9 Changes to Make to Your Birth Plan During Covid-19
If you’re planning on an out-of-hospital birth at home or at a birth center, it’s likely that not much will need to change about your birth plans (though you can trust that your birth team is likely already preparing by making changes to their protocols,) however if you were planning for a hospital birth, it’s likely that your plans and dreams for your birth are feeling upended. New rules and protocols are being implemented every day as the disease progresses, so instead of relying on just waiting and seeing what you’ll be allowed to do, I find it’s better to plan for the unexpected, so you don’t feel blindsided by that if it ends up becoming rule.
Much of birth is already out of our control - that’s the beauty of it, that it asks us to surrender to it’s wild, all-encompassing enormity. But I understand that this particular kind of feeling “out of control” is not necessarily desirable or welcome. So it is my hope to help mitigate some anxiety over loss of control by providing some simple changes you can make to your birth plan, and requests you can make of your birth team, to help you feel like your plans are back in your hands.
I know there is an influx of birthing folks who were previously planning a hospital birth who are now choosing to explore home birth in an attempt to avoid the hospital all together. These suggestions were made with birthing folks in mind who either have no choice but to birth in a hospital, or who are otherwise not intending to alter their birth location.
If you are planning to birth for the first time, I know it can be difficult to determine how long laboring at home is “as long as possible,” and depending on your level of preparation to cope with your contractions, it might feel like you’re further along than you are. This is where it can be helpful to hire a virtual doula who is trained by sight and sound to guess where you’re at in your labor. Or you can call your midwife or OB and ask to speak with them - they should, by hearing how you speak through a contraction, be able to determine if it’s a good time for you to come in or not.
Getting caught up in how many minute apart your contractions are can be counterintuitive to the needs of a birthing person, who needs as much focus and lack of stimuli as possible. We certainly don’t need to be rattling off numbers and requiring conscious thinking of the birthing person. So if you are going to track contractions, have either your virtual doula, partner, or a virtually tuned-in friend track them for you. And remember - labor is not linear. How far apart your contractions are is a dance that could ebb and flow depending on any number of factors (for instance, it’s likely that they will slow down in space a part once you get in the car on the way to the hospital, but they might feel more uncomfortable or intense simply because you’re confined to your seat and can’t move with them.)
Establishing the breastfeeding relationship is always important, pandemic or not. The initiation of breastfeeding after birth sends a flood of oxytocin to the birth parent’s body which helps clamp down on the uterus and prevent hemorrhaging. But when you are trying to do everything within your power to bolster a fresh slate of an immune system, breastfeeding becomes even more vitally important. I have found that postpartum folks can overcome any number of breastfeeding adversities and obstacles when they are rooted firmly in the physiological function and nutritional knowledge of breastfeeding. It is when there is a gap in understanding what a normal breastfeeding relationship is, or a lack of understanding the physiology breastfeeding that new parents can easily become discouraged and feel like it’s just not working for them. But science is on your side here, even if a misguided healthcare provider is suggesting not to breastfeed or to limit/eliminate contact with your newborn, The World Health Organization (WHO) clarifies that.
So my suggestion is to learn normal:
learn the effects of epidurals, magnesium sulfate, and other drugs on the let down reflex and milk production
learn that breastfeeding babies don’t gain weight not he same curve as formula fed babies (so you don’t unnecessarily scare yourself thinking your baby isn’t gaining enough)
learn that it’s biologically normal for newborns and infants to want to “use you as a pacifier” between feedings
learn the normal window for milk to come in (sometimes it can be up to days, but this is okay because colostrum is so nutrient dense)
learn about colostrum, and the size of a newborn stomach per day after birth (hint: it’s much smaller than you think!)
learn about inflated newborn weight because of the use of IVs during labor (which will make it look like baby lost more weight than they really did after birth)
learn about what’s normal, expected pain (like the discomfort of the early days of learning breastfeeding) and what’s not normal pain (like the pain of mastitis)
learn about the role and function of breastfeeding when the breast/chestfeeding parent is sick themselves
learn about the medical racism and implicit bias that goes into deciding who does or doesn’t get the aid of a lactation consultant in hospitals, so you can know when to advocate for yourself and demand assistance
learn about the supply and demand chain that breastfeeding is and the effects of stress on the let down reflex, learn how even one bottle feeding (without still pumping to stimulate the let down reflex)
learn about “baby backwash” and how the saliva that passes through the parent’s skin is deciphered by the breast/chestfeeding parent’s body to create a perfectly tailored medicine if your baby is experiencing an illness
My suggestions for actual further reading and research beyond just my quick bullet points are:
Breastfeeding Made Simple and The Big Letdown by Kimberly Seals Allers to learn some of the social and systematic obstacles you might come up against in your breastfeeding relationship, and Your Baby’s Microbiome to learn more about the role breastfeeding plays in building your baby’s immune system. And ultimately, consult a lactation consultant or midwife when you come into troubles, as not all doctors are also well-versed in breastfeeding. And stay up to date on WHO’s latest recommendations on breastfeeding.
This is another one that stands on its own, pandemic or not, but it is now more vital for you to stay out of the hospital as long as possible, and interact with less professionals during your stay there. If you want to delve into the research, I suggest reading the evidence based information on inductions. But also read it with a grain of salt, recognizing that because not everyone has a standard 28 cycle, not everyone’s “due date” is absolutely accurate. Due dates an an estimate in the first place, so potentially harmful decisions based solely around an estimate should have the pros and cons heavily weighed.
Or you can choose to wear nothing at all, if you find yourself feeling the urge. This urge is a natural stage of labor commonly referred to as the “loss of modesty” phase, and it means you’re getting close to transition.
This is one I wouldn’t typically recommend outside of Covid-19, because the less technological input the birthing person it intaking, the better. But under these circumstances, if your support people are not going to be able to be present, it’s best to have them virtually available to you on a larger, fixed screen. Make sure to arrange these plans with your virtual doula, and discuss when they’ll be on call to virtual attend your birth.
Another one that should be standard, pandemic or not, but in a pandemic, and during a time when PPE and gloves are a limited resource, there’s all the more reason to reduce vaginal exams. There are other methods of determining where the birthing person it at during labor . Remember that vaginal exams are ALWAYS optional in the first place, and should be conducted with full, verbally expressed consent of the birthing person (and no, “I’m just going to check you real quick,” is not the equivalent of obtaining consent.)
A normal hospital birth with everyone going about their standards procedures and protocols would have you in contact with 20-30 people during your stay. There have already been two cases of pregnant people who were not symptomatic for Covid-19 before labor, testing positively after labor, and roughly 25 hospital staff members came into contact with them without wearing their own PPE. If you’ve ever been in a birthing space, you know there is a lot of close contact and heavy breathing happening with the birthing person, so as the birthing person, your use of PPE won’t just be to protect yourself, it will be to protect the hospital staff too. The majority of procedures conducted after birth can either be opted out of all together or postponed, if you want to reduce your baby’s contact with the myriad of hospital staff coming in and out to do their testing.
48 hours after birth is standard, but you can request a 24 hour discharge.
I hope you found this information helpful and reassuring. This new situation we’re all adapting to can be reclaimed as an opportunity for empowering yourself, and reclaiming individual choice in birth. If you find yourself falling into apathy about the state of things you’ll be birthing in, please do not hesitate to reach out for help, listening, and reassurance. YOU’VE GOT THIS.