March 17, 2020
We are getting questions from clients about whether or not we are having regular prenatal appointments and what precautions we are taking.
We are also getting calls from women, who were planning hospital births and who are scared to go to the hospital now, seeking information on home birth.
Deb has these words to share with our homebirth clients:
I realize that there is quite a bit of concern during this time regarding COVID-19 and what is best for each individual.
“At this time, very little is known about COVID-19, particularly related to its effect on pregnant women and infants, and there currently are no recommendations specific to pregnant women regarding the evaluation or management of COVID-19.
Currently, available data on COVID-19 does not indicate that pregnant women are at increased risk. However, pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections such as influenza and SARS-CoV. As such, pregnant women should be considered an at-risk population for COVID-19. Adverse infant outcomes (eg, preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, this information is based on limited data and it is not clear that these outcomes were related to maternal infection. Currently it is unclear if COVID-19 can cross through the transplacental route to the fetus. In limited recent case series of infants born to mothers infected with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for COVID-19".
In thinking about the next few weeks and prenatal visits I want to be proactive in helping all my clients to feel confident as they come to their prenatal care appointments. I have decided that I will be shortening visits as possible to be able to disinfect more throughly between visits. I will have hand sanitizer at the door that I would encourage each visitor to use prior to entering. I will also be monitoring my own temperature throughout the day, and would ask that before coming for a visit that clients will take their own temperatures prior to appointments so they can be rescheduled early if necessary. Symptoms that would require a reschedule are as follows: fever of 100F or greater, cough, difficulty breathing or shortness of breath, gastrointestinal symptoms.
While at this time I am not requiring that children or partners be excluded, if it is possible for there to be other arangements made for children to not come, I am sure that other clients would appreciate the minimized exposure and it could help us move our visits along more quickly in order to provide more time for sanitzing.
Although this is the case for prevention of any transmition of illness, it is a good time to reflect on what we know to be best practice of good hygiene:
* Wash your hands frequently and regularly with soap and water or an alcohol-based hand rub.
* When washing your hands with soap and water, do so for at least 20 seconds. Wash hands after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
* Cover your mouth and nose when coughing or sneezing (eg. coughing into your elbow or into a tissue).
* Stay at home when you’re sick; we can reschedule visits for a time when you are well.
* Avoid touching your face particularly after touching other surfaces.
* Maintain at least 1 meter (3 feet) distance between yourself and anyone who is coughing or sneezing.
* Keep a small bottle of alcohol-based sanitizer that you can use if you’re not able to wash your hands readily with soap and water.
*Do stay home as much as possible. Dining out, going to movies,etc should be avoided.
There is no need to wear a mask, the CDC is not currently recommending masks for the prevention of this virus. The best protection is to follow proper hygiene as mentioned above.
Although there is much information out there that could become quite stressful, the best thing to do in addition to washing hands so to not give into the fear and stress. Spend time outside getting fresh air and exercise. Drink lots of water. Turn off the news and social media. Read for pleasure. Practice breathing exercises, stretches like spinning babies. Meditate and pray. Immerse yourself in a creative outlet that you enjoy like: cooking, baking, art, knitting. These things require focus and concentration which can help soothe the mind. Listen to wonderful pieces of music that can bring calm.
It continues to be my honor to serve you during this important time of your life. Please continue to communicate as needed and desired about any concerns or questions regarding this or anything else as it affects your pregnancy.
Love and prayers,
As usual, Evidence-Based Birth is doing an excellent job of staying on top of the research and evidence as it becomes available and compiling it into one place to make things easier for the rest of us. Here is the Coronavirus/COVID-19 Evidence-Based Birth Resource Page. You can sign up for email updates from this page.
For the women who are inquiring about home births, I am always happy to talk with you more about home birth!
