As the COVID-19 pandemic began to sweep the world in March 2020, one very immediate effect was the drastic changes to birth and labor that many new and expecting parents were experiencing. Some women in active labor were not allowed to have a doula or midwife by their side in the hospital, and others couldn’t have their partner or support person accompany them at all and were obliged to give birth alone. Visiting hours limited women’s support persons in the hospital, and for those with premature babies, new rules sometimes separated them from their babies in the NICU for hours every day. Women might labor for hours wearing a face mask, and certain pain relief measures, such as gas and air, stopped being an option.
Even now, in 2022, some of these scenarios haven’t changed all that much. My family lives in Bavaria, Germany, and as I write this in April, hospitals require birthing partners to be masked and have negative COVID tests in addition to proof of vaccination or recovery, and visiting times for partners in the hospital are highly limited; most hospitals will only allow partners in a specific two-to-three-hour time span. Siblings or other family members continue to be banned from hospital visits, and all partners need to wear an N95 mask during the birth.
I’m pregnant, with my baby due in June, and these considerations weighed heavily on my decisions about where to give birth, how to approach my birth plan, and how to involve my family. Under normal circumstances, I may have considered giving birth in a hospital as I did with my other two children, although a birth center had been something I had been contemplating regardless. But now, COVID and its related restrictions, which continue to influence how hospitals operate, changed my plans, and I intend to have my baby at a birthing center.
I know I’m not the only one taking these considerations to heart. All of these points have certainly impacted many pregnant and birthing women around the world since the start of the pandemic. For some women, it really threw their birth plans for a loop. Other women struggled if their baby was separated from them in the NICU, or if they tested positive in the early weeks of the pandemic and were preemptively separated from their baby.
One woman I spoke to, Holly, had a baby in April 2020 in California, and he ended up in the NICU for a month. “COVID definitely put a damper on it, because we couldn’t freely see him and were limited on visiting hours,” Holly said. “I’m preparing myself for another NICU stay, and I’m sure it will be even more difficult with COVID restrictions and a toddler at home.”
Christin had a September 2020 baby in southern Germany. In her words, she “opted for early discharge to avoid being in the hospital longer than absolutely needed. That didn’t quite happen because my son didn’t breathe right for a little while, so they wanted to observe him in the NICU for the night. When everything looked good the next day, we left.” Priya, also from southern Germany, who had a baby in May 2021, was induced and reported that her husband was “not let in till it was clear that I was in established labor.”
The postpartum period is also affected by COVID. Some studies show preliminary data on what women have experienced as a result of COVID when it comes to postpartum support such as breastfeeding assistance, recovery checkups, and healing from stitches or a C-section.
The countless stories I heard about women’s partners not being allowed to be present for the birth, partners missing the actual pushing (because they were told to wait till the last possible minute), and women not being allowed visitors in the hospital—all due to COVID policies—did have somewhat of an influence on where I chose to give birth this time around.
Very early on in the pregnancy I registered at a local birth center. My other two babies were born in German hospitals, and I had indeed been contemplating a birth center for my third baby regardless of COVID (I found I was generally a fan of low-intervention births, didn’t love lengthy hospital stays, and have had low-risk pregnancies), but COVID helped seal the deal. I alternate my checkup appointments with my gynecologist and the midwives at the birth center. In Germany, midwives are medically trained and certified and perform most births, including hospital births, unless there is a necessary medical procedure such as a C-section or vacuum assist that they are not qualified to perform.
For me, there are certainly COVID-related advantages of giving birth in the birth center instead of a hospital. If I were to have a hospital birth here, as of the time of writing, I would have to wear a mask for a lot of the laboring, except perhaps the last hour or so. Asthma and a recent bout of COVID (after being triple-vaccinated) have left me with a lingering cough and occasional difficulty breathing, so I’d prefer not to have to breathe deeply through contractions with a mask on. My husband and the midwives would be masked.
I’ll get to go home after about three hours if all is well. If I gave birth in a hospital, I’d likely stay there for several days. However, at the moment, all hospitals in Germany strictly limit visitors and are still letting in adults only for several hours every day, with a rapid COVID test. This would greatly restrict the support I value from my husband in the first few days postpartum, not to mention that most hospital rooms in Germany are shared, so I’d potentially be exposed to other patients’ and visitors’ potential illnesses for several days. I also like the idea that I will be able to introduce the baby to my other two kids right away, instead of several days after birth, since they wouldn’t be able to visit the hospital due to the restrictions.
Another reason I considered the birth center is that I am guaranteed a 2:1 midwife ratio during my birth. Hospitals in my German city in general have staffing issues, but it’s been really exacerbated during the pandemic. Many of my friends report very stressed staff and not a lot of personal attention and care at the hospital, and since quarantine restrictions are still in place, if a midwife, nurse, or hospital worker gets COVID (definitely not an uncommon phenomenon here) they will be out of work for some days, leaving the already reduced staff stretched even more thin.
While many families have chosen to stick to their initial plans during the pandemic when it comes to labor and birth, many families have changed their birth plans for similar reasons to me: opting for a home birth so that the partner is guaranteed to be present, scheduling a planned induction to make sure that a partner and doula can get a COVID test on time, and many other scenarios.
My greatest hope is that some of the struggles moms have faced during the pandemic when it comes to birth and postpartum might highlight the general problems surrounding women’s health and mental well-being during this time of life. In the western world, there’s often far less societal support, particularly in the United States, during this intense and vulnerable period, and the COVID pandemic has simply pulled off even more of the layers to reveal just how many gaping holes there are. Here’s to filling those holes.