Birth Plans in a Pandemic: Preparing for Baby

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NASHVILLE, Tenn. (WKRN) – News 2 has teamed up with March of Dimes, Tennessee to release a special series, “It Starts With Mom.”

In addition to moderating each panel of experts, News 2’s Nikki Burdine discusses her experience with her own preemie daughter, who was born at 28 weeks in 2019.

The panels come during Prematurity Awareness Month and on the heels of Tennessee’s recently released report on preterm birth rates in the state. Tennessee received a “D” because too many babies are born too early for the 5th year in a row in our state. Last year, the state’s preterm birth rate was 11.2%.

The U.S. is the most dangerous developed nation in the world to give birth. Two babies die every hour and two women die from pregnancy complications each day. The COVID-19 pandemic is only amplifying these issues. 

Birth Plans in a Pandemic: Preparing for Baby – Panelists

  • Dr. Amber Price: Chief Operating Officer at Tristar Centennial Women’s and Children’s Hospital
  • Kristin Mejia-Greene: Founder of Homeland Heart Birth & Wellness Collective
  • D’Yuanna Allen-Robb: Director, Child & Adolescent Health at Metro Public Health Department
  • Tyresa Husbands: Vice President & Program Manager at Homeland Heart Birth & Wellness Collective

The pandemic’s effect on the birthing experience

The first topic looked at how the birthing experience has changed for families due to the pandemic. D’Yuanna Allen-Robb said planning is key. “Who do you want to have there to be with you? If you are giving birth at a hospital or plan to give birth at a hospital that’s put a protocol in place that’s limiting the number of people who can be there.”

From the hospital’s point of view, Dr. Amber Price talked about how hospitals and doctors are helping patients get ready. “It’s difficult for hospitals because we certainly understand and value support for our patients, it actually helps keep our patients safe, to have family members with them who can advocate for them as well. So, we welcome that, under every circumstance, but in a pandemic, we are also beholden to dictates that come out on a government level and through the CDC. So we’ve had to juggle that and make great decisions around that.”

Within Price’s healthcare system, they have not put restrictions in place for a partner or doula at a patient’s bedside. “And then one of the other big things that we had to decide early on when the CDC recommended separating moms and babies. How do you navigate that, and a lot of that just sits in making decisions early on of what you can and can’t compromise on,” said Dr. Price. “We decided very early on not to compromise on that, and not to separate moms and babies. But it’s been very difficult for hospitals and may not have that infrastructure and may not have the resources to do that, who want to advocate for their patients, but didn’t really have an option or resources to do that. We’ve struggled through that we’ve supported each other through that. I’m happy to say that, particularly in Tennessee, most hospitals did not restrict partners.”

Kristin Mejia-Greene works with moms on all aspects of childbirth. “The first thing I’m going to say is that I primarily work with black families. So, like 99.9% of the women that I work with, and the families that I work with are black, so not just of color, but they are specifically black families. With that being said, you have to understand that there’s already a heightened level of awareness when it comes to our health and our risk factors. With maternity care period, even outside of a pandemic, right. Outside of a pandemic, black women are in crisis. Now we add the pandemic and we are seeing again, how important it is to make sure that we have a plan. How important is it that we discuss this plan with care providers? What we are pushing for a lot these days really is communication between our client and the care provider. We are really trying to empower I mean, like normally as doulas and support people Our job is to empower moms to ask the questions that they need to ask or you know, really get comfortable with their kids. provider when it comes to their care, but now it’s more important than ever.”

The gap in health disparities

The pandemic has only increased the gap in health disparities, but it has always brought it to the forefront, meaning more people are finally aware that this gap exists. “We’re taking the time to really grab hold of those ears and say, Hey, listen up, if we’re going to start making shifts now, so now we’re seeing this big shift in telehealth, right? That’s amazing, as it relates to disparities, because now we’re addressing people who may not have transportation, we’re addressing people who, may not have childcare, they’re all these different facets of our lives that were happening before, that nobody really cared about,” said Mejia-Greene.

Tyresa Husbands recently gave birth in the middle of the pandemic and shared her experience. “My birthing experience was a little, it was a little bizarre, simply because, it wasn’t my ideal experience.”

Husbands relocated from New York to Nashville specifically to give birth here, because of the state of health care amid COVID-19 in New York at the time. “It’s like scarier up there. I knew for a fact if I gave birth up there, I would probably have to give birth with just hospital personnel, no personal visitors. That was something I was not open to. I came back down south and I looked at three different hospitals and settled on Nashville General, which gave me the more personal experience I was looking for whether it was prenatal care, down to my doctor explained to me exactly what to expect when I got to the hospital, because I explained to him, you know, I have anxieties about what to expect, and who could I bring with me, because of course, as a doula, you want to do it,” said Husbands.

Birth plans

While planning is always recommended, it’s also important to remember babies don’t always follow your plans.

“A birth plan can be as detailed as, ‘I want yellow socks when I’m pushing my baby out.’ The reason we encourage birth plans are for a couple of reasons. One, because as a mom, you want to have an idea of an order in which things may go or like what things are going to look like,” said Mejia-Greene. “I encouraged my moms so we, when I’m with my clients, I set a birth plan appointment so we do an in-home birth plan appointment before like their 34-35 week visit because what I want is for you to take your birth plan with you to your physician and say, hey, these are the things that I have planned out, do you? Can we go through this? And you let me know if any of these things are not feasible?”

