Under normal circumstances, the prospect of giving birth can be a source of anxiety for any expectant mother. Add a global pandemic to the mix and the stress ramps up significantly. With fears about possible exposure to COVID-19 looming in the background, pregnant women around Minnesota are seeking ways to cope with this new anxiety, including limiting prenatal visits; selecting smaller hospitals, or signing up to deliver at independent, midwife-run birth centers.
At Health Foundations Birth Center and Women’s Health Clinic on Grand Avenue in St. Paul, business is booming, said founder and owner Amy Johnson-Grass. More expectant mothers than ever before are calling to see if they can ditch their plans for a hospital birth and welcome their baby to the world in the center’s quiet, converted bungalow.
COVID-19, Johnson-Grass said, “has really got pregnant women worried.” Starting the second week of March, when coronavirus became the only topic that anyone was talking about, she added, “we’ve seen a huge increase in calls and inquiries. It really was quite remarkable.”
While Health Foundations typically handles between 20 to 30 births per month at its St. Paul location (it also has two other locations, in Minneapolis and Hudson, Wisconsin), the center saw 40 births per month in February and March. And April has been running at the same pace, Johnson-Grass added.
“I thought by now we’d start seeing it slow down a bit, but it really hasn’t. I think women and families are scared and unsure of what the summer, fall, even into next winter has in store.”
Interest is so high that Health Foundations is now keeping a waiting list for the rest of April and May. To make room for even more births at the center, Johnson-Grass said, she and her staff have made some key adjustments.
“We’ve accommodated our space in a different way to meet the demand. Now, at any given time we can have four women laboring.”
Johnson-Grass chalks up the growing interest in her center to expectant parents’ fears that giving birth in a hospital setting could possibly put their — and their new baby’s — health at greater risk.
“Hospitals are where the sick people go,” she said. While she believes that women “absolutely can have safe births in the hospital,” she explains that the expectant mothers who are calling her are “worried about their increased chance of exposure to the virus and so they are seeking out alternatives to hospital births. We are a safe alternative and so many are turning to us.”
‘I felt safe’
But not every woman wants to — or even has the option to — give birth outside of a hospital.
In early April, Minneapolis resident Megan Rozowski gave birth to her second daughter, Roza, at Methodist Hospital in St. Louis Park. Roza’s birth was a planned C-section; Rozowski’s oldest daughter, 5-year-old Sarka, was born via emergency C-section, and Rozowski didn’t want to risk potentially life-threatening medical complications from attempting a vaginal delivery the second time around.
That decision meant that Rozowski had no choice but to give birth in a hospital.
Rozowski said that she tends to be concerned about her family’s health, so she’s been taking coronavirus seriously for months. “I started paying close attention in February, when the COVID stuff started happening,” she said. “In the beginning of March, I stopped going into the office and started working from home. I stopped eating out at the end of February. I asked my husband to do the same. And I pulled my older kid out of day care the second week of March.”
But Rozowski knew that even the most careful self-isolation strategies couldn’t completely protect her family from what she felt could be “the unknowns” of a hospital birth in the age of COVID-19.
“I was afraid of where the hospital would be by the time the baby was born,” she said. “We have a lot of family in New York, so I was anxiously fixated about how are things going to be here by the time this baby was born.”
Rozowski read about birth options but it was clear to her that even in this virus-obsessed age, a home birth or birth center birth would be much riskier for her than a hospital birth.
“The odds still seemed like a hospital birth was a much safer option for me,” she said.
As the date of Roza’s birth grew nearer, Rozowski said that she started to feel at peace with her decision. “Nothing can be 100 percent safe,” she said, “but this was as good as it can get. This was what we needed to do, and I was happy with that choice.”
In the end, the hospital experience almost felt anticlimactic. When Rozowski and her husband arrived at the Methodist’s Family Birth Center on the morning of their scheduled C-section, her fears subsided.
“Once I got to the hospital, it was much less stressful than I thought it was going to be,” she said. “The whole place was completely dead. There are no elective surgeries happening now. Nobody’s visiting. I put up a sign saying I wanted everyone who came into my room to wear a mask, and everybody did, even the people delivering the food.”
Rozowski said her first birth experience was “difficult and traumatizing,” so, even despite the anxious background hum of COVID-19, this second birth somehow felt much more peaceful.
“The whole time I was at the hospital, I felt safe,” she said. “It wasn’t scary. I didn’t need as much help from the nurses as I did last time. The breastfeeding went really well. We were fine in the room alone most of the time unless I needed meds. We were there for 48 hours, and then I was feeling fine, so we went home.”
Since Rozowski’s been home, her newly expanded family has been staying in quarantine. Since Roza is eating well and gaining weight on schedule, she made the decision to skip the traditional first in-person well-baby visit.
