Nestled in a lot on the corner of Northwest Sixth Street and Northwest 26th Avenue in Gainesville, a stone and shiplap house sits quietly amid the sound of passing cars. The pale yellow and rust colored boards have begun to fade, and ivy clings to the stone, wrapping itself tightly around the corner of the building. A wooden staircase flanks its right side, leading you up to a sunny porch deck. There’s a sign hanging from the screened door that reads: Greetings clients! Please wash your hands and wear a face mask upon entering the office.
This is the Midwives Cooperative. With the warm glow of lamps and a cushiony, worn couch, it feels like home. The only difference is the addition of an exam table in the office’s back corner and the many black and white birth photos that line the walls.
Just because the world has seemingly stopped for a little while doesn’t mean that life (or its creation) has too. Women are still getting pregnant, still giving birth and still need all the support they can get. The novelty and unknowns about COVID-19 have led to reconsideration about the need to give birth in a hospital setting.
That’s why for many expectant mothers, the opportunity for midwifery care can look like a bright light in a dark time of uncertainty and fear.
There’s been no pause in care since the outbreak of COVID-19 in the spring, said Abby Reichardt, a licensed midwife and partial owner of the Midwives Cooperative. In fact, midwives have been at the core of the pandemic response across the country.
Reichardt has seen an uptick in inquiries since March. She estimates that before the pandemic, the Midwives Cooperative was hosting one or two interest orientations weekly. Over the summer however, the midwives were hosting two to three orientations every day.
Andrea Reece, a licensed midwife with Gentle Journey Midwifery in Gainesville, had a similar surge in new inquiries. However, she is no longer accepting new patients.
This piqued curiosity is the result of not only COVID-19 concerns but also the closures of two birth centers in Gainesville since the beginning of 2020. Gentle Journey’s birthing center closed in February, prior to the start of the pandemic. In May, the Comprehensive Women’s Health Birth Center closed due to COVID-related safety precautions. It is unclear if or when the center will reopen.
“There’s a lot of concern about bringing a person into the world during this crazy time,” Reichardt said. “Now, people are faced with limited decisions: either I go to the hospital or I contact a midwife.”
Of the many apprehensions that expectant mothers face, two stand out: fear of exposure to COVID-19 and worry about the lack of a support system allowed in the hospital room.
“When COVID first started, hospitals weren’t letting any support people in, and that’s a big deal for somebody having a baby. It’s a life-changing experience,” Reece said.
At North Florida Regional Medical Center, patients are allowed only one visitor during the duration of their stay. No children or additional visitors are permitted. UF Health Shands Hospital has a similar policy.
These stringent visitor policies are partly why Mishaila Harmon, a Hawthorne resident, initially wanted to have a midwife-assisted home birth. But the distance from her house to the nearest hospital was too far past the 30-minute guideline most midwives adhere to.
“I’m new to Florida and have no family here. But because I have three other children, my husband had to stay with them and couldn’t be with me to deliver our baby,” Harmon said.
She also personally refuses to get tested for COVID-19 and was worried that this would complicate the procedure for her labor and delivery.
Harmon ended up giving birth at the North Florida Regional Medical Center. She was alone. Her husband and kids waited in the car to meet the new addition to their family.
On the other hand, the home births that Reichardt, Reece and other midwives attend do not have such strict visitor restrictions. Reece said that many expectant mothers have shown interest in using a midwife because of this.
The personalized care that midwifery provides has been both a source of comfort for mothers and a challenge for providers during this time.
“With a midwife, people expect a lot of closeness,” Reichardt said. That same level of intimacy frankly isn’t possible given constantly changing COVID regulations. Both the Midwives Cooperative and Gentle Journey have transitioned to telehealth services to conduct most prenatal appointments, which can be difficult given the hands-on nature of pregnancy assessments.
And while mothers do not need to wear masks during labor and delivery, the midwives do.
“A lot of people in labor don’t want to hear talking and chatting, so much of our encouragement is nonverbal. Even just looking them in the eyes or smiling,” Reece said. “That communication is lost when you have to be masked.”
Reichardt notes how newly puzzling the experience is.
“Taking care of a laboring mother and newborn is inherently intimate. You’re in each others’ physical space because it’s necessary, but now it feels a little more restrained,” she said.
Beyond the physical limits that COVID-19 has imposed, midwives also have to grapple with the emotional struggle between intimately caring for mothers and their babies and ensuring their own safety. Neither Reece nor Reichardt have had to interact with a COVID-positive mother yet.
But the possibility lingers.
For a mother who does contract COVID, midwife-assisted home birth would likely not be possible. She would have to switch her entire birth setting and stay in isolation afterwards. It’s a tough conversation that Reichardt has had to have with her clients since March.
Even so, Reece and Reichardt caution expectant mothers from completely ruling out the idea of hospital births. They say fear-based decisions for home births aren’t a great reason for transferring to midwifery care.
“Home births have their own risks. We don’t want people coming to us out of desperation rather than making a truly informed and empowered decision,” Reichardt said.
Home births are not a feasible option for women at high risk during their pregnancy, even during the COVID-19 pandemic. So, Reichardt, Reese, and other licensed midwives have continued to only accept low-risk patients despite their influx of inquiries.
The situation is different for Kristen Cook, a certified nurse-midwife and registered nurse at All About Women Obstetrics and Gynecology in Gainesville. Her position as a CNM allows her to attend deliveries at the hospital, and she has seen firsthand the COVID-related changes being implemented at North Florida Regional Medical Center.
“We’re universally masking, and it helps that our maternity unit is in a separate part of the hospital. I think that makes a big difference,” she said.
Cook added that All About Women has taken significant precautions, from initially stopping all non-urgent visits to calling and vetting patients before their scheduled appointments. But she said that the level of care during labor and delivery has stayed the same.
“How much time we’re spending in the room with the patient and at their bedside hasn’t changed. We know that’s important,” she said.
Though they may differ in type of care, certified nurse-midwives and licensed midwives alike have to deal with anxious parents and constantly evolving information. Reichardt, Reese, and Cook say a big part of their jobs at the moment is helping expectant mothers process their fear and concern about COVID.
For the midwives, it’s as much about emotional support as it is about physical support.
“Patients are looking to us for answers that we don’t always have,” Cook said. “This is a new virus that none of us have experienced before. Not being able to tell them the answers that they want to hear is always hard.”