Amid the ongoing coronavirus pandemic, birth centers and midwife services in the Spring, Klein and Cy-Fair areas have seen an uptick in pregnant women interested in alternative birthing options.

Typically, low-risk expectant mothers who are interested in midwife services such as home births decide early on in their pregnancy which type of birthing option they would like to pursue, said Jaelin Stickels, a certified nurse midwife at Holistic Heritage Homebirth. However, as a reaction to newly implemented precautionary restrictions in hospital delivery rooms, some mothers are deciding to transfer out of traditional hospital deliveries much later in their pregnancies.

“Right now what's happening is people are getting to be [36-37] weeks [pregnant] and talk to their provider and their providers are telling them, ‘Hey, you can't have your spouse, you can't have your doula [in the delivery room].’ ... Now, they're scrambling, calling around, talking to different midwives about what options they have,” Stickels said. “We've had someone transfer [at] 38 weeks.”

However, safety measures vary by hospital. In addition to screening visitors and employees in designated entrances and restricting children under the age of 18 from entering facilities, CHI St. Luke’s Health hospital is allowing only one visitor in labor and delivery rooms, according to a statement.

Likewise, Chief Nursing Officer Sharon Ikeler said HCA Houston Healthcare Northwest is taking precautionary measures to ensure the safety of mothers, babies and their families by also allowing one designated visitor to be present for births. Additionally, the hospital is also canceling all parent education classes and tours until further notice and will instead be implementing virtual options.

“Every birth is unique and we will continue to ensure a safe environment for the most important moments in a mother’s life,” Ikeler said in a statement. “The Hospital’s Women’s Atrium allows for a separate entrance for laboring moms, providing safe access to the labor and delivery unit. At this time, visitors are restricted with the exception of one named visitor to support laboring mothers, provided they meet the hospital’s screening requirements.”

Midwives and birthing centers are also taking their own precautions in reaction to the coronavirus outbreak. At Cy-Fair Birth Center, owner and midwife Patricia Ghaly said she is spacing out clients’ appointments, taking extra care to wear masks and sanitize equipment, and implementing telehealth services for clients.

“We're not doing in-person visits every time, so we still have to maintain the same standard of care,” Ghaly said. “We want to make sure that everybody's healthy and prepared mentally and physically for their birth.”

For the birthing process, Ghaly said the center is also taking extra steps to screen anyone involved for coronavirus-related symptoms.

“During birth, we haven't necessarily limited the number of people that can come, but they’re screened,” Ghaly said. “If they haven't been with [mothers] in isolation, then they probably don't need to necessarily come to the birth, but if there's another health care professional or a doula or something like that [who] has been hired to attend their birth, then ... of course we're allowing those.”

However, challenges may also arise for expectant mothers wishing to utilize midwife services. According to Stickels, transferring later in the pregnancy can have an effect on the relationship between a midwife and client.

“Typically, we have nine months to create that bond and relationship with our clients and not only that, all the education that goes with it,” Stickels said. “So, we take nine months to give all that education and now, we're on the ball trying to give it in a couple of weeks versus nine months.”

Additionally, families who may be going through economic strain as a result of the pandemic may not be able to afford alternative birthing options, Ghaly said.

“The state still doesn't really recognize [all midwife services] to be able to take Medicaid ... so women who are financially at risk don't have access to the preferred care, but they never have, and it's just gotten worse,” Ghaly said. “People losing their jobs and things like that; it's made it harder for people to be able to access care. So we have seen, unfortunately, a larger uptick in women choosing to do ... births at home without any care provider because of their financial strain, a lot of times.”

Ghaly said there is concern in the birthing community that women who choose to give birth at home without the presence of a trained professional may not have had the proper amount of time to assess the risks involved.

“Some women who find themselves in a situation where they don't want to be in the hospital, due to everything going on, but they don't have the financial wherewithal to be able to access ... care are taking the chance of birthing on their own, without any support from anyone who is trained in complications or to notice anything early on,” Ghaly said.

Dr. Sherri Onyiego, medical director for Nutrition and Chronic Disease for Harris County Public Health, said both academic and private health care partners are taking action to reach out and ensure women continue to stay engaged with the health care system.

“There are some very targeted efforts on ensuring that those women will stay connected,” Onyiego said. “A number of our health care partners are doing things on a telehealth platform to be able to abide by the social distancing. ... But, I think one of the key messages is ... we certainly don't want [that population of pregnant women] to forego medical care. If anything, we want them to stay in touch with their medical provider, and certainly, if they have any questions or concerns, to reach out.”