This week Pansay (Doula), Angela (CNM), and Maggie (RNC-OB) discuss COVID-19's impact on our birth practices. We are talking about remote doula support, how this crisis is impacting mental health for birth professionals and consumers, control during birth, and how we care for each other. We are also calling attention to Black Maternal Health Week and calling out racial disparities in care and our collective responsibility for addressing them.
This week Pansay (Doula), Angela (CNM), and Maggie (RNC-OB) discuss COVID-19's impact on our birth practices. We are talking about remote doula support, how this crisis is impacting mental health for birth professionals and consumers, control during birth, and how we care for each other. We are also calling attention to Black Maternal Health Week and calling out racial disparities in care and our collective responsibility for addressing them.
Maggie, RNC-OB: 0:05
All right, so welcome. So today I am talking with Ms Pan say, and Miss Angela and we are, you know, covering code. Still, it is, you know, this most pressing issue that we're seeing happening, So I wanted a chance to dive in with them about how this is impacting, you know, they're they're practice their professional lives how this is impacting the relations, their clients and then also did a little deeper into kind of the social terminus of health. And how we're seeing those play out kind of a long Koven and along how this is gonna impact particularly different, you know, care communities within maternal child health. So, yeah, so if you all want to just kind of started to share a little bit about how is this kind of changing the way your offering care so far?
Maggie, RNC-OB: 0:00
All right, so welcome. So today I am talking with Miss Pansay, and Miss Angela and we are, you know, covering COVID. Still, it is, you know, this most pressing issue that we're seeing happening...so I wanted a chance to dive in with them about how this is impacting, you know, their practice, their professional lives, how this is impacting the relationships with their clients and then also dig a little deeper into kind of the social determinants of health, and how we're seeing those play out kind of a long COVID and along how this is gonna impact particularly different, you know, care communities within maternal child health. So, if you all want to just kind of start to share a little bit about how is this kind of changing the way your offering care so far?
Pansay, Doula: 1:44
For me, it's just like I do see this with you know, all of the doulas in the Baltimore and, you know, Maryland area. This is a very difficult time for everyone. Very unfamiliar territory, within that, I am so grateful that we do have the home birth option. Like, you know, we have the option to help these women, who are very much afraid of being in the hospital setting right now to give birth. I have seen an amazing shift, like women I know would have never considered home birth, you know have been reaching out, you know, "please give me some options for that." So, you know, within the crisis, that's the beautiful part that we have several home birth midwives that have stepped up and taken on, you know, all of these women to give them a safer environment, you know, at home to have their babies. My current client was was due to deliver at Special Beginnings Birth Center in a few weeks and we have transitioned to a home birth. So it's it's been a very relieving, you know, shift that they have those options. The other side of that we know we have women who cannot afford, you know, to make that to make that change. So what do they do? You know, they are limiting the support staff, and also the hospitals are going just one person you're allowed to bring in, you know, with you. But we know that that's changing daily with all of the hospitals. It's just, you know, the rules are changing. So a lot of them are preparing to be alone that they might have to you know, give birth by themselves. I am seeing the majority of the doulas offer virtual services to help these women prepare to be there. I have even seen some footage and video, you know, off some doulas, you know, actually, in the middle of that virtual call. You know, some of them even walking mom up to the hospital door and then face timing, taking over, you know, from there. A lot of positive outcomes, but a lot of sad outcomes too, you know. I've seen another scene, another situation this morning where a nurse had passed on, you know, corona to mom and baby; baby is in the ICU. So a lot of sad situations, you know, also. But that's actually you know what, what they know it's a possibility just going into the hospital, setting. It's a possibility, you know. So right now I have seen doulas not charging, you know, for virtual services; they are really, you know, gearing up and coming together to try to support the women in Baltimore and Maryland. So you know, in hopes that they have some type of connection, even if it's virtually so they don't feel totally alone you know during this. I myself with my client, I am limiting my visits. I probably would have had two more face to face visits with my clients, you know, before the May birth. But because I can't guarantee, you know, as far as who is coming into my presence and where they've been, you know all that. I am limiting my visits, and I will not see her until you know, until the birth. And I, you know, I will be doing everything, dress rehearsal and preparation virtually, a very sad situation. But I am, I'm happy to see everybody pulling together from midwives to doulas, to lactation consultants, you know, really to take care of the women, the women here.
Maggie, RNC-OB: 5:45
Yeah, absolutely.
