"Covid is going to go away, hopefully one day, but people are still having babies."
Conversations with Central and Eastern Kentucky birth professionals about caring for pregnant people during the pandemic.
Late last week—as cases surged across the country—the Center for Disease Control and Prevention (finally, thankfully) issued the recommendation that all pregnant women get vaccinated against Covid-19.
“CDC encourages all pregnant people or people who are thinking about becoming pregnant and those breastfeeding to get vaccinated to protect themselves from Covid-19,” CDC Director Dr. Rochelle Walensky said in a statement. “The vaccines are safe and effective, and it has never been more urgent to increase vaccinations as we face the highly transmissible Delta variant and see severe outcomes from Covid-19 among unvaccinated pregnant people.”
This official guidance couldn’t come soon enough. 105,000 pregnant people in the United States have been infected with Covid-19, according to the CDC, with over 18,000 hospitalized. One-fourth of the pregnant women hospitalized have ended up in the ICU.
It’s also a much needed, and stark, about-face from earlier this year, when many pregnant and lactating people were being turned away from vaccination sites across the country. I investigated this issue for Romper back in February, and found a lot of fear and confusion among pregnant people due to the mixed messages they were hearing about whether or not to get the vaccine:
“Being turned away at vaccination sites can make pregnant patients feel like they've made the wrong decision,” says Dr. Sindhu K. Srinivas, M.D., director of obstetrical services at the Hospital of the University of Pennsylvania and a member of the Society for Maternal-Fetal Medicine Covid-19 task force. “[A pregnant person] who really toiled with this decision and decided that the vaccine is the right choice for them, who then has somebody question that decision and turn them away, makes it feel like, ‘Well, is this something harmful that I'm doing that I shouldn't be doing?’ which then perpetuates this continued issue of misinformation about the vaccine.”
As we stare down another fall and winter where traditional birth plans are being tossed out the window and masking during labor continues to be a best practice inside many hospitals, I spoke with four prenatal professionals working in Central and Eastern Kentucky about their experiences supporting pregnant people and new parents during the pandemic, what these lessons can tell us about gaps in care for maternal health, and shifting norms in the wake of Covid-19.
We also discussed the Kentucky Maternal and Infant Health Project, a collection of 21 bills introduced by the state House Democratic Women’s Caucus during the 2021 legislative session that offered many positive steps and solutions, but ultimately found no footing.
Here are their stories, in their own words.
(Meagan assisting a woman in labor, photo: Angelia Reed)
Meagan Thompson, Doula, About Birth, Georgetown
So far, I’ve attended 25 births during the pandemic: a handful of home births and the rest have been hospital births. I serve clients within about a 70-mile radius: I have clients as far east as Morehead and Campton, as well as down around Danville and Lancaster. All over the place.
Thankfully, I haven't had to do virtual support during labor. I did have one client who was planning a hospital birth, but then switched to a home birth because she, understandably, had quite a bit of anxiety about going to a hospital and possibly being exposed. Also, the restrictions that were in place at the time weren't ideal.
I think more people have learned about home birth because of the pandemic, and that a lot of people would be interested in it if it were more accessible in Kentucky. Right now, I think it's just one type of Medicaid that’s accepted by one midwife in Central Kentucky. So, most people are paying out-of-pocket for home births and that's not really accessible.
I also know that the Kentucky Birth Coalition is working on legislation to allow for the creation of birth centers. I honestly think the pandemic has showed that if we had that option available, it would make a lot of people feel more comfortable. Going to the hospital, especially in those early several months [of the pandemic], was really unnerving, and labor and anxiety don't work well together. Even in the best scenario, it was still traumatic for a lot of people to have to go into the hospital.
Overall, I feel like a big hurdle that we have to overcome with all of my clients is that there are a lot of traumatized people in birth work on all levels, from birthing people all the way up to obstetricians and midwives. I think addressing some of the trauma that exists in this line of work would be beneficial to everyone.
(Victoria Wilson in doula action, via Mother Well)
Victoria Wilson, Doula, Mother Well, Berea
I tell people I typically work with pregnant women from Lexington to London, but I've had women who live close to the Tennessee border, two-and-a-half hours away, drive up to the hospital [in Lexington]. Moms have literally driven two-plus hours to come get the care that they want to receive.