Dr. Price said sometimes they call birth plans ‘birth wishes.’ “So for example, if you’re planning on having your baby in the birth center somewhere, some of the practices that are important to you may be completely standard and are not worth you spending a whole lot of time spelling out or writing out that you want those things. A great example in our own hospital, is that the baby goes directly on your chest, that’s already kind of hardwired in our culture. And I will tell you that the longer your birth plan is, the less likely people are to read every minute detail of that. So, my advice is to find out what the standard practice is, find out where you don’t have common ground, focus on that in your prenatal visits. You know, figure out where your voice is really heard, focus on the things you’re absolutely afraid of. And make sure that those are loud and clear in your birth plan, if you have a terrible fear of needles, or you’re terrified that someone’s going to separate your baby, particularly during COVID, that needs to come out on top in bold print, so that the staff that’s with you, particularly there’s not much time in the moment, knows where to focus and knows where those things so that you really need to talk about, if there’s something super unusual that you want for your birth, or something that’s really important to you that perhaps is a really important religious consideration,” said Dr. Price.

Husbands is the perfect example of having a plan, but not being able to stick to it due to circumstances outside of her control.

“My advice would always be to have alternatives. What would I like to happen if I can’t do that? Write it down, make sure people have copies, and give it to people, make sure everyone is aware of what you want. Because you won’t be your normal self,” said Husbands.

Allen-Robb said it’s always important to trust your gut. “I try to help women understand when it comes to our bodies, we are the most informed and we are we have the most internal knowledge and information about our bodies, there’s obviously tests and things that doctors in the medical community can do to help us further understand what that is. So having said that, it’s really pushing the message to women that they have the right and the responsibility to put a plan in place, where ever facility where you are, this is a relationship with that facility.”

And, if you aren’t happy with the plan or the care you are getting, you have the right to fire someone.

“If you’re not satisfied with the OB care that you are getting, if you don’t feel like your voice is being heard, you have the right to fire that person. If you were to hire a contractor to paint your house, and you don’t like the process that they’re using, or you tell them that you want your house to be powder blue, and they’re painting your house, Sky Blue, you wouldn’t pay that person, right? You wouldn’t keep that contractor. It’s the same thing. It’s the same thing in medicine that you have the right, there’s lots of physicians, you can choose to go somewhere else,” said Allen-Robb.

During the pandemic, are we still encouraging women to breastfeed, and what precautions are we supposed to take?

Mejia-Greene said absolutely. “We know breast milk is the most is the optimal source of nutrition for babies. And so, we do want to be able to continue to encourage moms to give their babies the best start that we can. We also know that breastfeeding is going to be great for mom,” she said.

If you think you may be COVID positive or have symptoms, Mejia-Greene offers this advice: “Wear a mask when you’re within six feet of baby, which is obviously going to be that breastfeeding time, making sure that you’re washing your hands very thoroughly.”

Use your voice

For moms to be, Dr. Price has some encouragement, make sure you have a voice in your care. “Ask questions of your care providers throughout pregnancy, it is okay to slow down. It is okay to ask some personal questions. Sometimes, you know, if this were you, what would you do? Do you have children of your own? It’s okay to break down some of those boundaries and barriers with the healthcare system so that you build a relationship.” Dr. Price also echoed the sentiment that if you’re just not happy with the care you’re getting it’s perfectly acceptable to find another provider or ask for someone to advocate on your behalf if you’re not comfortable. “It is okay for doulas to be advocates. It’s okay for a doula to be in the room and say, you know, I love the example of you get in there and you can advocate for yourself anymore because your labor is going quick or you’re afraid or whatever that is. It’s okay to say hey, these things really important to her.”

Mejia-Greene wants to encourage moms to ask for help if they need it. “If a doula is something that you’re interested in, look into it. If you think it may be outside of your financial reach, ask I’m a big fan of…the worst somebody can say is no. And so please ask, do you have a sliding scale for us at ‘Homeland Heart’, we support the Nashville Strong Babies team. We support the zip codes in the Nashville Strong Babies area for free, and every zip code. Outside of that we work on a sliding scale for our moms, we also don’t refuse service to anyone for the inability to pay, what we’re concerned about is safety. We want to make sure that even in the midst of a global pandemic, we’re not going to be seeing a continued increase in the disparities in the rise in black maternal mortality, and black infant mortality,” said Mejia-Greene.

Husbands reiterates the importance of flexibility. “Be aware of your hospital policies and what your OB is telling you as policy, there’s, there’s often a difference between you know, what they’re willing to do and what the hospital is saying you can do.”

Finally, Allen-Robb said there are some things to remember after your birth experience, it’s important to give feedback. “There’s this idea of collecting patient-reported experiences so that we can measure, quality of people’s experiences. That feedback loop is also really, really important. I think it’s how hospitals figure out tweaks and policies at times if they’re getting this feedback from their customers from their patients about what opportunities there are. And word of mouth is also really important. If I’ve had a great experience at an HCA facility and not a great experience at another facility. Guess what I’m going to tell other women who are coming to me about where I delivered my baby, I’m going to tell them to go to the place where you’ve had a great experience.”

You can learn more from March of Dimes on their Facebook page.

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