Angela, CNM: 5:47
It's so incredible to me how how different regions, different hospitals, different areas are seeing so many things for practice and something things differently and seeing things differently in the community that I work in. Well, first off, I live in Las Vegas, and we are very fortunate that we did not get hit as hard with COVDI, like a lot of those big major cities, mainly because they closed down the strip. Early march, like the first week of March, the strip was shut down. And so that got rid of about 70-80% of our tourists. So even more so, working in the military system, I'm only seeing dependents and active duty folks and our population. As of yet, my pregnant women have yet to have a positive COVID. But we do have COVID teams. I'm actually on the COVID labor team as the only midwife on it, and we have three physicians who back me up. I pull the majority of the primary call. And the reason why is so that, because honest to Pete, we need our surgeons we cannot afford for one of our surgeons to get sick. Because if that happens, it is really gonna put a strain on the type of care that we have. So we have gone through the process of now splitting our floors. There are COVID teams and non-COVID teams for every specialty in our hospital now. So basically, the reason why they did that is to save on PPE. So the only people on COVID teams are there because these are the only ones who will get the PPE in the event that we actually take a take care of a patient who is PUI or COVID+. It caused a bit of chaos splitting our labor and delivery units. So now we have two labor and delivery units but the same amount of staff to to cover those units. And so it means that we are on divery a lot, which means that now our patient population is certainly gonna be exposed because the general population here in Vegas there is a high COVID rate. We've had, I think, about 57 deaths from COVID, including one at my kids' school County where they were serving food recently. So, you know, it certainly is concerning when we're putting our patients out on the economy because they come back to us afterwards and could potentially spread this virus not only to their family members, but to staff is well. Another thing that we have done, which is pretty aggressive, is we went to 50% staffing about three weeks ago and then within a week we went to 100% virtual appointments. This includes all of our pregnant women, all of them. They literally have two appointments where they see us in person, or their entire pregnancy, unless otherwise indicated. And really it is urgent things only. It cannot be, oh even vaginitis, we can't do anything like that. And if things like that come up, we do have a plan in place to address those issues. But 100% of the appointments occur by phone, even the new Obstetrical Physical Exam (OB PE). And if she's already had a dating ultrasound, we will not see her for that new OB P. E. If she is going to a high risk doctor because she wants nuchal translucency, that will count as her new OB PE. They don't get ultrasounds in the hospital. They talk about their labs, you know, the things that come up and at 36 weeks they will come into the office for a self-collection of GB swap and we're going to do drive through prenatal visits at that point. So we'll be doing fundal heights and dopp tones, but they're taking their own blood pressure at home, they're weighing themselves at home. And once they get to the age where we expect them to have regular fetal movement, that is how we are assessing fetal well being and obviously this is a very tough pill to swallow because we're so used to being able to see women and touch them. And I find myself with the few virtual appointments I have, I mean, sometimes they last like, 30 minutes because when you have a person, a woman in front of you saying this is bothering me, I can look at it, I can touch it, I can smell it. I can try to reproduce any of those symptoms and evaluate it. And now what I'm seeing is that man, If you're not really good at your clinical assessment, you are gonna be in trouble because I am asking a ton of questions and going through a ton of differentials when patients say things like, "Oh, I have this mid back pain like on my right side." And I'm like, "oh my God, is that her kidney? Is it CVA tenderness?" and I have to run through this whole algorithm. Where if I had just been right there in front of her, I could have just touched her, I could have just looked at it, and it would have helped to decrease the amount of time that that appointment took. So there's, you know, there's worry that like we missed something, you know what if, you know, these blood pressure tools that the patients are using are not calibrated correctly and we're missing, you know, the entire reason prenatal visits were established, which was to screen women for preeclampsia. But what if we miss that stuff? What if we miss intra-uterine growth restriction? Like it's a lot to take in, but I do understand the purpose and the rationale for it; you have to weigh the risk with the benefits. And is it worth being in the office, exposing every last one of my colleagues, potentially exposing every woman who's pregnant, her children that may come into the appointment as well. A lot of our patients have many co morbidities that will increase their risk for poor outcomes, if not death. So I tell myself the end of the day we have to do what's right by these women. And I also remind myself, and many of my colleagues that, you know in the vast majority of the world women do not have access to good prenatal care and in the vast majority of the world, pregnancy is normal until it is not. Women don't get a single day or prenatal care and they come in term, spontaneous labor. And they birth their babies and they take their babies home, you know, and I have to remember that in this country where we have wealth and good access to care and very educated providers, that the majority of our women are still going to be fine.
