Covid-19 is a brand-new disease with many unknowns. The Centers for Disease Control and Prevention cites a lack of data on special risks for pregnant women and infants, but with other viral respiratory infections, pregnant women have been more likely than others to suffer serious complications.
With care providers everywhere scrambling to keep up with continually changing guidelines and concerns about overburdened hospitals, Outer Cape families are learning about the limitations of home birth options and facing the challenges of keeping supportive loved ones at a distance.
Andrea Aldana of Eastham is expecting her first baby around July 21. She hopes to give birth at home rather than in a hospital — a choice more women are considering now than they have since the mid-20th century, when hospital birth became the norm throughout the U.S.
“I have gotten more calls in the past two weeks than I get in a whole year,” said Nicole Cisneros Pegher, a certified professional midwife who attended her first home birth in Truro in 2016, followed by a second in Provincetown two years ago. “This is really different. There are home-birth midwives who have come out of retirement to help,” she said.
As much as she would like to help all women now seeking her services, Pegher said, not everyone is a candidate for home birth.
Only women with low-risk pregnancies are eligible. Preparing for home birth means out-of-pocket expenses of $4,000 to $6,000, not covered by insurance in Massachusetts. Home-birth midwives provide prenatal care throughout pregnancy, monitoring clients carefully for risks like pre-eclampsia or gestational diabetes, conditions that necessitate a hospital delivery.
Pegher is receiving calls from women in late pregnancy who were planning a hospital delivery, but are now afraid of giving birth in facilities where Covid-19 patients are being treated.
“There is a lot of education that needs to happen if you get a call from a woman at 35 weeks,” she explained. “There is an additional risk to that.”
Aldana and her fiancé, Scott Sebastian, decided to hire Pegher before the extent of the Covid-19 crisis became apparent, because they were looking for a more personal and intimate birth experience. Now Aldana says she feels fortunate.
“I wouldn’t have been able to do that if I had waited another week,” she said, “because home-birth midwives are booking out so fast right now.”
Like hospitals and other care providers, Pegher has made adjustments, including conducting all non-milestone appointments via telephone to minimize possible exposure to the virus.
Meredith Goff, a certified nurse midwife, who on March 1 came out of retirement to offer services to patients at Outer Cape Health Services, said, “We are quite capable of giving safe care during this difficult time.” Like Pegher, Goff is carrying out most of her prenatal appointments via telephone.
“We want to keep pregnant women safe and, for the most part, if we can keep them out of the office,” Goff said, “then it’s safer for the patient.”
As a former home-birth midwife herself, Goff is aware of the draw of home birth at a time like this. “Women are understandably feeling reluctant to go into the hospital because of the possible risk of exposure to Covid-19,” she said. “I am very sympathetic.”
The Independent asked officials at Cape Cod Hospital to comment on the situation. Christina Peaslee, executive director of marketing communications and content strategy, declined.
But Goff encourages women to feel safe about giving birth at the hospital. “I am in touch with the hospitals,” she said. “I have not yet heard of any pregnant women who have tested positive, and a maternity unit is quite separate from other parts of the hospital.”
Families and their newborns face another set of challenges: being isolated just when they need support. Women attending prenatal appointments at hospitals are leaving their partners in the parking lot to minimize possible Covid-19 transmission. Chris Milewski, a Wellfleet fisherman, will not be able to join his wife for her milestone 14-week ultrasound at Beth Israel hospital in Plymouth.
“It’s a big appointment, so that’s hard,” Milewski said. “She really wanted me to be there for her, and to see the baby. She is pretty upset about it.”
Nora Corrigan, a current Fine Arts Work Center fellow in Provincetown, is due to give birth to her first baby on April 26 at Cape Cod Hospital. Her husband has not been allowed to attend recent appointments either.
“There is no one in the waiting room, no other mothers even, and all the staff wear masks,” Corrigan said.
She hopes that her husband will be able to attend the birth. That is their plan, but they know it could change. “We’re taking our cues from the midwives and doctors at the hospital,” she said, “and it seems like things on their end are changing every day in terms of best practice and what people understand about the virus and pregnancy and newborns.”
Alexandra Foley gave birth to her first child, a boy, at Cape Cod Hospital on March 15. She said that her husband was the only support person allowed to attend the birth, and he was told not to leave the maternity unit for the duration of their stay. Foley’s parents and in-laws were not permitted to visit their new grandson in the hospital, and more than two weeks later have still not yet met him in person.
Foley, her husband, and baby are now at home, but remain in isolation to protect the newborn from potential exposure to Covid-19.
“I’m sad that I can’t share our son with the people we love,” Foley said. “I can’t hug my mom or my mother-in-law, and I can’t get their support when my husband goes back to work. I’m going to have to figure it out solo, which is not what I thought it would be like.”
Goff is concerned about the vulnerability of new families during the postpartum period: “I think about women not having easy access to their families and the support that they need with a brand-new baby,” she said.
Liz Libby, a lactation consultant who works with women throughout the Lower Cape, agreed. She is offering assistance: a free virtual postpartum support group, as well as free online breastfeeding group meetings, through her website: risingtidewomen.com.
“Breastfeeding is the best immune protection for a baby,” Libby added. “When parents reach out to me, often what they need most is parameters on what is normal. Do I need to worry? A lot of that we absolutely can still do, virtually. We can provide emotional support and just say, yes, this is really hard and you’re doing a great job.”