More Sonoma County moms-to-be seek alternatives to hospital deliveries as coronavirus fight goes on

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Maggie Fleming was well into her third trimester and all set to deliver her second child in a hospital. She had given birth to her first, her daughter Vida, three years ago at Kaiser Permanente and had a great experience.

But about a month ago, Fleming, her husband, Damien McAmany, and their daughter all came down with a nasty respiratory illness. Although healthy, Fleming, 40 and pregnant, was among the high-risk group for the coronavirus. She was given a test, which came back negative.

But the process of falling ill, of being tested, of visiting the hospital as Kaiser’s staff upgraded safety protocols in the face of the pandemic, was stressful — not something Fleming needed in the final weeks of her pregnancy. So she began to reconsider her labor and delivery plan, seeking the counsel of friends who had delivered their babies at home as well as calling licensed midwives.

“I’m emotional, I’m hormonal, I’m crying and I’m by myself,” she said of one of her appointments when she was ill. She credited Kaiser with all the work it was doing to safeguard patients — “exactly what they are supposed to do.”

But “taking a coronavirus test — it was pretty scary to be in that space,” she said. “This is the last thing I want to be experiencing when I’m in labor,” she said.

Also on her mind? Sonoma County’s expected surge in coronavirus cases.

Fleming, who works in communications for Sonoma County government, had seen the data projecting a potential surge in of cases hitting local hospitals, which is now expected to peak at 1,500 local COVID-19 patients needing hospital care in late May or early June.

“We don’t want to be taking up a bed if they need the space to be used for someone who has a critical health issue,” she said. “We felt like it was the responsible thing to do. I know it’s not for everyone. But if it frees up the hospital staff to really care for those that might need it? That was a big piece of it too.”

Fleming chose a home birth attended by a tandem of midwives, and on Thursday morning, she delivered a healthy, 8-pound, 2-ounce baby boy.

The caregivers who specialize in such home- and clinic-based deliveries are facing a coronavirus-related surge in inquiries and bookings from women like Fleming, who are either nervous about laboring in a hospital setting where coronavirus and COVID-19 patients are being treated, or concerned that they may take resources — staff, beds, equipment — away from more urgent needs at the hospital.

The rush has strained midwives, who have seen their patient load spike amid the pandemic. That trend is especially strong in Sonoma County, where alternative delivery options were popular before the pandemic, with more than double the statewide rate of babies born outside the hospital, according to California public health records.

“At this point, we are turning people away, we are sending them to other practices,” said KathRyn Barry, a licensed midwife who works out of an office in Sebastopol.

The number one concern among those calling, Barry said, is that mother and baby will be separated after birth if either is infected with coronavirus. But Barry, while sensitive to concerns, said that fear cannot be the driving factor for those choosing to give birth outside of a hospital.

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“Choosing a home birth because you are terrified or hate the hospital doesn’t make you a good candidate,” she said.

But the calls keep coming from women seeking alternatives.

“Typically we do between 12-15 births a month and this month we have 24 families that are expecting their baby,” said Elizabeth Smith, owner and director of the Santa Rosa Birth Center.

“Daily, we are receiving anywhere from two to 10 phone calls looking for information.”

The Birth Center does not do home births. Instead, it brings women to its facility on Summerfield Road or provides midwives at either Santa Rosa Memorial or Sutter Santa Rosa Regional hospitals.

But the calls of late have almost exclusively focused on delivering outside of the hospital, Smith said.

“We see a need,” she said. “We feel like this is our contribution, moving healthy families outside of the hospital to free up resources.”

But Smith, as well, said out-of-hospital births are not a panacea and they are not for everyone.

“The sad reality is that no place is safe from COVID, so how can we sit with that unfortunate reality but also empower the patient to make sure they are making the absolutely best decision for them and their families?” she said.

While pregnant women are considered a high-risk population, the Centers for Disease Control reports that it is not known whether expectant moms are at a greater risk of contracting COVID-19 or of getting more seriously ill if they do become infected.

The CDC also has not determined if the health of the baby is put at risk during either pregnancy or delivery if the mother tests positive for COVID-19. The virus has not been found in amniotic fluid or breast milk.

And while hospitals are at the front lines of the fight against the pandemic, birth centers and licensed midwives performing home births have had to alter their protocols, too.

“We wear gloves and masks,” said Lisa Todd, a licensed midwife who works in the Sebastopol office with Barry. “It’s another layer of distance. For me it felt a little sad … There is a real intimacy in the work we do and it definitely puts up a little bit of a barrier.”

Per a recommendation from the California Association of Licensed Midwives, Todd and Barry are no longer utilizing birth tubs at home deliveries.

“The greater risk to us is when our gear gets wet,” Todd said.

There are other changes, too.

Some appointments that would have been handled in person are now via Zoom or other video-based programs — not ideal for a patient-caregiver connection.

But if those changes are deterring clients, local providers are not seeing it.

According to Smith, the Birth Center’s client load into the summer months has jumped 50%. Midwives at the Birth Center helped deliver three babies on Saturday alone.

One of those was Ember Dew.

Up until about three weeks ago, Ember’s parents, Heather Hanson and Bobby Dew, of Sebastopol, had planned for Hanson’s labor and delivery to be at Petaluma Valley Hospital.

But like Fleming, Hanson felt an increasing unease as the hospital ramped up screening and precautions related to COVID-19.

“Things are changing really quickly obviously with COVID,” Hanson said.

One of those changes, the prohibition of partners to attend appointments, helped spur a decision for Hanson.

“It was that appointment that he couldn’t go back with me that I realized that maybe I wanted to switch,” she said. “It was off my own intuition. I just didn’t want to be around that energy. I didn’t know how things would be in a few weeks. Things were so changing so quickly.”

Hanson chose the Birth Center, but she wasn’t an obvious match. She is 35 and had borderline high blood pressure during her pregnancy. She also came to the Birth Center past its typical deadline for accepting clients.

But Hanson said the birth of her son 15 years ago was done without pain medication and she had planned to go that route with her daughter. A practitioner and teacher of mind-body medicine, Hanson knew the ins and outs of natural childbirth.

A key concern? The cost.

“My initial misperception is that I would have to pay a lot of money. I am on Medi-Cal,” she said. “But they take insurance and they take Medi-Cal.”

Hanson went into labor at about 6 p.m. Friday. Ember was born at 5:55 a.m. Saturday.

“They had my birth plan memorized and followed it to a T,” she said.

Smith said it’s a sensitive conversation when a woman calls wanting a change. The Birth Center doesn’t automatically take clients, she said.

“I think asking people how they are feeling about things is a lot about what we do as midwives in general,” she said. “Instead of ‘How are you feeling?’ I’ll say ‘How are you doing? How are you doing with all this?’ ”

It’s a lot to deal with, she said.

“I try not to throw gasoline on the fire of fear,” she said. “We are in and out of the hospital. The hospital is a wonderful place for certain people. There is no shame in being in one place or another. The most important thing is that you feel empowered where you are. I happen to think that the hospitals where we are working are doing a fabulous job in keeping birthing families safe.”

“We certainly have zero judgment,” Smith said. “There is no gold star based on where you birth.”

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