Pansay, Doula: 12:52
Yes.
Maggie, RNC-OB: 12:52
Yeah, I think, you know, in our last episode we talked about a lot of that, like that piece of balancing out the public greater good,
Angela, CNM: 13:03
Yes
Maggie, RNC-OB: 13:03
and the individual experience and that, that is, it's impossibly hard, like it is so hard to to ask these people, these families who are getting ready to have a baby, which is already this, like, hugely transformational experience that they are trying to go through, and they're trying to navigate so many new dynamics and concerns and, you know, possible issues that come up and then to have to ask them to try to really make these, like, big sacrifices that are so different than what we are used to here it's really hard on that piece, you know, that you're talking to, like that relational piece like that is so much of what you know, prenatal care does. It obviouisly helps us to rule-out, you know, massive health issues, and that's very important. But so much of it too is that you're helping someone to get comfortable with the idea that you're gonna be there with them, you know, for this and that's across all of these different birth professional roles, you know, whether it's OBs and, you know, midwives providing, you know, prenatal care and doulas doing their appointments. I know we were talking, you know, with the last episode with Ray and, you know, doing home birth, especially that, like so much of their care, is based on the fact that you've been able to develop this really unique and tight relationship over, you know, seven or eight months of pregnancy so that you have this really high level of trust when you're going into, you know, birth, especially in an area where you maybe don't have as many, you know, access to different, you know, resources and and everything into that that balance. I think what we're asking of, you know, birthing people is just it's a lot; like I'm feeling for everyone right now who is pregnant and trying to navigate this and especially because we know, everyone doesn't come into it with equal resources. Both, you know, mental, emotional, physical, socioeconomic, all of it. You know, we're not all operating from the same kind of starting place.
Angela, CNM: 14:50
You know, the other thing that, it's interesting, I will say; so, we implemented our COVID teams almost exactly two weeks ago, we literally came up with a plan, and the next night it was implemented, and it went from best case scenario to all of a sudden, worst case scenario, all in one shift. We had all these plans about, when we do this, if we do this, if we do that, this is what happens next. And I literally got home from work on a Tuesday night and I got a call saying my first patient, who was PUI was coming in. It was supposed to be a slam dunk delivery because she was a grand multip and it ended up not being a slam dunk delivery. And we ended up in the O. R. We're contaminating our entire units of now at one in the morning, we're having to switch all of our non PUI patients down to another floor. And I mean, we had talked about this plan and, like, just barely set it up. And suddenly we were now dealing with worst case scenario. I think what was scariest for me was those precious moments that I lost just trying to get PPE on so I could actually go to the room to the patient, and not being able to comfort and support women the way I like to. I labor sit when my patients are in labor, especially, unmedicated. I am in the room with them pretty much the entire time, especially while they transition and I am in the bed with them. I am doing, you know, double hip squeeze a counter pressure and tell him that breathe and moan and full of this stuff that I can't do now. You know I can't do it and I can't be in the room with them. Continues, like because it increases my risk. You know, I don't feel like I'm with the women that way, and it's heartbreaking.
Maggie, RNC-OB: 16:59
Yes; it is heartbreaking. I mean the whole situation. It's just like it's hard to find the wins, like we're seeing these moments where communities are coming together and where we're able to come up with all these, you know, inventive plans to provide better support, and those are, you know, the silver lining, the moments that stand out. But it is just, it's such a hard position...
Angela, CNM: 17:22
It is.
Maggie, RNC-OB: 17:23
to be in. I worry about how this plays out as it continues, you know, for a longer time. Like we're still by most public health guesses in like the beginning.
Angela, CNM: 17:35
Oh, absolutely.
Maggie, RNC-OB: 17:36
stage, you know? And so, as this continues on for an indeterminate amount of time, where do we go from here? How does this realistically play out? How does everyone deal with this continuous extra stressors on top of their normal life?
