As March unfolded and her due date approached, Alexis Cole of Troy was planning for a hospital birth.
“I never thought I’d be a person who had a birth at home,” she said. In fact, she added, “I don't even know anyone who had a home birth.”
That was before COVID-19 began killing Michiganders.
Michigan Health Watch is made possible by generous financial support from the Michigan Health Endowment Fund, the Michigan Association of Health Plans, and the Michigan Health and Hospital Association. The monthly mental health special report is made possible by generous financial support of the Ethel & James Flinn Foundation. Please visit the Michigan Health Watch 'About' page for more information.
At 4:02 a.m. April 10, 6-pound, 2-ounce Aza Cole slipped into her father’s waiting hands in the couple’s home bedroom. Family members awaited elsewhere in the home. Midwife Heather Robinson and a doula assisted.
“They were amazing,” Cole, 28, said. “The entire thing was just beautiful.”
As the coronavirus strengthens its foothold in Michigan hospitals, Robinson and other midwives say they are perfectly positioned to help new moms fearful of the deadly contagion to safely deliver their babies at home, all while relieving the burden on busy hospitals.
- The latest: Michigan coronavirus map, locations, updated COVID-19 news
- What Michigan's new coronavirus stay-at-home executive order means
- When Michigan unemployment, stimulus checks, and $600 CARES money will arrive
One obstacle? They say Michigan’s insurers and state regulators are unwilling to have insurance cover their services, which means only those who can shell out thousands of dollars can afford their services.
“In a world where we need to think outside the box, it’s entirely possible for an organization, or for a government or a nonprofit, to set up a stand-alone birth center with help between licensed midwives,” said Stacia Proefrock, president of the Michigan Midwives Association.
Still, public health officials note that, despite public anxiety about entering hospitals with coronavirus cases, maternity wards are still the safest places to deliver a child.
Stories from the front
Bridge Magazine, Detroit Free Press and Michigan Radio are teaming up to report on Michigan hospitals during the coronavirus pandemic. We will be sharing accounts of the challenges doctors, nurses and other hospital personnel face as they work to treat patients and save lives. If you work in a Michigan hospital, we would love to hear from you. You can contact reporters Robin Erb email@example.com at Bridge, Kristen Jordan Shamus firstname.lastname@example.org at the Free Press and Kate Wells email@example.com at Michigan Radio.
The American College of Obstetrics and Gynecology — while advocating for a woman’s ultimate right to choose where she delivers — has long taken the position that hospitals and accredited birth centers are the safest settings for birth.
Home birth is associated with fewer maternal complications, but it has a more than twofold increased risk of perinatal death and a threefold increased risk of neonatal seizures or serious neurologic dysfunction, according to a 2017 position paper by the physicians’ group on home births.
Last month, ACOG encouraged women to remain with the healthcare provider they’ve been using during “this time of increased stress and uncertainty.”
“Hospitals and birth centers that are both licensed and accredited remain safe places to give birth in the United States,” it reiterated.
But expectant moms interviewed by Bridge remain worried, especially as COVID-19 patients continue to fill Michigan hospitals.
Proefrock said phone calls for services by her Ypsilanti-based practice have more than doubled in recent weeks from women whose due dates are April, May and June. She is booked through July.
Expectant moms worry about exposure to COVID-19 in the hospitals, fears that are compounded by some hospitals’ rules that limit delivering moms to just one companion during the birth, she said.
“The way things have changed so quickly, it’s unsettling for them,” Proefrock said.
“The entire thing was just beautiful,” Alexis Cole said of the birth of baby Aza as husband, Brian, and a midwife and doula assisted. (Courtesy photo)
Even before this year’s coronavirus crisis, an increasing number of expectant moms were having babies outside hospitals.
After a gradual decline between 1990 and 2004, out-of-hospital births — such as those in homes or at birthing centers — climbed from 35,578 in 2004 to 62,228 in 2017 when about 1-in-62 U.S. births were outside of hospitals. Births at home climbed 77 percent over that same time, according to a review of data published in 2019 in the peer-reviewed medical journal, Birth.
In 2018, the three recognized tiers of midwives — midwives, licensed midwives and licensed nurse midwives — delivered 9,134 of the state’s 110,093 newborns, just over 8 percent. Even then, most midwife deliveries were in hospitals.
Just 452 Michigan babies were delivered in homes or at birthing centers by a certified midwife, a certified nurse midwife, or midwife, according to state data.
But as COVID-19 descended on Michigan, Heather Robinson’s phone began to ring.
Heather Robinson (courtesy photo)
As one of the few African-American midwives in Michigan, the owner of Birth Beautiful Detroit is already in high demand in the Detroit area, the epicenter of COVID-19 death and illness.
Home births not only allow expectant mothers to avoid healthcare settings, they also allow mothers to be surrounded by family during a perilous time.
