How To Adjust Your Birth Plan During COVID-19

For many pregnant women, their “birth plan” is everything. Oftentimes we enter the labor and delivery experience with high hopes, specific expectations, and dreams of how it’s going to go. Epidural… without drugs… home birth… hospital birth… pushing in a bed, in a squat, or in a pool… each of us has thoughts and preferences, rules even, of how we want to bring our babies into the world. Some of us want only our significant others there; others bring an entourage and a professional photographer.

In the end, we all know the most important thing (truly the only real thing that matters) is that Mom and baby are safe. But facing a proverbial “fork in the road” in our birth plan can be hard. Accepting that we do, in fact, need the drugs or accepting that, as it turns out, a c-section is in order, or accepting that baby came too fast and making it to the hospital in time never even happened—all of these unexpected changes in the “birth plan” can be difficult for the mother to accept. Because this is the most important thing she’s ever going to do. She’s creating a new life, a life she’s felt inside her for months, kicking and rolling around and responding to her voice. She’s dreamt of this moment, of this day, of these hours, since she was little, and she wants it to go a certain way.

And frankly, when we task our bodies with the incredibly daunting experience of birthing another human, we should be in charge of how it goes, dammit.

As we all know, however, that’s not how life works. Babies arrive early. Or they are breach. Or there’s a drop in heartbeat. Or Mom doesn’t dilate. Or she loses too much fluid.

Or a global pandemic happens.

Today, and for the last few months, COVID-19 has forced women all over the world to adjust their birth plans. Women are giving birth in hospitals without their partners there. Others are switching to home births. And some are meeting their babies in a quarantined room where everyone wears masks and no one can visit.

COVID-19 is changing everything, including birth plans, and it’s not fair. But it’s the reality right now in order to keep mothers and their newborns safe and healthy.

Talitha Phillips, a doula who works at Claris Health in L.A., offers some words of advice in this time of crisis. “Now, perhaps more than ever, it’s critical that women understand the birthing system they are stepping into, whether that’s a hospital, birthing center, or home environment,” she tells Scary Mommy. “I encourage each mom and partner to thoroughly research and do their homework so that they can advocate for care for themselves and for their baby.”

That means knowing your hospital’s current policy regarding COVID-19. Some are still allowing birth partners, some are not. Some are only allowing partners until baby is born and not again until discharge, others are allowing partners to stay the entire time. Some hospitals are allowing visitors, others have banned anyone non-essential from coming in. Some hospitals have maintained the standard number of days for postpartum women to remain admitted, whereas others are discharging women earlier if they seem healthy in order to minimize their hospital exposure.

Phillips says it’s crucial for women to understand the current policies wherever they plan to give birth to help avoid unexpected distress during labor.

However, she also says pregnant women should still ask themselves the same questions they always have when formulating a birth plan, even during this pandemic. Questions like: What’s important to you? Who should be a part of the process? Who has a calming presence? Describe the ideal setting — lighting, scents, a hot bath or shower? Do you feel safer laboring as long as possible at home or in a clinical setting?

Also, as in normal, non-pandemic times, Phillips encourages women and their partners to research and give thought to other topics such as fetal monitoring, labor positions, induction, interventions, and newborn medications, as these are also issues that will arise and may be choices the mother has to make quickly.

Will every woman get to give birth in their ideal setting? No, unfortunately not. But that doesn’t mean women shouldn’t still formulate their plan—one that is realistic and their best case scenario.

Also, as a doula, Talitha Phillips says another part of her job is to ensure women know their rights. “Mothers need to know that hospital policy and physician preference do not automatically eliminate patient rights, and they have to be knowledgeable about their rights,” she says. “The more educated a mom is, the more confident she is in navigating moments like this.” And, another big part of Phillips’ job is helping the mother “remember the ultimate goal of holding her baby in her arms. Temporary changes, as frustrating as they may be, don’t negate the ultimate goal.”

So, in this unprecedented global crisis, the likes of which we’ve never seen in our lifetime, what’s the best option for women right now? Are home births better than hospital births? Are home births safe?

The ACOG (American College of Obstetricians and Gynecologists) maintains that “the safest place for you to give birth is still a hospital, hospital-based birth center, or accredited freestanding birth center.” But the ACOG goes on to say, “Every woman has the right to choose where she will give birth. It is important to not take any risks that might put you or your newborn’s health in danger, especially while there is a high risk for getting COVID-19. Talk with your ob-gyn or other health care professional about your birth plan and any concerns.”

Talitha Phillips says she understands why women are questioning their original plans and now wonder if it’s safe to go to the hospital right now. “I think one of the most important considerations, at this time, both for moms and their partners, involves motivations. Are they making decisions out of fear or in confidence? For example, are they considering an induction or scheduled c-section so that they can try to control the timing of labor? Are they choosing an in- or out-of-hospital birth simply because they’re afraid of the alternative? If these decisions are driven by fear, they may not result in the best possible outcomes.”

The best way to make decisions a mother can feel confident in, Phillips says, is with proper research, so that their choices are built on confidence and knowledge, not fear — a sentiment the ACOG definitely agrees with.

For example, “To anyone considering a home birth or birthing center birth, interview various midwives, ask the hard questions, and express any concerns or fears,” Phillips says. “By speaking with a few different midwives, women will see which one is a good fit. And, asking a lot of questions helps instill confidence in knowing whether this is a viable and good option for her. Questions may include: ‘How long have you been doing births? Have you dealt with hemorrhages, shoulder dystocia, resuscitation for a baby? What is your hospital transfer rate? What is your emergency transfer rate? What is your cesarean rate?'”

She also says it’s important that women remember how incredibly strong, empowered, and capable they are, wherever they give birth. “No matter how many people are in the room with you as you give birth, you are not alone. There are people who love and believe in you, and you have everything you need to get through this,” she says.

Talitha shared with Scary Mommy that one of her clients recently switched to a home birth experience, and it was successful because the mother was “educated and empowered” in her choice. This mom also had the support of her OB/GYN, who understood her decision and agreed to serve as her backup physician should she end up needing a hospital transfer or induction.

“She embraced each decision calmly, built the support team she desired, and ended up with the exact birth that she’d been describing since the day I met her early in her pregnancy — a peaceful, calm, relaxing environment surrounded by those who believed in and supported her each step of the way,” said Phillips.

Personally, as someone who had three traditional birthing experiences, in hospitals, with OB/GYNs and epidurals, the thought of a home birth sends my anxiety through the roof. I definitely wanted a slew of doctors and nurses right next to me and my baby in case anything went wrong. But I also never gave birth during a pandemic. My husband was by my side through the entire labor, delivery, and recovery. He was there for not only our children’s first moments, but also their first baths, first shots, hearing tests, and diaper changes until we were discharged. The thought of doing that alone is heartbreaking.

So as much as I cannot fathom the thought of a home birth for myself, looking at the world today and what hospitals are up against, I can empathize with the many women who are making changes they didn’t originally anticipate as they prepare their “birth plans” in this time of COVID-19.

Because like literally everything else in the world, from education to travel to shopping at Target, birthing a baby is now impacted by this virus. And mothers are simply doing what mothers do—making the best decisions they can for themselves and their children.