Angela, CNM: 17:56
Yes. You think about, you know, how immunity works and you know, the ideal is herd immunity, right? And this allows for a small majority to not be vaccinating. So we're talking about 70-80% of the population, the general population needs to have immunity to whatever bug that's out there in order for the vast majority of us and those who are not able to be vaccinated or those who choose not to to not be impacted. Well, the only way to get 70-80% of us immune is to be exposed to it, either naturally or through vaccine. And with us trying to stay home to decrease that incidence right now because we can't handle the workload in the hospital, it's gonna be a very long time. They are talking about, like doing research for vaccines. A vaccine, if it were, you know, being worked on today may not even be ready to give to the general population for at least a year to a year and 1/2 and then we need to understand the potential risk associated those long term risks, which we may not understand. And you know, that's a mind blowing thing to consider that we could potentially be in this social distance isolation, self quarantine phase for a very, very long time, a very long time. And that's the reality of it. It truly is. It's the reality of it.
Pansay, Doula: 19:27
I think this suffering. I think both of you kind of touched on this. How this will affect all of us. You know, health care professionals, our clients specifically actually, yeah. You know, the core of our work is connection and touch...
Angela, CNM: 19:48
Touch. I miss touching women. I miss touching bellies and feeling those babies
Pansay, Doula: 19:54
That's hard; that's hard.
Maggie, RNC-OB: 19:56
I know, I do. I definitely worry about that. The human touch, the connection piece of it, and where that goes with all this and how we kind of work to maintain that. And I also I also feel like when we're looking at everyone and just the mental health, you know, repercussions of this and how that's going to play out. I've read some articles about, obviously we're already seeing just the huge impact it's having on health care professionals, you know who are dealing with is constantly. The way it's impacting doulas who aren't able to be there providing care and then kind of have that, like "survivor guilt," kind of feeling of not being able to actually be somewhere that they want. And it's just, you know, it ends up, it's complicated on so many different, you know, levels. And I also worry about the marginalized communities in, you know, in our care, like we know that health care delivery is not the same across the board.
Angela, CNM: 20:54
Nope. It's not equal.
Maggie, RNC-OB: 20:55
...in our country on a good day. And this is certainly not a good day, you know, like we are not operating anywhere close to that, and I definitely I worry. And, you know, this episode is coming out in, you know, Black Maternal Health Week, and I am really worried about our moms of color. I'm worried about birthing people of color and how all of the different ways that this disease is impacting our public health, how it's impacting our economy, how it's impacting all of these different facets of our life, and that is going to definitely impact communities of color in a higher degree because of the systemic racism that exists in our country all the time. And I'm already seeing, you know, reports that the rates of COVID in, you know, black community, their numbers are far higher than their actual, you know, percentage of the population in affected areas. I know in Milwaukee they were talking about how you know, black people are about 27% of the population, but they were 50% of the COVID cases, and they were 87% of the deaths from COVID [~4/3]. And, you know, similar in Michigan, where they've started to, you know, do all racial aggregating. They're talking about their 14% of population and their 35% of cases and 40% of deaths. And I know we're gonna keep getting more of these results from other states cause it's just happening. People are calling that we need to break down all of these results by race. We can start to look into some of those the different way that care plays out. I'm worried about how it's going to impact our women of color who already have higher rates of so many different comorbidities, like we know that because of the effects of racism that we have higher rates of diabetes and asthma and hypertension and all of these different autoimmune diseases, which we know puts people at higher risk then if they actually get COVID, and how that's gonna impact their care. And how is that gonna impact their care especially they're pregnant, and then they have this other layer you know of risk added into it.
Angela, CNM: 22:58
Yup. You know, the thing....we touched on something off line that is just man. It just hits the nail right on the head about how you know this is not a new thing in healthcare having these health disparities that are so so so vividly defined and separated by race and culture and ethnic background, and social status. I think that obviously it's not surprising that we're still seeing that with this COVID outbreak, and it has a lot to do with our foundation. You know, it's getting to the root of the issue, which is, you know, having people who already are underserved, poor access to care, poor access to knowledge or have a knowledge deficit purely because they lack the ability to learn or because of their social surroundings, have certain beliefs about certain things. So you put these people, these same people who are already an at risk group, and they're exposed to something like COVID, well, their outcomes are gonna be greater because the foundation was laid many years ago. The foundation was laid at birth, it truly was, was laid at birth and they didn't come out of that. And unfortunately, what I see happen is we tend to in our society, we tend to, not give the people who don't seem like they have a chance the opportunity. I will say, even as a young adult growing up in this inner city area literally, I could see the projects right down the street from our house and I went to the worst high school in my community. People didn't put money into our community, into our school because they didn't think we were worth it. And what I will tell you is that of the five of us in my graduating class who went to college, these were the five people that our school put all the resources into because they were like, "Oh, well, these five people might have an opportunity to do something. Let's just pour all the resource is into them" and everyone else was ignored. You know, everyone else was ignored, and that's what continues to happen across the board, even in health care. It's like, mmmm, I see them. And even when I worked in private practice like my O. B. is a black woman, and she had this thing about people with private insurance. That people who did not have private insurance, who had Medicaid, they were all seen in her Decatur office, and then everyone else was seen in her uppity Johns Creek office because those were the ones with private insurance and the ones in the Decatur office were the ones who were most vulnerable. Those were the ones who never got health care unless they got pregnant. Those were the ones who didn't have access to routine screening. Those other ones who, if they get sick now with COVID, they're gonna be left out, they're gonna be left out alone. They're gonna die alone because no one's gonna be able to be around them and no one's gonna be able to learn from it.
