestingly, in my qualitative study of women's experiences of planned home birth, “Being Safe,” was the most important determinant influencing the women's decision to have a planned home birth (Lothian, 2013).

Because midwives attend almost all birthing center and home births, there is also an increased awareness of the option of having a midwife. The Lancet Series on Midwifery (Renfrew et al., 2014) provides evidence of the myriad of positive outcomes of midwifery care including lower maternal and infant mortality, fewer interventions, increased childbirth satisfaction, and improved breastfeeding. A key component of midwifery care is the relationship that develops between the woman and her midwife.

Amazingly, states have lifted (temporarily) restrictions that limit scope of practice for midwives and advanced practice nurses. The Institute of Medicine report, The Future of Nursing (2011), takes a strong stand that nurses and midwives be able to practice to the fullest extent of their education and training. It would be a great step forward for women and babies, and for all of us, if state restrictions on scope of practice were abolished permanently.

Has the pandemic pushed us in the direction of a paradigm shift? Will we finally have a maternity model of care that truly respects women, trusts the safety and value of physiologic birth and breastfeeding, and respects and values women's choice to safely give birth outside the hospital? Will midwives finally be able to practice to the full extent of their education and training in every state? Full integration of midwifery into the maternity care system is important in keeping out of hospital birth as safe as possible (Vedam et al., 2018). Will midwives finally be fully integrated into the maternity care system?

The experience of birth is profoundly important for women and their babies. It is well past time to rethink where birth for healthy women takes place. Is the hospital the best place? Hospitals are always for people who are sick, not just in times of pandemic. This pandemic should force us to take the birth setting issue seriously.

IN THIS ISSUE

In each issue of The Journal of Perinatal Education, we share a birth story. In this this issue's “Celebrate Birth!” column, Kim Reardon, childbirth educator and poet, captures her client's strength and commitment as she managed her labor and the birth of her baby in a poem. The power of poetry in telling a story is amazing!

In this issue's feature article,“The COVID-19 Pandemic: The Role of Childbirth Educators in Promoting and Protecting Breastfeeding,” Diane Spatz highlights the critical importance of breastfeeding and the role of the childbirth educator in ensuring that families receive appropriate evidence based information about breastfeeding. Especially in these times, it is essential that families know that human milk and breastfeeding are literally lifesaving interventions. She encourages childbirth educators to include breastfeeding information in all prenatal classes.

Deep Garg and his research team conducted a systematic review of the role of kangaroo care in the management of neonatal hyperbilirubinemia. Hyperbilirubinemia is a common clinical sign in neonates and we know that Kangaroo Care has a wide array of benefits for mothers and babies.“The Role of Kangaroo Mother Care in the Management of Neonatal Hyperbilirubinemia in Term and Preterm Neonates: A Systematic Review” provides evidence of a reduction of bilirubin and duration of phototherapy in term and preterm neonates and adds to the ever-growing list of benefits of Kangaroo Care.

There is very little research on the outcomes of childbirth education, so Hands' and her colleagues research, “The Effect of Hospital-Based Childbirth Classes on Women's Birth Preferences and Fear of Childbirth: A Pre and Post Class Survey” is especially welcome. The purpose of this study was to examine the effect of a hospital-based childbirth class on fear of childbirth, anticipation regarding the birth experience, birth preferences and perception of the birth experience among first-time mothers. The posttest revealed a decrease in fearfulness and an increase in birth anticipation, including increased excitement about the upcoming birth.

“Hospital Care Practices Associated With Exclusive Breastfeeding 3 and 6 Months After Discharge: A Multisite Study” looks at the longer term outcomes of hospital practices on breastfeeding outcomes. Crenshaw and Budin conducted this study to describe, from mothers' perspective, maternity care practices associated with breastfeeding at 3 and 6 months. Mothers who recalled having skin-to-skin care and rooming-in for 23 or more hours/day were more likely to report exclusive breastfeeding when surveyed at 3 months. Perception of not enough milk and difficulty latching explained more than 85% of supplementing and weaning at 3 months. Women also reported that returning to work influenced their decision to supplement or wean.

Finally, in this issue, “Japanese Women's Concerns and Satisfaction with Pregnancy Care in the United States” addresses immigrant women's high level of stress during pregnancy due to language barriers, cultural differences and differences in the standard of prenatal care. In this study, Little, Motohara, Plegue, Medaugh, Sen, and Ruffin evaluate the level of concern Japanese women in the United States feel during pregnancy and their level of satisfaction with their care. The women reported a high level of prenatal concern regarding their baby's health, pain control, the short length of hospitalization after birth and the lack of breastfeeding support. Despite these concerns, postpartum women ended up being satisfied with all items except the short duration of their hospital stay.

Biography

JUDITH A. LOTHIAN is a maternal child nurse and childbirth educator. She is a Professor at the College of Nursing at Seton Hall University. Dr. Lothian is the Associate Editor of The Journal of Perinatal Education and the co-author of Giving Birth with Confidence: The Official Lamaze Guide.

DISCLOSURE

The author has no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.