I have seen many news articles, targeted campaigns, TV shows, and even movies supporting home births. But in all my 20 years as a regulated midwife, nothing in my recollection came close to changing people’s minds about the place of birth more than SARS.
Home Births During a Pandemic
During a pandemic, people quickly remember that hospitals are, and should be, for sick people; that is, those needing medical care. Ironically, however, in Canada and the United States, childbirth is the top reason people are admitted to hospitals.During a pandemic, it soon becomes apparent what a bad idea it is to have healthy women and newborns in the same place as those who are unwell due to a contagious infection.
Lessons From SARS
SARS was one of the rare times in my career that I had both obstetrical and pediatric colleagues openly supporting the idea of home births and encouraging people to stay out of the hospital. At that time, we understood hospital care should be saved for those who were at high risk. This was even more clear as the situation worsened during the SARS epidemic.There were many other important lessons learned during SARS, particularly for Canadian midwifery—although there is almost no academic literature on this subject. However, I do have some anecdotal experience to share as a front-line care provider during that time.
Midwives are an important part of the health force that is often overlooked. Our specialty is low-risk normal birth: This is where we have the most expertise and where we can be most effective.
This is a time when other birth attendants—mainly obstetricians—will be called on for their clinical and surgical specialty skills to manage those pregnant people who have complications, have COVID-19, or are unwell for other reasons.
Midwives can be divided into those who work within the hospital setting and those that work outside within the community. This would help prevent movement in and out of people’s homes and health care settings.
Midwives have a lot of crossover skills between nurses and physicians. We can stitch and prescribe, like a physician, but also start an IV and take blood, like a nurse. There are many things we can use our skills for beyond birthing.
Some midwives have more advanced skills such as being able to assist during surgery, perform bedside ultrasounds, and conduct vacuum deliveries. These skills could be important as the health force declines.
Birth centers, or other out-of-hospital birth locations, should be considered and opened as places for low-risk people to give birth and for healthy newborns to stay.
Finally, the needs of those who are pregnant are often overlooked. Home birth has many potential benefits, but most importantly in a pandemic, we need healthy people to give birth with the best chances of staying healthy—which doesn’t always mean hospital.
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