Pansay, Doula: 26:26
This is hard. It's just really hard.
Angela, CNM: 26:28
It is hard.
Pansay, Doula: 26:29
You know, what can we do? We were already fighting to protect these women, you know, to be respected in birth. You know getting more of them to educate themselves on their options and getting doulas. And now it's like we're pulling all of that, and all those resources where they can't even have that you know now. Where they will be there, you know, alone, and the prior issues still staying, you know? So, I don't know. It's just a very scary time. It's hard.
Angela, CNM: 27:04
It is. You certainly feel powerless. I will say it is like right now I am so, so grateful to be able to serve my country in the capacity that I am. I absolutely love being in the Air Force. I love being in the military. I love what we do. Man, I wish that I could do more. And when I say more, I mean like with the general population, because military represents about 1% of the population. And guess what? We all have access to good health care. Our people have the very best, you know, the vast majority of this country, don't. And those are the ones I would like to seeing us serving more, because those are the ones who are vulnerable and most at risk. And if women and babies are not protected, then the livelihood of our future means nothing. Like women and babies are the future. And unless people really wake up and pay attention to that, it doesn't matter if it is a white woman and a white baby, every woman, every woman, every woman and her baby is the future. And we need to respect that. And we need to protect it. You know, we have to protect it or we have nothing.
Pansay, Doula: 0:00
Yeah.
Maggie, RNC-OB: 28:37
Absolutely. I mean, it is, it's an issue. You know, we see that in our country, because of who founded our country and the way that power fell out from there, that people of color have a harder time in our country, a
Angela, CNM: 28:55
Oh, for sure.
Maggie, RNC-OB: 28:55
And that is an issue that everyone needs to take seriously. And I know there's been a lot of, even in just in the past couple years, you know, a lot more social justice is being talked about from different perspectives and people are realizing that race is not an issue that's in a box. It's not something that you get to, like, step into and out of. And it's something that I think, speaking as a white person, I can somewhat. I can choose to be involved in issues that impact that. But that's wrong, like, that's not okay that I get to choose whether I care about these disparities. And so I want to just kind of call out everyone on this issue
Angela, CNM: 29:41
Yes.
Maggie, RNC-OB: 29:41
And especially in a time where we're in a crisis and we know that all care is gonna be diminished a little bit because we're gonna have staff that are burnt out, and sick and we're not gonna have the same access and resources that we do any other time, that I just I want all of us, no matter what your ethnic and cultural background, no matter what the color of your skin is, to really be tuned into these inequalities that are present in our system already, to listen a little bit more closely to every person who's in front of you every time that you're giving care. And try to get past some of these biases we have that don't let us see everyone as our equal, that don't let us see everyone as our family member, that don't let us put our whole compassionate lens on people. And I'm calling myself out as much as anyone. Like we, you know, none of us are perfect. We all make mistakes. I am certain I have not provided the same degree of care to every single person who's ever been in my care.
Angela, CNM: 0:00
Oh, absolutely. I am guilty of that as well.
Maggie, RNC-OB: 30:42
And so I would just love for us to just all step into that a little bit more consciously, and especially for those of you who have means, those of us who have privilege, those of us who are able to, to just extend a little bit more grace and kindness and awareness to everyone else in our society who is going to suffer more from this, like there are some of us who will be more okay whenever COVID ends than others.
