Even in a pandemic, the natural cycles of life and death continue, and nobody knows this better now than the obstetricians and midwives working in New York City. Weddings can be postponed, birthday parties and Botox rescheduled. A baby’s arrival cannot.
City hospitals not only juggle thousands of coronavirus-positive patients every day, but also the often-unpredictable appearance of new life. Frightened by the situation in hospitals, and worried about potential COVID-19 exposure, mothers are increasingly turning to midwives, doulas, and at-home birth options. And city birth workers are overwhelmed by the sudden demand.
Meanwhile New York State already struggles with high maternal morbidity rates, as well as health disparities for women of color. (In New York City, black women are eight times as likely to die from childbirth complications than white women.) The pandemic’s stresses on the system present an added hurdle. So the state is scrambling to find a way to safely and adequately care for expectant mothers.
The proposed solution: additional birthing centers, set up around the city. On April 20, Gov. Andrew Cuomo launched what he called the COVID-19 Maternity Task Force, with his secretary, Melissa DeRosa, and numerous local health leaders. Their mission was to establish better, safer options for childbirth, and their solution is to establish what they are calling “birthing surge sites,” created by existing birthing hospitals and centers. On Wednesday evening, ten days after the task force was formed, the governor accepted the group’s six recommendations in full— including a recommendation calling for universal COVID-testing of pregnant people.
“The policies being advanced today will be implemented immediately to address the very valid fears and concerns that so many women are now facing, and to address issues that impact pregnancy and infants,” DeRosa stated in the press release. “I’m grateful to the task force for their quick work,” Cuomo added.
The hope is that new birthing centers—which traditionally help mothers deemed at “low-risk” of complications to give birth in a home-like setting, with the help of midwives—will ease the stress on hospitals and calm anxious mothers.
How quickly this can happen is unclear. One path to expedited creation of childbirth facilities lies in the task force’s recommendation for faster licensure of qualified health care facilities that are converted into “labor and delivery spaces.” Sascha James-Conterelli—president of the New York Association of Licensed Midwives and a member of the task force—said via email that she did not yet know how many birthing centers would be established, or how long it would take to establish them.
In the press release that announced the task force, DeRosa writes that “this pandemic strained our hospital system in a way no one could have ever imagined,” and that when it comes to births, “we can and should explore additional ways to make the experience less stressful.” After 16 medical professionals, midwives, and advocates convened on a call mid-week last week, the group passed its recommendations on to the governor.
James-Conterelli has served on multiple New York task forces including this one, and said that while the conference call was one of the shortest she remembers, progress was made in figuring out how to create new and re-designate existing areas as birthing centers both inside and outside of hospital settings. She also said that the task force is pushing for equity among New York State’s different communities. Indeed, one of the six task force recommendations called for community and community-based organization involvement in continuing maternal health studies and in education outreach efforts during the pandemic.
“We’re very concerned around creating or widening the gap between disparities we already have,” James-Conterelli said in an interview.
Earlier in the week, James-Conterelli explained that the task force planned to focus on assessing which areas around the state have the greatest need, and then analyzing existing birth options, staffing, equipment supply, and facilities across the state to reallocate resources and revamp existing structures. James-Conterelli also said in an email that the hope is that new birthing centers become permanent establishments or have “a shortened pathway” to permanency. Other hurdles also remain unsolved, however. “The bigger question is where will the funding come from to establish these birth centers,” she wrote.
Still, she said, the impact of the task force could be a positive for New York healthcare beyond the pandemic.
James-Conterelli said she hears anecdotally that under normal circumstances, home birth midwives receive around six calls per month. Now, during the pandemic, many are receiving around 100 calls every day, she said, from anxious parents hoping to give birth at home.
Back on March 28, Cuomo reassured women they would not be giving birth alone, despite earlier press reports suggesting at least two NYC hospitals planned to ban birth partners or support people from the birth, leaving the woman alone. Despite the governor’s reassurance, some hospitals have been accused of continuing to bar birth partners from postpartum recovery units. (A change.org petition, signed by more than 23,000 people, is protesting this policy.) The task force’s second recommendation will now allow support people to stay until the mother is discharged.
The nature of the virus, meanwhile, makes an already stressful experience even more difficult. At a time when women need to feel connection and support, they see only masks and restrictions. “I feel bad that I can’t emote using my facial expressions,” said Cynthia Lynch, a New York City midwife who wears PPE when guiding her patients through the pangs of childbirth. Only her eyes show beneath the mask and protective shield, she said. “It’s hard on everybody.”
The birthing centers will hopefully relieve some of this stress. Support people and spouses are allowed at the birth, and although midwives and other health workers wear PPE, many women say they find the experience at centers like this one less intimidating than hospitals.
Currently, there are only two birthing centers in New York City.
Of the 4 million births that occur in the U.S. each year, only .3 percent of births in the U.S. occur at home, while 98.8 percent occur in hospital labor and delivery units, the American Association of Home Birth reported in 2013. But in a 2017 report, the association recorded an 82 percent increase in the birth center industry since 2010.
In the city, the pandemic has resulted in massive requests for midwives and alternative birthing options. Exact numbers are not available for measuring this demand, but the state’s Office of Profession lists 1,234 total licensed midwives in New York State, and just 438 in the five counties that make up New York City.
At the Brooklyn Birthing Center, the oldest free-standing birthing center in the city, virtual informational meetings for prospective parents have gone from 10 to 20 families per week, to 50 to 100 people per week, according to Trinisha Williams, director of midwifery at the center. “We’ve had so many patients inquire about our services that we have not been able to necessarily meet the needs,” Williams said.
The Center has no waiting list so far, Williams said, and it is doing its best to take on what it can handle. It has plans to open a second Manhattan location on May 1st. In order to meet demand and build this new center, the Center is relying on loans and sponsorship from Every Mother Counts, a non-profit that seeks to improve pregnancy and birth outcomes, Williams said. The Center is in the process of hiring midwives to run the new outpost, she said, which will have five new birthing rooms.
According to James-Conterelli, New York has already jumped through the major legal hoops necessary to set up proper midwife-led birthing centers. The plan just needs implementation.
“That needs assessment was already done for birth centers and midwives and birthing options and doulas,” said James-Conterelli. “During COVID-19, all that did was bring it to life.”