Tiearra Sampson described the hospital birth of her son nearly five years ago as “the worst delivery ever.”
“They gave me morphine. The morphine didn’t work. They gave me an epidural. It didn’t work,” Sampson recalled. “I still felt pain. I was throwing up."
After 12 hours in labor, she ended up having an emergency cesarean section at the Hospital of the University of Pennsylvania (HUP).
Still, Sampson, who is expecting her second child this summer, said she’d rather have a home birth — though she is aware of the risks — than take the chance of exposing herself or her baby to coronavirus during a hospital delivery.
Sampson is one of a growing number of Philadelphia women who are seeking home births, even after a prior hospital delivery did not go smoothly. What’s more, they’ll have to pay roughly $5,500 for a midwife, who is highly trained but whose fee is not covered by insurance.
The difficult decisions are being fueled by a lack of answers, compounded by a pandemic-era disconnect. Pregnant women such as Sampson say that virtual prenatal appointments — conducted by video or phone — haven’t helped to calm their unease. Obstetricians can’t guarantee that laboring women won’t contract the virus at the hospital. And it’s too early to know how the new disease might affect pregnant women and their babies.
Obstetricians and pediatricians have cautioned against home birth, advising women, especially those late in their pregnancy or at higher risk for complications, to stick with their initial birth plan.
“Pregnant women need to know that hospitals continue to be a safe place for delivery. In fact, they’re still the safest place for delivery,” Sindhu Srinivas, a maternal-fetal medicine specialist and HUP’s director of obstetrical services, wrote in an Inquirer op-ed. “It would be much more dangerous for a patient that is not a suitable candidate for an out-of-hospital birth to proceed with that option if it is not appropriate.”
Yet expectant mothers are struggling to reconcile limits on prenatal appointments due to social distancing with assertions by doctors that hospitals are safe.
“It’s not like I get to teleport onto the labor and delivery floor when I go into labor,” said Port Richmond mother Careen Goebig, who is nine months pregnant with her second child.
‘It’s a mess’
Sampson, 29, said she hasn’t seen her obstetrician in person in more than a month. HUP staff canceled her previous two prenatal appointments. She said she’s had appointments by phone, but it’s not the same.
“We can talk about whatever, but it’s nothing like being there in person to check my blood pressure or to measure my baby,” Sampson said. “I’ll send an email to my doctor, and I’ll get an email back in two days, but a lot can happen in those 48 hours. It’s a mess."
Sampson said she recently had a consultation with a midwife whose relaxed demeanor and attentiveness quieted her fears. She’s certain that she wants to try for a natural birth at her West Philadelphia home, even if there’s a chance she’ll have to be rushed to the hospital for another C-section.
Sampson said she believes that the birth of her son in September 2015 at HUP ended in a C-section because the obstetrician did not give her body enough time to delivery vaginally. “Everything was forced. I wasn’t being heard,” she said.
At 28 weeks pregnant, Sampson, a social worker with the city Department of Human Services, and her longtime fiancé, who works in waste management, are scrambling to come up with money for a home birth. They have a little savings, but she’s worried they’ll need that “rainy day” money as ballast in the battered economy, she said.
“God forbid we shovel out the money for a home birth and something happens, and we don’t have the money we need to live,” Sampson said. “That stresses me out.”
She said she’s frustrated that her health insurance plan won’t cover the cost of a certified professional midwife, or CPM, because the state only licenses midwives who also are registered nurses.
“It’s like, why? Why jeopardize two human beings when you could do something about it," Sampson said of the virus risk. “We’re not considered in this at all.”
‘Holding my breath’
Hospital administrators say they’re taking precautions to protect laboring women and their newborns from exposure to coronavirus. For example, hospital staff are required to wear masks at all times and are screened for virus symptoms daily. The same goes for pregnant women and their partner or other support person.
Women who have tested positive for coronavirus give birth in isolated rooms, and labor and delivery staff don higher-grade personal protective equipment (PPE), such as N95 masks.