Angela, CNM: 31:14
Some of us that will not. And I think, Maggie, I love what you said about just being self aware. I think that as human beings, we know we're not perfect. You know, no one is perfect. And trying to do the right thing is a practiced behavior. You're gonna fail it some times, some moments, but I think the most important thing is just being aware of our own biases and of our own feelings and attitudes about things and working to change that behavior on on a regular basis so that it becomes habit, it becomes second nature. I like to pride myself on being super open minded and neutral on topics and being this all inclusive person. But sometimes I find myself, thank goodness, you know, I reflect a lot because of the school I went to. And I find myself caught up in these biases, and I really I'm like, "Angela. What are you thinking? Snap out of it right now. Snap out of it and approach this differently." And what I find is that I generally soften the mood or the conversation that I'm having with this person that I originally was feeling some way about, for whatever reason, usually feel pretty guilty that I had to train myself to do that to begin with, but also relieved that I'm able to recognize that in myself and change the course of the type of care that I give someone. I think we all need to practice doing that on a regular basis, because that is how we at least start to bridge the gap.
Pansay, Doula: 33:05
Constant self reflection.
Angela, CNM: 33:08
Self reflection. It's important, like I think we need to in general, just not be so quick to react. It tends to be so emotional as humans; we cannot read act all the time. There's usually time to reflect and think about our approach. We need to do that at this time with the health of our entire world in danger, you know, especially when it comes to women of all backgrounds. All race, ethnicity, socioeconomic status. Because we're all the same.
Pansay, Doula: 33:42
Yeah.
Angela, CNM: 33:44
This is a tough conversation.
Pansay, Doula: 33:47
Yeah, I was just wiping my nose with a sock, haha.
Angela, CNM: 33:52
[laughter] It's just, it's heavy.
Angela, CNM: 33:55
It's heavy; yeah, very much.
Maggie, RNC-OB: 33:56
It is heavy. I don't know that we've had, like, a light conversation yet, but this is definitely a particularly [sigh] heavy one.
Pansay, Doula: 34:07
For one, it's gonna be a long road. It's like it's no end in sight, right. You know, when you think about you know, what we're already dealing with, and how we're already trying to support and, you know, help the women. You know, our [maternal morbidity and mortality] numbers are climbing. Things have been getting worse. So, yes, we can think about how to better, you know, support. And how to better lend ourselves to them. But again, it's just so scary because the numbers are growing and it's just I don't know. Seems to be getting worse, yeah.
Angela, CNM: 34:40
Yeah.
Pansay, Doula: 34:41
I guess. You know, one month at a time, one woman at a time. You know, when they're in your presence, to be present? Yes, with them. And like you said, that self reflection awareness and, the other component to that is that we try better to tend to ourselves.
Angela, CNM: 34:59
Yeah.
Pansay, Doula: 35:01
Because how can we even assist them if we're steady dwindling and, you know, not flourishing? That's not good. And all of us will have some type of PTSD.
Angela, CNM: 35:15
Yes, PTSD, absolutely.
Pansay, Doula: 35:15
from this, you know, on top of what a lot of us already suffer from. You know, our women already have fears and concerns going into this. I can't wrap my mind around preparing to given birth and just not knowing if I'm coming out because I might...yeah [sigh].
Angela, CNM: 35:38
Yeah. There are places across the country, I'm in this OB COVID forum, a lot of us have just voiced our concerns about different practices across this country. Specifically, there's an OB who is sharing how in Florida right now they are just doing C-sections on any woman who test positive for COVID without even given her a trial of labor. And it is mind-boggling. And she was voicing her concerns about this. And she was just like, "I just don't know what to do in my particular practice in the setting where I'm seeing this." I'm like, let the midwife tell you that your governing organization says C sections only when medically indicated and COVID does not change that; it does not change that at all. There's no reason to now start increasing a woman's risk even more because there's a virus floating around. It seems outrageous to me, seems outrageous and I think, obviously, if a women comes in an acute respiratory distress that's totally different, totally different. But if she is stable, and she is able to get to complete. And even if she can't push effectively, guess what? There's these beautiful things called forceps that will help to save that Mama and her baby from a major abdominal surgery unless absolutely indicated, you know. I'm so grateful that I'm in the practice. I am because that is all of our OBs. They were like, "well, forceps are making a comeback. We all need to get trained up. We all need to do this because we need to decrease and continue to have an impact on morbidity as it relates to c-sections." Because COVID, this pandemic, it's not gonna last forever. But that woman's uterine scar and the potential risk for all her subsequent pregnancies will, They will, you know, you can have an accreta after one uterine surgery, you can die. Like I just, we can't do that to women just because we're afraid.
Pansay, Doula: 0:00
Right.
