Waiting on Labor and COVID-19

Waiting for labor is always a time of being "in limbo". It's even more true with the current social distancing and personal safety considerations necessary with COVID-19 spreading. Here are some of my thoughts on getting through the next few weeks if you're due any day. (Originally written for my Birth Doula support clients.)

Disclaimer: The information that follows is for educational purposes only and should not be considered medical advice. Always communicate with your Midwife or OB to determine which options are suitable for your unique situation.

Pregnancy and Birth During the Coronavirus Pandemic

I want to take a few minutes to update you and address some concerns that I’m hearing come up among my clients and other expecting moms.  This is truly something we haven’t dealt with before and many of the answers we’re looking for are not readily available. There are already many unknowns that come with pregnancy and birth. It would be easy to panic, but I don’t want you to do that!

This is going to be long, so get comfy.

Let’s jump right in.

What do we know about COVID-19 and Pregnancy?

One thing is certain, your baby is safer inside of you than outside, as long as you both are healthy. You are also safer at home than in a hospital or birth center, as long as everyone in your home is healthy.

From the CDC:

How can pregnant women protect themselves from getting COVID-19?

Pregnant women should do the same things as the general public to avoid infection. You can help stop the spread of COVID-19 by taking these actions:

• Cover your cough (using your elbow is a good technique)
• Avoid people who are sick
• Clean your hands often using soap and water or alcohol-based hand sanitizer

From the WHO:

The World Health Organization recommends mother and baby staying together after birth and emphasizes that skin to skin and breastfeeding are important for a baby’s health, even amidst the COVID-19 pandemic.

Should I go ahead and plan an early induction?

Some clients have expressed concern about where this pandemic situation might be by the time they are due and wondered if it would be safer to plan an early induction. Here are some things to consider:

If you and your baby are healthy, waiting for labor is safer than inducing. 

For a first-time birth, an induction frequently takes as long as 36-48 hours from start to finish. Yes, 1.5-2 full days is very common! Being in the hospital for an extended period of time is not only better to be avoided right now, but it also might not even be an option! Beds will be at a premium if this outbreak continues and may be restricted to those ready to birth and who have a medically-indicated need for interventions.

If you have planned on a low-intervention birth, elective induction is the opposite of that. Continuous monitoring the entire time, drugs to create contractions throughout, etc. It’s a very medical process. Dr. Rachel Reed provides a good overview if you aren’t already familiar.

What if I need an induction for legitimate health reasons?

It’s possible that something may arise where your or your baby’s health indicates that induction is safer than waiting for labor. In that case, it’s important to learn your Bishop Score via a cervical exam and understand that a lower score means you’ll need more medical intervention to create labor progress. Your due date coming soon or just passed is not a medical reason to induce.

One induction option to consider and ask about, especially during the current Coronavirus outbreak, is to use a Foley bulb as an OUTPATIENT procedure to begin your induction. This means you would go into the clinic rather than the hospital, have the Foley catheter inserted through your cervix, then go HOME to wait for it to gradually stretch your cervix to 3-4 cm and slide out on its own. The next day you would go into the hospital to begin the medical part of your induction. This approach provides the benefits of you spending the early part of your induction at home and starting the medical part with a higher Bishop score. I will note that the Foley has become more common for inpatient / hospital use in recent years, but the outpatient approach is not yet common in our area.

How do I safely wait for labor to begin?

Realize that few women go into labor on or before their due date. (See handouts attached.)

Set your mind on 42+42... 42 weeks of pregnancy and 42 hours of labor.

Yes, I said 42! You might go into labor before 42 weeks and birth before 42 hours of labor, but both are normal and common. If you accept (in a positive way) that these timelines are realistic, then you won’t get as discouraged while you’re waiting. Anything short of 42+42 will feel like a gift!

In addition to the hygiene practices mentioned at the beginning, staying safe means good rest and nourishment for you and baby. Stay well-hydrated. Don’t get hangry!

