How You Need to Change Your Birth Plan For COVID

Pregnant? Very pregnant? It's time to revisit your birth plan.

Sure, you agonized over your birth plan and now it’s all shot to hell. Or is it? With overrun hospitals, birth plans should change right now, but it’s not all out the window. Who will visit the delivery room, whether to use a doula, and even how long you’ll stay all need some rethinking. But your pain management, hospital bags, and day-of preparations should all remain. Fortunately, you don’t need an overhaul — just a bit of flexibility baked into your plan.

So with the coronavirus, what’s changed is that hospitals are overrun — running out of personal protective equipment and the medical personnel who wear them. That’s not going to stop some 300,000 women from giving birth in the U.S. this month. Some of these women are switching to hospitals outside of the hotspot cities they live in while others are opting for home births. But don’t make a decision in a panic. “Now is not the time to be changing your birth plan,” says Denise Jamieson, chair of gynecology and obstetrics at Emory University School of Medicine.

Though experts advise against overhauling your plan, you will have to be flexible — because the details will change whether you like it or not. Here’s how COVID-19 could impact your birth plan, and what you need to do to build a backup.

Ask All The Questions

The coronavirus situation is changing daily across the country. The protocols your hospital uses may be changing too. The first step in altering your birth plan is to find out how COVID-19 medical policies will affect labor and delivery.

These are the questions you need to ask. If you don’t like your chosen hospital’s answers, find out if you can switch to another within your network. Then pester the new facility with these questions too.

  • Are you testing women and visitors for COVID-19 before they enter the hospital?
  • How many support people am I allowed to have?
  • Can my support people come and go, or do they have to stay the whole time?
  • Are there changes to your policies of inducing labor?
  • Are there changes to how you’re offering C-sections?
  • How early are your discharging mothers and their babies?
  • Do you have enough doctors, nurses, and midwives in the labor and delivery unit?
  • Should I be prepared to go to another hospital?
  • What other hospitals would you recommend as a backup?

Make Video Chat Plans

One of the biggest changes in labor and delivery room is the number of visitors allowed in. Though each hospital is different, many are only allowing one visitor. Some hospitals include a doula in that count while others consider doulas part of the care team. Others are banning them outright. “Doulas provide a really critical form of coaching and support in labor that is evidence-based,” says Chitra Akileswaran, an obstetrician-gynecologist at Highland Hospital in Oakland, California and co-founder of Cleo, a support system for working families. “It’s really unfortunate that a lot of families won’t have access to that.”

As an alternative to coaching women in the delivery room, some doulas are offering virtual support during childbirth. Get in touch with your doula and see what options are available for you. If you want to go the video call route, check that your hospital can support telemedicine during labor and delivery. If they can’t, you can consider switching hospitals, or you can ask your doula to provide support in person before and after the hospital stay.

Make a Transitional Spot in the Nursery

After giving birth, you may be discharged more quickly than usual to free up hospital resources and reduce your risk of infection. Usually, new mothers and their babies leave the hospital two days after a vaginal birth. Now, as long as mom and baby have no health complications, they typically stay for between 24 and 36 hours. “What that means is that you’re left to figure a lot more out on your own at home,” Akileswaran says. New parents will receive less direction on how to care for a newborn, including how to breastfeed.

Breastfeeding is difficult even in the most difficult of times. “Especially for first-time moms, it can be very frustrating,” says Timothy Rafael, director of maternal fetal medicine at Long Island Jewish Forest Hills in Queens, New York. To help mothers as much as possible, hospitals are packing in practice into the hours following birth, giving mothers lots of time with lactation specialists. After being discharged, they may be able to consult with the specialist over telemedicine or call a doctor with any questions. Some hospitals, including Rafael’s, are even sending home health aides to check up on the new baby and its parents a few days after birth.

Breastfeeding isn’t the only obstacle you’ll face upon returning home. The first day, you won’t just be exhausted — your sleep schedule will be erratic too. Get as much rest as possible, Rafael says. Try using a pump so another caregiver can feed the baby while you’re sleeping.

And if older siblings want to meet the baby? Don’t worry. As long as they have been in quarantine and aren’t suspected of having COVID-19, it’s safe for them to meet the newest member of the family.

Have a C-Section Recovery Plan

Many of the precautions that apply to vaginal hospital births also apply to C-sections. Most hospitals don’t offer elective C-sections on a normal day, but those that do may stop during the pandemic because of the stress on operating rooms and medical staff. Scheduled C-sections may differ a day or two from their planned date to fit hospital availability. But many C-sections are emergencies. Be prepared in case you need one unplanned.

Like vaginal deliveries, the stay for moms giving birth by C-section will also be shorter. Instead of three or four days in the hospital after birth, families may only have two or three as long as both the mother and baby are healthy. At home, a medical professional may check up on the incision via telemedicine or house call.

After lying down in a hospital bed for most of the past several days, moving around at home can be difficult. Be careful when you stand up. When moving from lying down to standing, sit for a few minutes in between. Then, ask someone to help you balance as you get on your feet. When you do sit, a recliner will probably be more comfortable than a hard, straight-backed chair.

Revise Your Home Birth Plan

Despite the risks of home births, midwives are reporting that increased numbers of women are asking for them as some families attempt to avoid the hospital. Some medical professionals are even encouraging it for low-risk women during the pandemic, as some did during the SARS epidemic in 2003. But Jamieson disagrees with this advice. “Health systems are taking measures to ensure that hospitals remain the safest place to deliver a baby,” she says. Akileswaran also advises against the switch. “The decision to have an out-of-hospital birth or a home birth is not a light one,” she says. “It’s not a backup plan.”

Home births and hospital births have about the same rates of perinatal and neonatal deaths, according to a recent meta-analysis. However, several factors complicated the study, including that only low-risk pregnancies are considered for home births. Still, the American College of Obstetricians and Gynecologists recommends hospital births and considers home births more than twice as likely to result in perinatal death and three times as likely in neonatal seizure or serious neurologic problems.

If you were already planning on a home birth, you can proceed as planned, though you should take extra precautions. On a normal day, between 23 and 37 percent of first-time mothers that attempt a home birth end up in the hospital, usually because the baby can’t get through the birth canal. Even for women at the lowest risk of complications, “a routine labor can turn into an emergency situation in the blink of an eye,” Rafael says. If something goes wrong, you need to be able to access emergency medical care stat. But that may not be possible — or may be dangerous — with emergency rooms saturated with COVID-19 patients. “If you’re not planning to have a baby in the hospital, then I think it’s more important than ever that you have a plan for what happens if you do need emergency care,” Jamieson says.

Reconsidering your birth plan can be overwhelming. But don’t panic, and don’t rush your decision. Healthcare providers are there for you to discuss your options. Even when the whole feels out of control, you can still take control of your birth.