Maggie, RNC-OB: 37:53
I know. I do hope that as we keep going, as the dust is settling on the initial panic that we all felt, because this is something we haven't experienced in a very long time and certainly not on this level. That as, like you said, as everyone's getting their policies and procedures down, as we're getting, hopefully, more access to PPE so that people feel protected and safe caring for people, as all of these things were falling into place... that we will be able to take a collective deep breath...
Angela, CNM: 38:28
Yes.
Maggie, RNC-OB: 38:30
Kind of pause and re evaluate a little bit. I know you know, we've talked a lot about, you know, we just there's still so much that's unknown about COVID, because it's literally been a couple of months that it's been out. So people who know the most, only know a couple of months, and that's a really hard place to be. And that's not how we're just operating, you know, from medical point of view.
Angela, CNM: 38:48
Learning every day.
Maggie, RNC-OB: 38:49
Yeah, I'm hoping we'll be able to pause and stop some of those kind of knee jerk reactions that we all had because sure, you're just trying to kind of think, "Okay, what's the quickest thing I can do right now?" And so for some pregnancies, and I've heard the same thing in different OB forums; people are feeling like, you know, there's no need for "heroic SVDs" or that, you know, be quick to do epidurals so that there's lower risk of needing to intubate, under general and all of these things that people put in place. And I don't think those come from bad intentions.
Angela, CNM: 39:22
No.
Maggie, RNC-OB: 39:23
Of course. I think those people are looking at their frame of reference, a small portion that they're seeing that's something they can control. Honestly, I think it's a control thing. We're all trying to take control to minimize risks. But I'm hoping that as we're seeing this kind of play out and we're realizing that, like the kind of care that was being given to, you know, people over in China doesn't necessarily match up with what we need to do here. That those you know, the higher rates of cesarean that were happening over there are not linked to COVID itself persay.
Angela, CNM: 39:51
Yes.
Maggie, RNC-OB: 39:52
And as more of it comes out and everyone, our big kind of governing bodies ACOG, and ACM and all of these different groups that they're gonna take some time and pause and really look at what's happening and the care that we typically provide here. And, you know, how can we still mitigate risk as much as we want? Obviously, we want to make this as safe for everyone involved while still being conscious of the fact that this is not happening in like a bubble.
Pansay, Doula: 40:21
Right.
Maggie, RNC-OB: 40:21
This is gonna keep going on past then. And, you know, a lot of us have acknowledged that probably, for a number of reasons, because of decreased support, because of infection concerns, we probably we will see higher cesarean rates this year, probably in most places across the country. But we don't need to like accept that in a fatalistic way.
Angela, CNM: 40:43
As the norm too; yes.
Maggie, RNC-OB: 40:46
We can still work towards in all the ways that we can, in situation that do not need it, to, you know, to kind of work to still move to what we ultimately want to see in terms of our, you know, maternal morbidity and mortality rates and not having COVID just be the cherry on the top of this abysmal situation that's been brewing there.
Pansay, Doula: 41:09
Yeah.
Angela, CNM: 41:13
I agree.
Pansay, Doula: 41:13
My hope is, is through all of this that, with that major shift to home birth that it kind of opens more people. You know, that low risk moms can stay at home and let's leave the hospitals for what it's there for. Yeah, you know, since so many women who have shifted and you know, bringing hoping for marvelous outcomes that they look at those numbers and like, "Wow, how well it went, Yeah, a lot of them were late transfers and it went good" and kind of want us to stay there, you know? Yeah, stay with it. So that's that's my hope.
Maggie, RNC-OB: 41:55
Yeah, I definitely think this is highlighting for, you know, for low risk people because not everyone is a good candidate.
Angela, CNM: 42:01
They can stay out of the hospital.
Maggie, RNC-OB: 42:02
Of course, you know we recognize that and not everyone wants it, for any number of reasons. And that's also lovely. But there are significantly more people who are good candidates, if that's what they desire, for out of hospital birth. So how can we build up home birth practice? How could we have better again, like we've talked about over and over, better integration of care. Which means that we need licensure, for people across the board so that we can have open and honest care discussions. You know, how do we integrate that better?
Angela, CNM: 42:31
We need to be standardized.
