There are still many things we don't know about the COVID-19 infection and its effects on pregnancy. As the pandemic continues to overwhelm hospitals across the country, there has been a massive surge in requests from alarmed pregnant women to switch from hospital birth to home birth or alternative birthing facilities on short notice. So, what safe birthing choices does a pregnant woman have?

As cases of coronavirus climb, so does the anxiety levels of pregnant women. Some of these women worry about the large volume of infected patients in the hospital that could put their newborn at risk of contracting the virus after birth. Additionally, as healthcare systems implement heightened safety precautions, many hospitals are restricting the number of visitors allowed - including spouses - during deliveries. These fears are causing some pregnant women to rethink their current birth plans and consider alternative delivery options.

Labor and Delivery Options

  • Hospital;
  • Hospital-based birth center
  • Freestanding birth center (accredited)
  • Homebirth (illegal in some states)

The American College of Obstetricians and Gynecologists (ACOG) continues to assert that the safest places to give birth are a hospital, hospital-based birth center, or accredited freestanding birth center. If an issue were to occur, a hospital setting can quickly provide you and your baby the highest level of care.

Changing Perspectives on Safe Birthing Options

With COVID-19 leading more women to consider giving birth at home, the American Academy of Pediatrics (AAP) has released new guidelines for planned home births.

The AAP recommends that women considering home births meet all of the following criteria:

  • Healthy, low-risk pregnancy
  • Have a pre-established network in case a hospital transfer need arises
  • Have certified personnel present who will attend the birth
  • Ensure the care of a home birth infant is equal to the care of an infant born in a hospital
  • Have two care providers present at delivery. One should be trained to perform full resuscitation of the infant according to the Neonatal Resuscitation Program.

This low-risk criteria also means the patient should have no pre-existing diseases, such as diabetes or hypertension. The patient should also only be carrying one fetus who is over 37 weeks gestation. 

Similarly, several state administrations are finding and implementing ways to quickly authorize accredited, freestanding birthing centers as alternatives to hospitals due to the overburdened hospital system.

RELATED: Neonatal Nurse Practitioner Programs

How is COVID-19 Impacting Pregnancy and Childbirth Policies?

Because COVID continues to linger and spread, federal and national entities are issuing policy changes and guidance to allow expanded services to be covered by insurance during this public health emergency.

The Association of State and Territorial Health Officials (ASTHO) reports that many states have already introduced bills to increase women's access to prenatal, delivery, and postpartum services. Additionally, these states are proposing and enacting legislation to address COVID-19 and the resulting healthcare decisions made during pregnancy, childbirth, and beyond.

Due to changing birthing trends and growing demand for home births, several states are considering standardizing midwifery and home birth practices. States such as North Carolina have proposed the "Access Midwives Act," which would help cover the shortage of maternity care providers, increase the flexibility of licensure requirements and scope of practice, and expand workforce capacity. 

For women at-risk for adverse birth outcomes, doula support provides a positive birth experience and reduces maternal morbidity. Flexible Medicaid reimbursement policies that make doula services affordable may lead to improved health outcomes. Some states are now pushing this legislation that provides reimbursement for doula care.

Additionally, a few states are stressing the importance of a patient's health and wellness in the postpartum period during COVID. The recent stay-at-home mandates and risk of isolation and loneliness may increase the incidence of postpartum depression. These state policies would provide urgently needed services for women at risk. 

Finally, new laws in some states are expanding the "family leave" act during epidemic-related emergencies and child care due to mandated school closures. This legislation would expand Medicaid to enhance access to healthcare, reduce maternal mortality rates, promote revenue and economic activity, save and create jobs, and protect the wellbeing of mothers and children in each state.

Looking forward, state and territorial health departments should act quickly and consider.

  • Increases in home births
  • The need to expand maternity care provider capacity
  • The impact on obstetric health care settings
  • Adverse outcomes for vulnerable populations

The COVID-19 pandemic is changing the way that pregnant women receive their services and care and will continue to expand their birthing options. Steps should be taken swiftly to improve access to alternative birthing options in the U.S. by mandating reimbursements in all states by Medicaid, commercial, and public payers. Additionally, state and federal legislators should increase the flexibility of licensure requirements and scope of practice for nurses and certified healthcare professionals, such as certified nurse midwives, beyond the COVID response. As our understanding of COVID-19's impact on maternal and child health evolves, our public health system and healthcare policy response should follow suit.


Janine Kelbach, RNC-OB
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