Changes to Birth Plans Due to COVID‐19: A Survey of Utah Midwives and Doulas

Abstract

Introduction This study seeks to understand the experiences of Utah midwives and doulas caring for patients during the recent coronavirus disease 2019 (COVID‐19) pandemic. Specifically, the goal of the study was to describe the perceived impact on the community birth system and explore differences in the access and use of personal protective equipment (PPE) between in‐ and out‐of‐hospital births. Methods This study used a cross‐sectional, descriptive study design. A 26‐item survey developed by the research team was sent via email to Utah birth workers, including nurse‐midwives, community midwives, and doulas. Quantitative data were collected during December 2020 and January 2021. Descriptive statistics were used in the analysis. Results Of the 409 birth workers who were sent a link to the survey, 120 (30%) responded: 38 (32%) CNMs, 30 (25%) direct‐entry or community midwives, and 52 (43%) doulas. The majority (79%) reported changes to clinical practice during the COVID‐19 pandemic. Community midwives (71%) who responded indicated practice volume increased. Survey participants reported an increased patient preference for home births (53%) and birth center births (43%). Among those with one or more patient transfers to the hospital, 61% experienced a change in the process. One participant reported that it took 43 minutes longer to transfer to the hospital. Community midwives and doulas reported poor access to a regular source of PPE. Discussion Survey participants reported changes to planned birth locations during the COVID‐19 pandemic. When necessary, transfers to hospitals were reported to be slower. Community midwives and doulas reported having insufficient access to PPE and reported limited knowledge about COVID‐19 testing resources and resources for educating patients on COVID‐19. This study adds an important perspective to the existing literature on COVID‐19 by indicating that policymakers should include community birth partners in community planning for natural disasters and future pandemics.

Experiences of Midwives Attending Home Births in Massachusetts During the COVID‐19 Pandemic

“…9 Our findings regarding negative experiences of home birth transfers during the COVID-19 pandemic concur with the findings of a qualitative study of 11 midwives in Washington State 16 and survey results that included 68 CNMs and CPMs based in hospital and community settings in Utah. 20 Both studies reported predominately negative experiences of transfer during the COVID-19 pandemic. However, respondents in our survey also reported positive transfer experiences during the pandemic.…”

“…One such quality improvement initiative based in Washington State called Smooth Transitions focuses on several key components to improve transfer experiences from community birth to hospital settings. 20 Such components include co-creation of transfer guidelines among community birth and hospital-based stakeholders, regular meetings to review transfers among all involved health care professionals, including emergency services personnel, and consistently evaluating the experiences of birthing people who are at the center of transfers in care. Instituting state-wide quality improvement processes like Smooth Transitions to evaluate transfers of care among different hospital and community birth settings may be considered to help ensure that every transfer of care occurs professionally, kindly, and respectfully among all stakeholders-care providers, emergency services personnel, and, most importantly, the transferring birthing family.…”

“…Massachusetts is one of the many states across the country that does not have CPMs represented in its perinatal quality collaborative. One such quality improvement initiative based in Washington State called Smooth Transitions focuses on several key components to improve transfer experiences from community birth to hospital settings 20 . Such components include co‐creation of transfer guidelines among community birth and hospital‐based stakeholders, regular meetings to review transfers among all involved health care professionals, including emergency services personnel, and consistently evaluating the experiences of birthing people who are at the center of transfers in care.…”