Maggie, RNC-OB: 42:31
And how do we have more birth centers, more free-standing birth centers that, you know, kind of bridge the gap between home and hospital. And, you know, for some people, they feel more comfortable being in a different environment. Great, you know, so how can we kind of build on some of those things to again to turn all of this as like an eye opening moment about what can be done. That we can do all this great telehealth. So how can we use that to reach people who have a hard time getting regular access to an in person appointment? Great. Let's take advantage! Right, but do they have a phone? Do they have a way that we could do some of this? You know, like, how can we take some of these things that have been hard, find the silver linings, and use that to take kinda change the tide of maternity care. So I definitely hope the same.
Pansay, Doula: 43:16
Yes.
Angela, CNM: 43:17
I totally agree. I totally agree. One other thing I just wanted to kind of highlight on something Pansay mentioned is that you know, I am hoping that in the midst of this storm ,that we are able to change attitudes about out of hospital births, specifically homebirths. We have gotten to the point where we are accepting of birth center births, but somehow or another not necessarily home births. One of the issues I see in the middle of this COVID pandemic is that a lot of people are becoming desperate and are either choosing to have an unassisted home birth. Or they may be willing to just birth with anyone who may not necessarily even be a birth professional. And I think that we need to certainly be a voice to advocate for getting quality care no matter what the birth setting is, and also to let women know that in each setting, there are going to be safety nets and guidelines to ensure that your infection risks are decreased and your safety is the priority. There are birth options for every woman, whether she wants to have a hospital birth, a home birth or birth center birth. And I think that it's really important that we somehow as a birth community, get that out to women and possibly even just answer their questions and decrease their birth fears. You know, because many of them are afraid now to go into the hospital because of it. And I understand that, I mean, that's a really rational fear. But I certainly don't want women to put themselves at risk because despite that, some women are still not great candidates for out of hospital births, you know? And I am a huge advocate; I had a home birth with my fourth baby with a Certified Professional Midwife. I had two doulas and I had her birth assistants, and it was incredible, you know, and so I want people, I want women to know that they have options and they need to talk to their health care providers so that they don't make poor choices in the mist of this chaos because they're afraid.
Pansay, Doula: 0:00
Yeah.
Maggie, RNC-OB: 45:51
Yeah, absolutely. And I hope for people, you know, listening to us talk about all this that they are feeling empowered to have these conversations. Whether you know, you're birth consumer, you're a person who is pregnant listening and you feel like, "great. Let me actually talk to people about this." Let's not harbor that anxiety just inside of ourselves. And as birth prose that we keep cognizant of all of these different things that are going on and certainly protecting ourselves and being aware of that, but really continuing to just tune in to the people we're providing care for and what their concerns might be. And I also think, proactively having some of these conversations. I think that's appropriate to discuss that as a "hey, I know you're likely concerned about X,Y,&Z. Let's discuss it. Let's see, you know what makes sense for you." Instead of, you know, kind of shirking away or hoping it doesn't, you know, come up. I think all these conversations are best met just straight on and not, you know, not trying to beat around the bush and pretend that some of these issues aren't happening, because it doesn't make them go away. It just means we don't talk about it. It limits that ability we have to really connect.
Angela, CNM: 47:01
Always love talking to you ladies. It makes me happy.
Maggie, RNC-OB: 47:06
I always, even with heavy conversation like this, I always feel uplifted hearing from people who share the same desire to just make birth better and to continue working throughout absolutely incredible circumstances. I'm so grateful for both of you.
Pansay, Doula: 47:21
You know, the same, just listening to you both. And Angela, you the work; I commend you for the work and the service that you are giving.
Angela, CNM: 47:29
Same absolutely, same, Pansay. You have no idea. I am so grateful for all of the women I have encountered and met on this journey in this field where we service women and meeting all the incredible doulas across the way who have taught me so much about myself, and were a part of the reason why I even chose to become a birth worker and become a midwife. Just being able to appreciate every aspect of the care that we're able to offer women and understanding that it works best when we all work together. So I am eternally grateful for all you ladies in this circle.
Maggie, RNC-OB: 48:29
Absolutely; I love it. Well we will continue to do great things as we all band together. Thank you all! Talk soon.
Maggie, RNC-OB: 0:00
Thanks for tuning in! We love to talk birth, and we'd love to talk about it with you. Please join the conversation by finding us on Facebook, Instagram or Twitter, we're Your BIRTH Partners on all platforms. You can find more resources about the topics we discussed on our show notes blog: yourbirthpartners.org. We'll be sharing some organizations there that can benefit from your donations that particularly work to support birth for people of color. And we would like to hear your stories, what's going on in your community and how we as a broader birth community can help to sway how we provide care and make it better for everyone. Till next time!