Pregnancy and birth in the era of Covid-19

In an essay called “Pregnancy, Birth and the Covid-19 Pandemic in the United States” published in May 2020 in the journal Medical Anthropology: Cross-Cultural Studies in Health and Illness, Kim Gutschow, Williams lecturer in religion and anthropology/sociology, along with Robbie Davis-Floyd, senior research fellow in the department of anthropology at the University of Texas–Austin, and David Schwartz, Clinical Professor at the Medical College of Georgia, look into how U.S. maternity care practices changed due to Covid-19. They found birthing doulas and partners being left out of birthing rooms while hospital providers lacked protective equipment and unclear guidelines among other issues. The researchers answered a few questions about the article.

You and your co-authors describe this piece as a rapid-response article. Why is it important to gather and share this information immediately?

Kim Gutschow: Given the rapid spread of Covid-19 throughout the U.S., it is important that people recognize shifts in maternity care, shifting protocols and their effect on pregnant women. Further, given birth is one of the most common reasons for a healthy woman between ages 20 and 45 to be admitted to a hospital in the U.S., which are now understood to be sites of contagion, we felt it important to record the shifting practices and attitudes around hospital births and out-of-hospital births in the U.S.

Robbie Davis-Floyd: So that people can be made aware of the rapid changes and their extremely negative effects on pregnant women and their families, which in some states are already being fought against, with some success, as we show in the article.

What is it about the experiences of certified nurse-midwives (CNMs) or certified professional midwives (CPMs) that made them your focus for this article?

Davis-Floyd: They are all frontline workers in the pandemic, and yet their contributions are undervalued because there are too few of them. We gave special attention to CPMs because they are legal, licensed and regulated in only 35 states; thus their ability to practice in the other 15 states is hampered as they must stay more or less “underground.” As we show in the article, requests for transfers of care to home and birth center practices run by CPMs and some CNMs are skyrocketing—the CPMs especially find it quite ironic that, while normally devalued, they are suddenly being called on to become major caregivers in a pandemic. We hope that calling attention to the safe services they provide will push more states to legalize them. As for hospital-based CNMs, we were delighted to see that some of them are supporting their clients to switch to out-of-hospital/community birth. And in hospitals, CNMs are known for their more compassionate care.

Gutschow: CNMs and CPMs are the frontline workers in pregnancy during this pandemic and yet their contributions have been undervalued by the formal obstetrics lobby. During the early months of Covid-19, pregnant women flooded CPMs and CNMs with requests to transfer their care to home births or freestanding birth centers. Yet there were not enough CPMs and birth centers practicing to accommodate even a fraction of the women who wanted to birth in an out of hospital setting.

We argue that Covid-19 offers further evidence that midwives (CPMs or CNMs) can safely attend most low-risk births, and that they could work more effectively and with less risk of contagion outside hospital settings, at free-standing birth clinics or at home.

Dramatic times require dramatic measures. Via executive order, Governor Cuomo [of New York State] lifted the restrictions on out of state CPMs attending births in New York State as he realized that women would need the services of birth clinics and home birth midwives.

Were you surprised by what you learned?

David Schwartz: No, I have seen a similar phenomenon during the West Africa Ebola epidemic. (David has worked on Ebola and the vaccine since the 1970s)

Gutschow: Not very much. It makes perfect sense that women have and will continue to seek out-of-hospital births as hospitals are sites of contagion. Birth is not a disease, it is a normal physiological process that requires treatment/prevention for a small number of treatable complications, many of which can be handled by midwives. Those of us who work in/on maternity care (obstetricians, midwives, researchers) know that 85% of all pregnancies and births have no complications.

Davis-Floyd: I was surprised and delighted that the Boston obstetrician we cited did eventually change his tune about the value of out-of-hospital birth, once he realized from the other responses on the listserv that many hospitals did not meet his criteria for safety, in terms of enough PPE, etc. His open-mindedness in the face of logic was remarkable, as was the respectful dialogue engaged in by our respondents.

Will this project continue in some form going forward?

Gutschow: Yes, I am co-editing with Robbie Davis Floyd a special issue of Frontiers in Sociology on the impacts of Covid-19 on maternity care around the world. We have begun collecting abstracts and already have submissions from all major continents. Globally, in 2020 roughly 116 million babies will be born under the Covid-19 pandemic and many of those mothers and newborns will be affected by shifting maternity care, as well as shortages of PPE and risks of contagion in facilities.

In addition, I have just finished editing a book with Robbie called Sustainable Birth in Disruptive Times. This volume has 50 authors, writing about sustainable maternity care in over a dozen countries, and every chapter has lessons that are relevant to maternity care during COVID-19. So yes, I will continue to work on maternity care in disruptive times as these ruptures are also opportunities to reform and revise care in ways that benefit marginalized women and their communities.

Davis-Floyd: Kim, Dave, and I were already in regular correspondence as we were finishing Sustainable Birth in Disruptive Times—which is now done and off to the Press (Springer)—and we work together well, so we just kind of went for it, as we really wanted to make a contribution