Pay attention to your baby’s daily active vs rest cycles. During active times, count their movements. This is called Fetal Kick Counting. As you tune into your baby’s pattern of activity, you’ll establish a baseline. (Assuming that you’ve been getting prenatal care up until now and know that your baby is healthy.) This way, as you are waiting day by day for labor to begin, you can observe if your baby’s movements decrease from their normal pattern. If that happens, you need to check in with your provider.

How do I know when to go to the hospital or birth center?

If you’re planning unmedicated labor, you’ve already learned that laboring at home is a big part of being able to do that. But staying at home as long as possible before heading to the hospital for birth is EVEN MORE IMPORTANT with this outbreak to reduce the time you spend in the hospital. Using my support as your doula at home before heading to the hospital is really critical!

I don’t check dilation. How will you know how far along you are? There are other indicators besides cervical exams that can give clues about your progress. There are plenty of changes that happen during labor that we can observe from the outside.

One technique that you can prepare for now is looking for your purple line. Tip: You’ll need help with this one!

The purple line is a physical darkening of the skin in your natal cleft (aka butt crack!) that occurs along with dilation during labor. Some studies indicate that about 75% of women display this change during active labor, so there is a chance it might not appear for you. I suggest having your partner take a look at it now (and yes, even snap a photo) as a reference so that you will know the difference vs what might happen during labor. It’s easiest to see when you’re on all fours and with good lighting. Here’s more instruction about the what and how to, along with some other external signs to note.

I want you to have the confidence to labor at home; however, if at any time you feel strongly that you need to get to your planned birth place, mother’s intuition ALWAYS takes priority!

What if they restrict visitors to the hospital or birth center?

As the COVID-19 spread progresses, we are seeing more and more places limiting visitors to only 1 or 2 per patient, but in some places they are not allowing ANY!

I know… Yikes! We as Doulas are actively advocating to be allowed in addition to a family member. I have my proof of certification on hand in case that is asked for, which is happening at some local hospitals. You need to speak up, too! But it may not be enough.

So what can you do if this happens? If I am unable to come to your labor room, I can be your Virtual Doula and provide support by phone or video chat throughout your labor, giving the hands-on cues to your partner. I recommend having the Zoom app installed on your phone, tablet or laptop. Be sure to bring charger cords and a stand of some sort for your device so it doesn’t have to be held the whole time. I’ve been a Virtual Doula for friends who lived in other states but counted on me for support. It works!

Are you having second-thoughts about birthing in a public facility?

You might be concerned about even leaving your home for birth at this point. If you are healthy and low-risk and committed to birth without pain meds, there is an alternative care option: Homebirth. And you should ask your insurance if they will cover it under these unusual pandemic conditions where most of us are being encouraged (if not ordered) to stay home and leave the medical facilities for those who are truly sick.

In response to this health-care crisis, my friends at Clarksville Midwifery have temporarily opened their schedule to take last-minute patients who would now prefer to birth at home in the care of Midwives. Jenny Fardink, CPM, and Christy Peterson, CNM, are licensed in the State of TN to attend homebirths. As with any prenatal care provider, they usually require that you enter their care earlier in your pregnancy. Although their services are not covered by insurance, if you are already past 34 weeks and want to transfer care, they are discounting their fees. Contact them to get a full explanation of everything that is included in that fee.

If you are in a different area, reach out to Midwives near you to learn if they are offering something similar. In Tennessee, you can find a list of Midwives on the TN Midwives Association site.

Staying calm while you wait

Whew! It’s a lot to think about, I know. So many decisions to make on top of what you were already anticipating. (I’m right there with you. I had to cancel the two workshops I was scheduled to teach this weekend, which I had been working towards for a couple of months.)

What can you do while you wait? Practice your labor positions and relaxation techniques!

Rebecca Dekker recorded a guided relaxation session on the Evidence Based Birth YouTube channel. I enjoy listening to the rain and a crackling fire in the background while I work or rest. Search for words like relaxation, white noise, or nature sounds to find your own calming audio/visual tools.

Remember that I am here to support you. Reach out if you have questions or just need to talk to someone who won’t freak out or pressure you about your choices.