Feeling right at home: Domestic deliveries on the rise in age of COVID-19

Kayla Bloise had always been intrigued by the idea of home birth. The Riverhead resident had wanted one when she was pregnant with her son Julian, now 3, but several factors prevented it. There was the cost, which was not covered by her insurance, and the hesitation of her husband, Francisco, who had serious concerns about the safety of giving birth outside a hospital. 

So Ms. Bloise did what the vast majority of American women do and gave birth in the hospital. She had what she called an easy delivery, free of complications and without any pain interventions, like an epidural. 

When COVID-19 struck during the third trimester of Ms. Bloise’s second pregnancy, however, she felt it was time to make an executive decision.

“I told my husband, listen, I’m not giving birth in a hospital during this time,” she said. And so, just six weeks before she was set to deliver, Ms. Bloise called a midwife to assist in a home birth. 

These days, she’s not alone. The continued threat of the coronavirus has upended people’s lives in many ways, and for some pregnant women — especially those who were due during the early months of the lockdown in the spring — the thought of giving birth in a hospital became scary instead of comforting. Home birth midwives in the area, including some who work exclusively inside hospitals, say the pandemic has caused many expectant mothers to take a closer look at the home birth option. 

The COVID bump

Gaia Midwives is an independently owned and operated practice with an office on Second Street in Riverhead. It provides a variety of services, including prenatal care, home and hospital birth and postpartum and newborn care. Business has been brisk in 2020. From March through July of 2019, Gaia had a total of 89 inquiries for home birth services. In that same time period this year, it had 134. There were 34 inquiries in March alone, compared to just 13 the year before. By April, they were fully booked through August.

“I think a lot of people were mostly scared about the uncertainty around what would happen when they entered the hospital system,” said Ashley Meccariello, a partner at Gaia. “They felt they were losing a sense of control about their birth plan. They were worried about not having their partner witness the birth of their child. Even now, women are going for ultrasounds and can’t bring their partners with them. It’s a huge moment of bonding, so it’s been hard for these families.”

Dr. Christina Kocis is the division head of Stony Brook Midwifery, and while they do not attend home births, she said she saw a marked increase in curiosity about home birth from clients who had originally intended to have a midwife deliver their baby in a hospital setting. They did not keep track of how many women inquired about home birth or switched providers to have a home birth, but Dr. Kocis said the spring was an “interesting time,” as they were also inundated by new patients from the New York City area who were desperate not to deliver their babies in hospitals that were overwhelmed by the virus. 

It became clear rather quickly that there simply were not enough homebirth midwives in the area to meet the spike in demand for their services. 

Janet Titmus-Delettera of North Shore Midwifery in Rocky Point said she was turning away five or six people daily during the earlier weeks of the lockdown, particularly when many hospitals were telling pregnant women they would have to wear masks and could not have a partner with them during their labor and birth. New York Gov. Andrew Cuomo ultimately issued an executive order that allowed pregnant women to have one partner or support person with them, but some had already changed their birth plans.

A tough choice

Carrie Stanley of Mount Sinai was also in her third trimester when the coronavirus struck in March. 

The mother of five had delivered her first two children in a hospital and had a home birth with Gaia for her third. Her fourth child, conceived in her second marriage, was delivered in a hospital and she was planning the same for her fifth.

That changed when she began to hear about COVID-19 reaching the U.S.

“I don’t know if we even had any cases on Long Island then, but I’m a nurse and I just had this uncomfortable feeling,” she said. “I’m familiar with hospitals, and I know how hard it is to keep germs off people. Things spread.”

Ms. Stanley said her husband was “a bit apprehensive” about home birth, but she felt confident it was the right choice, especially after getting to know Amanda Sini of Gaia, who attended the birth. Despite the fact that she switched providers in the 34th week of her pregnancy, Ms. Stanley said she felt comfortable because the midwives at Gaia were confident about taking her on. 

Her new daughter, Valerie, was born, at home, in the middle of the night on April 8.

“It was great,” Ms. Stanley said. “I didn’t have a lot of anxiety. I had more anxiety about the pandemic than I did about having the baby at home.”

Ms. Bloise used Ms. Titmus-Delettera’s services for her home birth, which occurred 10 days early, in the early morning hours of April 11. Ms. Titmus-Delettera told Ms. Bloise — who was seated in the kids’ bedroom in an inflatable tub covered in plastic sheeting and filled with water — that it was time to push. Her son Julian came into the room to watch the birth.

“I will never have another hospital birth,” Ms. Bloise. “It was such a great experience to be home.”

Valerie Stanley, born at home in April. (Courtesy Photo)

The culture of birth

Women and families who choose home birth may be viewed as outliers or risk-takers by the general public, but that is a more recent phenomenon than some might think. Sara Topping is executive director and co-founder of East End Birth Network, a grassroots nonprofit that provides education, support and resources for pregnant women, mothers and families on the East End. She is a certified holistic doula and a licensed massage therapist by trade, as well as both a product and veteran of home birth. Ms. Topping points out that powerful cultural forces shape experiences and expectations around birth, and described the way that plays out in the U.S. in particular.