But “for too many people,” Robinson said, “it’s just too cost-prohibitive.”
It’s unclear how long COVID-19 cases will stretch the resources of hospitals in Michigan, or how long many hospital workers will be without enough personal protection equipment, such as masks.
Also unclear are the risks of the virus in labor and delivery.
It is not clear whether the mother can pass the virus to her fetus or infant; the virus has not been detected in amniotic fluid or breastmilk, according to the U.S. Centers for Disease Control and Prevention and the World Health Organization.
It is also not yet shown that pregnancy puts a person at greater risk for COVID-19 infections or their child at greater risk for birth defects, said Dr. Gregory Goyert, the division head of maternal fetal medicine at Henry Ford Hospital, who earlier in April took to Facebook Live to reassure expectant families of the safety of hospital maternity wards.
Doctors have sought to assure expectant moms that hospitals are the safest places to give birth, but Alyssa and Ben Panesiu, whose first two children were born in a hospital, said they will turn to a midwife instead. (Courtesy photo)
The labor and delivery unit at Sparrow Hospital in Lansing has been locked down from unnecessary traffic. Delivering moms are allowed just one companion at their bedsides, and workers are screened at the beginning of each shift.
There’s less traffic back-and-forth between floors and, if a mom is COVID-19-positive, she will deliver in a part of the unit that will be closed off from the other moms by a fire door, said Dr. Jennifer Hoffman, chair of the Lansing Sparrow’s Ob-Gyn Department.
“From a medical standpoint, we understand that new moms are nervous about being in a hospital during a pandemic,” she said.
Her concern, she said, is not a judgment on the care provided by midwives but instead reflects her worry about first responders, who are falling ill and stretched thin by the pandemic.
“It’s about what if you needed help and there wasn’t time to get it?” Hoffman said.
This much, though, is clear, Goyert, the Henry Ford specialist, said: “We do not encourage home birth under any circumstances for most patients.”
“There's a lot of research that's been done that demonstrates that the risk to baby is significantly increased for most patients with home births. The COVID epidemic does not change those recommendations,” he said.
Because of long-standing positions like these, most insurance plans in Michigan do not cover home births by midwives, even though they cover births in health care settings by certified nurse midwives, said Jeff Romback, who oversees policy and planning at the Michigan Association of Health Plans, which represents many of the state’s largest health plans.
In Southeast Michigan, parents’ out-of-pocket costs range from about $2,400 to $4,200 for midwives, a fee that includes prenatal visits, the birth, and postnatal visits for six to eight weeks after birth, including three visits in the first week after delivery.
There are no immediate plans to change that insurance coverage, said both Romback and Bob Wheaton, spokesman for the Michigan Department of Health and Human Services, which determines the criteria for Medicaid coverage in Michigan.
Wheaton noted that midwives' services are covered in “clinical settings like a hospital... We believe this is appropriate.”
That means Alyssa Panesiu will shell out $3,800 for the services of a midwife.
She also ordered online a $65 birth kit, which includes a cord clamp and gloves, and the $140 newborn screening kit that will test the child’s heart and hearing. There are new towels and receiving blankets on the way, too.
Like Cole, she had planned a hospital birth, but COVID-19 ushered in a whole new level of “nerve-wracking” as her June 7 due date approaches.
Her other two children were born in a hospital, but now?
“We see over and over again there’s not enough (personal protective equipment in hospitals). My obstetrician’s office isn't even seeing me, and we’re doing telemedicine instead,” said the Madison Heights woman.
“So … then, what are you doing asking me to go to the hospital?” Panesiu, 28, asked.
She said her husband, Ben, has underlying conditions — worrying them both that he’s possibly more vulnerable to the severest of COVID-19 infection if he comes in contact with the virus.
Following guidance from the CDC, many hospitals require that companions stay with moms from the moment they arrive at the hospital in labor until they leave. That could mean two days or more for 4-year-old, Emmy, and 2-year-old Lucca to be without their parents.
Suddenly, the idea of a beautiful hospital birth becomes “the most miserable day or two ever,” Panesiu said.
When contractions are close enough, Ben will drape the bedroom in sterile plastic sheets — “like a scene from Dexter,” she quips, referring to the TV series about a serial killer.
The hassle and cost is worth it, she said: “We’re rewiring our expectations...It has been tough, but we’re at the point now we’re excited for this new experience.”
- Hey, Michigan, here’s how to make a face mask to fight coronavirus
- Michigan coronavirus dashboard: cases, deaths and maps
- Michigan families can get food, cash, internet during coronavirus crisis
- How to give blood in Michigan during the coronavirus crisis
- 10 ways you can help Michigan hospital workers right now
- Michigan coronavirus Q&A: Reader questions answered
- How to apply for Michigan unemployment benefits amid coronavirus crisis