“I ordered a baby scale, had it sent here and we did a telemedicine visit instead,” she said. “The clinic pushed me to do an in-person visit, but nothing was off, so we did it that way.” She explained that she’ll continue that approach until Roza’s two-month visit, when she’ll get her first vaccines.
“That visit is important, and I wouldn’t miss it,” Rozowski said. “If this were my first kid, I’d probably take her in, but I know what I’m doing this time. If anything seems wrong before then, of course I’ll take her in, but right now this approach feels right to me.”
A different kind of surge
At Health Foundations, staff members are working hard to keep up with the growing number of women signing up for their services.
“At the moment, we are rivaling some of the local hospitals or midwife groups with the number of deliveries we are doing each month,” Johnson-Grass said. Births at the center are fully covered by all the major insurers and Medicaid, and she added, generally cost as much as 30 percent less than hospital births.
Johnson-Grass said the increased interest in the center is heartening, but with it comes new complications. Because birth centers are not categorized as hospitals, they are not considered as high priority for personal protective equipment like masks, face shields or gowns. This means that Johnson-Grass has had to work closely with suppliers to obtain equipment.
While local hospitals have begun to limit the number of people who can attend a birth, for now, Health Foundations still allows women to bring a professional doula along with a significant other.
Exceptions like these require a level of trust between clients, staff and contractors. Everyone who comes into the center has to have their temperature taken and pass a screening process.
Health Foundations families are also asked to self-quarantine. “We ask that after 35 weeks they don’t have contact with anyone else outside of their home,” Johnson-Grass said. “The pregnant women are really following that guidance because they want to go into labor and delivery and their postpartum period as healthy as possible.”
So far, they have not had any problems getting patients to comply with these requests. “The women in our practice are doing a fantastic job of not bringing COVID into the birth center,” Johnson-Grass said. “This is a different kind of approach. It’s a partnership.”
Sticking with the plan
New Richmond, Wisconsin, resident Hannah Gulich was due to give birth to her second son May 2. Earlier this spring, as COVID-19 cases began popping up in Minnesota, she and her physician hatched a plan to make sure that the birth would go just as she hoped it would.
“There were all these horror stories about not being able to have your significant other with you during the birth,” Gulich said. She felt distressed by the idea of laboring alone, without the support of her husband, Steve. She also didn’t like the idea of giving birth in a hospital full of COVID patients. “My doctor said, ‘We can see how it goes. If things get really bad here, we could always induce you a week or two early to beat the worst of it.’”
But then, Gulich said, things didn’t get as bad in Minnesota as she’d feared they would. While there are plenty of infected people in the state, there are also plenty of hospital beds, and, because of the state’s relatively flattened curve, plenty of medical personnel are still available to staff the maternity department.
“When news was first coming out,” Gulich said, “I was way more stressed about what was going to happen. I knew I had a month or two left before I was due. Now, as my due date is closer, it is not as bad here as people expected. I’m feeling way less stressed now than I did a month or two ago.”
It was a good thing that Gulich’s stress levels were down because her second son Cooper had his own plans. He came a week early, on the evening of April 23, giving Gulich no option to do anything other than follow her original plan for a hospital birth.
“It went really fast,” Gulich said. “We got there before 6 p.m. and he was born by 7:05.” Cooper weighed in at a healthy 7 lbs. 15 ounces.
Even at her most anxious moments, Gulich said that she and her husband never really considered having their baby anywhere other than in a hospital. “It was where we planned to have this baby,” she said. “We picked this approach for a reason.”
Her OB is based at Lakeview Hospital in Stillwater, where Gulich gave birth. She said that the hospital’s physical setup, with the OB department “really separate from the rest of the hospital,” calmed most of her fears. And even with that distancing, she and her doctor agreed to limit her in-person prenatal visits: “They’ve switched some appointments to over the phone or video. The few appointments I have gone in for I have been the only one there. I feel like that’s reassuring.”
Cooper’s birth differed from his brother’s in a few significant ways: Because of precautions about possible spread of the virus, laboring mothers were not allowed to walk the halls of the hospital. But with such a speedy delivery, that wasn’t much of an issue. “I didn’t really have time for that anyway,” Gulich said.
Another big difference is that the newly expanded Gulich family won’t be able to welcome visitors — for the time being, anyway. While Gulich said she’ll miss those early visits from grandparents, aunts and uncles, she’s also enjoying having some focused bonding time with her new baby.
“If you’d talked to me a month ago, I’m sure I would’ve sounded more stressed,” she said. But she’s settling into this new routine and discovering that she likes it.
“It’s going good,” she said. “It’s actually kind of nice. This time around I feel way more relaxed.
And I’m thinking it might be nice to be just the four of us for a while anyway.”