But Philadelphia-area hospitals do not yet have the capability to test every expectant mother and all staff for coronavirus to screen for asymptomatic cases. That may change as rapid, “point-of-care testing becomes more universally available," said Aasta Mehta, an obstetrician-gynecologist and women’s health policy advisor for the city Department of Public Health.
That said, Mehta, who practices at Penn, added, “Pregnant women who are afraid to deliver in a hospital should know that hospitals are taking really strict precautions to help prevent the spread of the virus from one person to another. ... There’s no guarantee, but there are a lot of precautions being taken.”
Goebig, now 38 weeks pregnant, had planned to give birth at Pennsylvania Hospital. Then she went to one of her final prenatal appointments on March 25. Her husband and son, almost 4, stayed in the car. She intentionally left her sweater and purse behind to avoid any contamination.
When she walked into the hospital lobby at Eighth and Spruce Streets, she was greeted by “a post-apocalyptic world." Staffers wearing masks and gloves took her temperature and asked whether she felt short of breath, a signature of coronavirus. She pointed to her bulging belly and joked about how, nowadays, she’s always huffing and puffing. Mostly to hide her fear. At the elevator doors, that fear shot up, she said.
“I’m like, ‘Oh, my God, how am I going to press the button?’" Goebig said. “I didn’t have a tissue or anything so pressing the button was like terrifying. I was holding my breath on the elevator because you never know who was in there before you.”
Things only got worse from there.
“I was scared to sit down,” said Goebig, 26.
She had an appointment with one of Penn’s certified nurse midwives and was surprised to be seen instead by a nurse practitioner, who explained that only one midwife was scheduled to work that day and she was busy. Goebig said she grew increasingly concerned that a hospital birth wasn’t going to work for her. She asked to talk to the midwife to get her opinion on a home birth.
“I expected her to kind of instill some fear in me, to say, ‘You should still be coming to the hospital,’” Goebig said. “Instead she took a seat and started naming some midwives she would recommend for home births.”
The American College of Obstetricians and Gynecologists (ACOG) has stressed that hospitals and accredited birth centers are the safest settings for birth. Although carefully planned home births result in fewer medical interventions, such as C-sections, ACOG cautions that home births are associated with more than twice the rates of deaths in infants and an increased risk of neonatal seizures or neurologic problems.
The birth of Goebig’s son at Penn in August 2016 was not ideal, with Pitocin to induce labor, an unwanted epidural and vacuum suction to get the baby out.
“Switching to a home birth — that’s scary. God forbid something goes wrong, and you are not in a hospital," she said. “Every single [decision] feels scary, and we just have to choose which one feels the least scary. … At least in my house, I know who cleaned it, and I know who was there before I gave birth."
Cost was another consideration. Goebig’s husband, a steam fitter, was recently laid off.
Home births generally cost $5,500, though some midwifes are offering discounts because of the pandemic. Health insurance plans, including Medicaid, will not cover a home birth in Pennsylvania if the provider is not a certified nurse-midwife, most of whom work in hospital settings. A Philadelphia-based midwife, Asasiya Muhammad of Inner Circle Midwifery, has started a petition urging state lawmakers to enact an emergency measure to extend health insurance coverage to certified professional midwifes. So far, Gov. Tom Wolf has only relaxed some requirements for nurse-midwives, such as making it easier to reactivate their medical licenses.
After agonizing deliberations, Goebig and her husband made a decision: They will have a home birth with a certified professional midwife (CPM) and pay out of pocket.
“We’re doing it,” Goebig said Monday night. “A relief.”
Only five CPMs, including the one Goebig selected, perform home births in Philadelphia; all carefully screen clients and don’t take on high-risk pregnancies, according to interviews with several midwives. Midwives said they approach birth as a natural process, giving a woman’s body time to push out a baby and avoid medical interventions, unless absolutely necessary.
“I’m sure it’s going to be extremely difficult, especially if it’s anything like the first time,” Goebig said, then paused.
“Not difficult. Challenging. I’m willing to ride through the pain that eventually will be over to make sure that I’m doing the safest thing for my baby. I’m not worried about myself at this point.”