Home vs. Hospital: Where to Give Birth When Trying to Survive a Pandemic

Home vs. Hospital: Where to Give Birth When Trying to Survive a Pandemic

Patiense Mckenzie

This article is part of the Winter 2020 Magazine Issue series. To read the full Winter issue click: here.

“I can do it myself; hospitals were never necessary in the history of childbirth. My life would be at risk either way.” -My sister, Shaney Lawson, talking about her second at home childbirth experience

The realities of a visit to the doctor or the hospital are not what they were prior to the coronavirus pandemic. Once routine visits are now high-stakes operations. With all the focus on COVID-19, expectant mothers are left to worry if they will get proper treatment. Pregnant women are worrying if they are putting themselves at risk by giving birth at a hospital, and pregnant Black women have to live with the worry of surviving in the hospital at all. According to The Journal of Perinatal Education, “In the United States, Black women are 2 to 6 times more likely to die from complications of pregnancy than white women.”  Increasingly, home birth seems to these women like a safer alternative, especially during a global pandemic. As home births become more commonplace, there is potential for the practice’s normalcy to extend beyond the coronavirus, something that might benefit Black women, in particular.

COVID-19 has made mothers scared of the consequences of giving birth in a hospital. According to Dr. Michael Nimaroff, an obstetrician-gynecologist and senior vice president at Northwell Health, “Some hospitals have been so overwhelmed that gynecologists and obstetricians have been diverted to treat coronavirus patients.” Not receiving medical attention right away could lead to complications during a woman’s pregnancy or birth, and birthing a child at home could relieve someone of the stress of having to give birth in the midst of a pandemic.

Many pregnant women are worried about testing positive for the coronavirus after giving birth in the hospital. Hospitals could potentially put families, midwives and doulas, who are employed to provide guidance and support to a pregnant woman during labor but who typically do not have formal obstetric training, at risk if they want to be a part of their loved one’s childbirth experience. COVID-19 has become a major concern. If the mother shows any symptoms of the coronavirus, her baby must be isolated from her, which could potentially damage the mother’s bond with her child. Skin to skin contact is necessary to a baby’s development. According to Breastmilkcounts.com, “This contact relieves the child’s stress, stabilizes the baby’s temperature, breathing rate, heart rate, and blood sugar [and] releases a hormone that lowers mom’s stress and promotes healing.” Giving birth at a hospital could be a safer option for many, but it also poses the risk of potentially getting the disease and losing the opportunity to create an immediate bond between mother and child.

Many people, including Dr. Nimaroff, argue that a hospital “is still a safe space to have a baby.” The “immediate care” of medical professionals and the provided equipment also makes it a more comfortable option for many.  In some cases, people need to go to the hospital anyway when giving birth. Any birth brings the potential for complications, and for those who chose to do it at home, distance from  emergency care could be detrimental to the health of mother and baby alike. There are no guarantees that a home birth is safer in terms of the pandemic. Midwives who perform home births do not necessarily get tested for COVID-19 or require that their patients do so. Home birth can also lead to many complications. Home births can lead to “free birthing” or giving birth without the assistance of a skilled birth attendant, like a midwife or a physician. This practice is not recommended by medical professionals and is something that pregnant women should keep in mind when considering home birth, as things do not always go according to plan.

There are many factors that should dissuade women from considering home birth, including if the pregnancy is deemed high-risk, if the mother has previously had a C-section, or if it’s a multiple pregnancy. A New York OB/GYN, Dr. Sarp Aksel, told “Good Morning America” last year, “I don’t think there’s any such thing as a low-risk pregnancy, because any pregnancy can turn into a high-risk pregnancy in a matter of minutes.” Studies show that home birth increases the chances of a stillbirth. According to Dr. Askel, “If problems happen, a hospital setting can give you and your baby the best care in a hurry. And studies have shown that babies born at home are more than twice as likely to die around the time of birth than those born in hospitals.” Pregnant women should keep this in mind when trying to decide what birthing option is best for them.

However, the risks associated with pregnancy and birth are not one-size-fits-all. Many Black women worry about unanticipated complications but may think they have a greater chance of surviving at home than at a hospital. Black women are three times more likely to die in childbirth in the United States than white women, even with hospital care, including women like Sha-Asia Washington, who “Good Morning America” describes as dying in late September during an emergency C-section at NYC Health + Hospitals/Woodhull, a city-run hospital in Brooklyn, New York. Sha-Asia’s family believes that her death could have been prevented, and the hospital recognizes the disportionate deaths of Black women during their pregnancies and deliveries.

Shaney Lawson, 33 has two kids, and neither were born in a hospital. In her explanation of why she feels safer giving birth at home, she said that while she is fearful of COVID, her main concern has to do with the color of her skin. “As a Black woman, I cannot trust hospitals. I don’t want to have a C-section, and I don’t want a doctor trying to convince me the safest way to have a child is to cut me open. I want to have it naturally. I like that I didn’t have to drive. I had all my food, clothes and diapers here.”

All of this reveals one of the real issues of the medical system: Black women are undervalued. White women are often considered and carefully examined. Black women have been historically dismissed at the hands of medical professionals, because they have always been seen as strong enough to manage their own suffering. Many Black women simply do not feel safe giving birth in hospitals; they regard hospitals as doing to Black women what police do to Black men. Of course, for high-risk pregnancies, there is little choice but to go to a hospital.

“The dirty little secret is that these people are dying in our hospitals, which should be our safest places,” said Dr. Monica McLemore, a University of California, San Francisco researcher looking at the intersection of maternity care and race. However, safer options are also limited to Black women. For example, a Black woman looking for the comfort of a Black midwife or doula to deliver her baby has few options from which to choose, as, according to Pew Charitable Trusts, midwives across the country say they are stretched to accommodate additional deliveries because of the pandemic while taking precautions to protect themselves and their clients. 

According to the U.S. Center for Disease Control and Prevention, these issues could be improved “if hospitals and healthcare systems implement standardized protocols in quality improvement initiatives, especially among facilities that serve disproportionately affected communities and identify and address implicit bias in healthcare that would likely improve patient-provider interactions, health communication, and health outcomes.”

Black women are regularly dismissed by the same people who are attempting to heal them. They are seen as stronger than the average human by white society, but this is medically incorrect. According to the National Center for Health Statistics and the U.S. Department of Health and Human Services, Black women are more likely to have pre-existing conditions, such as hypertension, diabetes and asthma, illnesses that increase the risk of death from the coronavirus and may go undiagnosed prior to pregnancy. Black immune systems are not as strong as white professionals would like them to think. This misconception is what leads to the preventable death of Black women during pregnancy.

Where to give birth is a difficult and deeply personal decision and is only complicated by factors of race and COVID-19. The choice is for each individual to make, hopefully with a great deal of research under their belt.

Patiense Mckenzie is a senior studying English with a focus in creative writing and a minor in Spanish. Her passion is creative writing and poetry. Her career goal is to publish a book one day and to create a space for Detroit-local creatives to get paid for their art.