And that was kind of a benefit of COVID, in a way. It helped me be able to do more virtual visits and learn how to really connect with people on Zoom, so even though the first time I met these people in person was on their birthing day—when they were going to have their baby—it meant that we already felt connected. But just that dedication, especially right now, of, I'm going to drive, in labor, to the place I need to be, amazes me.
I think the pandemic forced parents to really think about what their birth experience was going to be like. For the first time ever, expecting parents were looking at this crazy new world and thinking: I have to have a baby. What's that going to be like? And I think there was a real hunger from families who wanted support—wanted help navigating the process—because they realized it was going to look very different than what they expected. In the home birth field, too, I think there was a huge increase in interest, for obvious reasons. All the home birth midwives I know have said, “For sure, I have never been this busy.”
But no matter where the babies were born, there has been an increase in people being intentional about what their birth will look like, and what they really need to get their baby here. More than ever before, I would say.
Janet Johnson, WIC Coordinator, Pikeville Health Department, Pikeville
This July makes 15 years that I’ve worked at the Pike County Health Department. I've been the Women, Infants and Children (WIC) Program Coordinator since 2016, but I've always worked in WIC. I'm the Regional Breastfeeding Promotion Coordinator for the WIC program, too, and I serve the whole Big Sandy region, which is the easternmost part of the state plus Lawrence County. I’ve also been an International Board Certified Lactation Consultant (IBCLC) since 2009.
When I first started working here in 2006, only 14.9 percent of infants on WIC in Pike County had ever been breastfed, and our clinic over at Belfry at one time had breastfeeding rates as low as 9 percent. But a few years ago, we actually got those rates up to about 40 percent of our WIC babies being breastfed. Now during the pandemic, we're back down to about 32 percent for the county. The pandemic has undone so much hard work.
We've got to do something for prenatal breastfeeding education. I don’t know what, but we have to do something. Usually through the WIC program, we're seeing these moms when they first sign up and then about every three months through their pregnancy, so usually twice before they deliver. That way, we're able to do some breastfeeding education in little, small doses during those visits, and then let them know what resources are available. They can put a face with the name, and we can say, "You can call me with any questions you have. You can email me. You can reach out to us."
But we've been doing WIC over the phone since March of last year, and it's just completely different over the phone. It's hard to have that personal kind of conversation, and let people know, “Yes, this is a local person who's here and willing to help you with this very personal thing—with birth and breastfeeding.” And so it's just so hard to even open up that conversation. People, when they get on the phone with you, they want off as soon as possible. So, you're just having to hurry to get through the WIC certification, and you don't really have a chance to do the education like what we had been able to do in clinic. It's so frustrating.
(Chante Perryman, via Baby Dreams)
Chanté Perryman, Doula, Baby Dreams Maternity Concierge, Lexington
For a while, no doulas were allowed in hospitals, and that was a shift for a lot of people. For me, it was no big deal switching to completely virtual: you just have to do all of the teaching and instructing beforehand. You have to show those dads, those partners—whoever the support person is—how to do [the supports] online before they even get to the hospital. So, when they call you and they're like, “Oh, she's having lots of back pressure,” you can just be like, “Okay, do those double hip squeezes or counter pressures.” And they automatically know how to do it without you trying to explain to them how to do it while they’re in the hospital.
So, for me, I’ve done more education. My clients were having more prenatal visits because I wanted them to know what's going to happen once they get to the hospital. I wanted them to understand it’s only going to be the two of you, and you might not have a nurse stay with you for a long time, so you're going to have to adapt. And especially for first-time families, it's just a whole new thing for them because they've never been in that situation.
I'm part of the Kentucky Birth Coalition, and we have constituents from all across the state meeting with legislators throughout the year. This year [when the Kentucky Maternal and Infant Health Project was introduced], it's really crazy because the legislators were all saying, “Oh, we have to make sure we get the budget passed! We have to make sure that COVID things are passing through!” And it's like, yes, that's important, but we still have families who are living their lives day-to-day. A lot of them are pregnant, and these maternal issues are super important. COVID is going to go away, hopefully one day, but people are still having babies.