But as I tell all my clients, I wish for you to make your decisions based on accurate, evidence-based information and what feels right to you. Please don’t make decisions driven by fear. Read the evidence from the link above, discuss with your provider what protocols and policies their office and your hospital will be putting into place, and then compare that with the information we give you on birthing at home. Make the decision that's right for your family.
It’s time to exercise more caution than usual, but it’s nowhere near time to panic. :-)
Pregnancy nausea commonly begins around the 6th week of pregnancy and commonly resolves around 12 weeks. Sometimes referred to as "morning sickness," pregnancy nausea is not limited to mornings! And although most nausea has improved or dissipated by the second trimester, some women feel nauseated their entire pregnancy. The nausea may disappear in the second trimester and return again in the third trimester. Nausea may or may not be accompanied by vomiting.
For some, it's a minor annoyance, and for some, it can be debilitating.
Hormones probably play a big role, particularly progesterone, which decreases motility in the GI tract. Increased metabolic demands during pregnancy can also cause blood sugar drops, which may lead to nausea.
There are a few tricks you can try to decrease the amount of nausea you feel or make it more manageable.
If these suggestions don't help, talk to your pregnancy provider. We have various supplements that we recommend to our clients that are often helpful.
Rarely, nausea and vomiting can be severe enough to be dangerous. If you are vomiting several times a day, are unable to tolerate foods or liquids, can't keep anything down, or are losing weight, talk to your healthcare provider!
One of our frequently asked questions is, "Do you do water births?"
The answer is yes, we do! Laboring and/or birthing in the water is a popular option among our home birth clients. We have two birth pools, which we loan out at no charge (there is a $30 charge for the disposable liner.) We will give you instructions on setting it up, how to fill it, when to fill it, how to drain it, and anything else you need to know.
The above photo is one of our tubs in use. The water is approximately chest deep and covers your belly when full. (That's me in the photo. I loved my waterbirths!)
Another question we are frequently asked is, "What do you think about waterbirth? Is it safe?"
The short answer is yes, we believe waterbirth is safe, based on our experience, along with the current literature. We have seen that immersing in a tub of warm water benefits laboring mothers by helping them relax, helping them to get into comfortable positions, making it easier to cope with contractions, and decreasing their perception of pain. If our client chooses to stay in the pool to birth the baby, we have not seen any increase of adverse outcomes for the baby in our practice.
If you would like to read more about this birth choice, Evidence-Based Birth published an excellent article on water birth, written by Rebecca Dekker, PhD, RN, APRN, in which she thoroughly examined the existing research that has been done on water birth (and there is an 80 page annoted bibliography available of all the research studies that have been done.) The conclusion:
For women, there are several benefits associated with waterbirth. There is strong evidence that waterbirth is associated with a lower episiotomy rate, and that women who use waterbirth will have higher rates of intact perineum and use less medicine for pain relief. The benefits or risks for the newborn are less clear, but so far the evidence shows fewer or equal NICU admission rates for waterbirth babies compared to babies born on land. There have been rare case reports of breathing problems or infections in infants after waterbirth, but these risks have not been seen in the large, recent, prospective studies on waterbirth. The ACOG/AAP opinion statement on waterbirth contained major scientific errors and was an inaccurate and incomplete review of the literature. Their opinion statement should not be relied upon to make informed decisions about the availability of waterbirth for women. Based on the data that we have,waterbirth is a reasonable option for low-risk women during childbirth, provided that they understand the potential benefits and risks. If women have a strong desire for waterbirth, and there are experienced care providers who are comfortable in attending waterbirths, then at this time there is no evidence to deny women this option of pain relief. Although we need more research on waterbirth, the available research shows that universal bans on waterbirth are not evidence-based.
Although getting in the tub during labor is a possibility at some of our local area hospitals, none of them allow water birth. Hospital policies mandate getting out of the tub before pushing begins.
If a water birth is what you desire, and home birth is an option for you, there are experienced midwives in Arkansas who are comfortable attending waterbirths. I would love to chat with you about it! Give me a call or text at 501-436-8525, or email me.