“When you think of birth and the way birth works, it’s all very personal, but it’s also very cultural,” she said. “And the way our culture in the U.S. has viewed birth more recently is highly medicalized and taking place in a hospital. But up until the 1950s, most births happened outside of hospitals. It wasn’t until the advent of modern obstetrics that people moved out of the home and into the hospital. I think a lot of people forget that.”

Ms. Topping said there is a “pocket of a homebirth culture” present on the East End of Long Island, something she expects to see grow with COVID-19. 

 “The hospital is really meant for sick people,” she said. “People having babies aren’t sick.”

The emergence of hospital birth as the norm in the latter part of the 20th century had unintended negative consequences long before a global pandemic was part of the equation. Ms. Topping pointed out that, generally speaking, Black and Indigenous women and women of color are three to four times more likely to die in childbirth than white women and said that statistics prove that midwifery — whether at home or in a hospital — decreases poor outcomes for those women, whose concerns can be more frequently dismissed or ignored in a traditional hospital setting.

“Black women are not being listened to when they need to be listened to,” Ms. Topping said. “That naturally exists in the profiteering age of health care in general, and it’s amplified by [the pandemic] as well.”

Making an informed choice

Ms. Meccariello and her partners at Gaia were, of course, happy to see increased interest in home birth, but despite the demands on their time that came with it, they followed the procedures they always do, which start with an assessment of what’s going on inside the heads of their clients.

“What it looked like was a bunch of meet-and-greets, and doing them virtually, asking them why they were choosing home,” she said. “There’s an emotional part of having your baby at home, and the psychological prep is really important.”

Those necessities were, of course, heightened by the pandemic.

“We tried to make sure there wasn’t a huge sense of fear about having a baby at home, or possibly having to transfer to the hospital. We wanted to make sure families were in a good head space and weren’t [choosing home birth] purely based out of fear.”

Of course, not everyone is a good candidate for a home birth. Ms. Topping, 38, was born at home and wanted to have her children at home, but had to deliver in the hospital the first time because she was pregnant with twins, automatically putting her in the high-risk category. She explained that home birth is also “generally an out-of-pocket” cost — an average of around $5,000, she said — and while some insurance companies will reimburse the cost, it can be a limiting factor. In addition, epidurals cannot be administered at home, so the ability to tolerate the often extreme and sustained discomfort associated with childbirth is always a big part of the conversation.

A common refrain among those expressing concerns about the safety of home birth is that an emergency can arise at any time and being at home could complicate the response to any unanticipated crisis. But Ms. Topping said the screening process in the months leading to the birth is designed to identify and mitigate any obvious risks.

For Dr. Kocis, the common thread between midwives who deliver at home and those who deliver in hospitals is stressing the importance of making a well-informed birth plan.

“It’s a big decision that needs to come with preparation,” she said, adding that she drove home that point right away with any clients who were considering switching to home birth during the height of the lockdown. “We try to encourage people to have a plan regardless of where they are giving birth.”

Dad Francisco Bloise and 3-year-old Julian with newborn Layla. (Courtesy Photo)

‘A midwife is a superhero’

Whether the spike in demand for homebirth services continues after the pandemic abates remains to be seen, and the trend’s potential staying power depends on several factors. 

“It may be on an upswing now because of COVID, but in general it will be more about availability and the number of midwives who can attend home births,” Dr. Kocis said. 

Word-of-mouth from women who had positive experiences with home birth in the midst of a pandemic could certainly give the trend longevity, but only if there are enough midwives available to meet the demand.

“Suddenly, home birth seems like a real safe option,” Ms. Titmus-Delettera said. “The question was always, is it safe? Now people are starting to realize that the hospital is not just a shining tower of wonderful safety. It’s a place where people go to be sick and die.”

Giving birth at home during a pandemic was a transformative and positive experience for Ms. Bloise and Ms. Stanley, as well as for their partners. If positive word-of-mouth ultimately leads to a sustained increase in home births, they will have played their part.

“A midwife is a superhero,” Ms. Bloise said. “In a hospital, you can feel like you’re being neglected at certain points, but with Janet, she was right there. She didn’t have another birth to run to.”

Francisco Bloise watched his initial hesitation about home birth disappear as he went through the process with his wife. He said he’d even be hesitant to sell his house in the future because it was the birthplace of his daughter.

Client satisfaction is essential for homebirth midwives, and informs the way they administer care at every part of the pregnancy, birth and postpartum journey, Ms. Meccariello said. 

“The care is tailored to the needs of the birthing person,” she said. “I always say to my clients that when I enter your home, I’m a guest in your space.”

A rush of hormone-fueled emotions is part of the postpartum experience for all mothers, regardless of their circumstances or where they give birth. For Ms. Stanley, one feeling dominated in the hours after Valerie was born, as she sat in her bed alongside her older children, eating breakfast, with a barely two-hour-old infant nearby, a baby she carried to term while homeschooling and caring for her other four children in the midst of a global pandemic.

“There was no beeping, no people coming in every five minutes,” she said. “For the first time, I felt so relieved.”