Abstract
Birth-related decisions principally center on safety; giving birth during a pandemic brings safety challenges to a new level, especially when choosing the birth setting. Amid the COVID-19 crisis, the concurrent work furloughs, business failures, and mounting public and private debt have made prudent expenditures an inescapable second concern. This article examines the intersections of safety, economic efficiency, insurance, liability and birthing persons’ needs that have become critical as the pandemic has ravaged bodies and economies around the world. Those interests, and the challenges and solutions discussed in this article, remain important even in less troubled times. Our economic analysis suggests that having an additional 10% of deliveries take place in private homes or freestanding birth centers could save almost $11 billion per year in the United States without compromising safety.
Highlights
TRYING TO STAY AT HOME FOR EVERYTHING DURING COVID: WHY WOULD YOU RISK GOING ANYWHERE ELSE FOR CHILDBIRTH?Births at home or in a freestanding birth center were increasing in the US even before COVID-19, but since decisions around birth generally center on safety, giving birth during this pandemic has brought safety challenges to a new level
Before COVID-19, the Committee on Assessing Health Outcomes by Birth Settings of the National Academies of Sciences, Engineering, and Medicine (NASEM, 2020: vii) clearly stated, to anyone still unaware at the beginning of 2020: “The United States spends more on childbirth than any other country in the world, with worse outcomes than other highresource countries, and even worse outcomes for women of color.”
The current President of the Midwives Alliance of North America, Sarita Bennett, emphasizes that there is a balancing place in US society for those not ready to choose birth in their own home but do not want to go to a hospital, especially during the pandemic: While we can talk about legalizing Certified Professional Midwives (CPMs), unless we address changing birth center legislation that is restrictive rather than evidence-based, there will still be limited options, especially for those who might accept birth center birth but aren’t ready to make the leap to home birth
Summary
TRYING TO STAY AT HOME FOR EVERYTHING DURING COVID: WHY WOULD YOU RISK GOING ANYWHERE ELSE FOR CHILDBIRTH?. We examine the intersection of the safety and economic efficiency of birth in private homes and freestanding birth centers, which has become even more critical as the coronavirus ravages bodies and economies around the world We contend that those interests, and the solutions of increased legislation, liability insurance, and better integration for midwives working in those settings remain important even in less troubled times. In Canada, in the US states that have legislated and adopted insurance coverage for CPMs, and in other countries that have discovered or continued to recognize the importance of midwives who provide care in the community outside the hospital, a critical commonality has emerged Bringing these midwives out from underground economies to have them fully integrated into what the World Health Organizations calls “the Reproductive, Maternal, Newborn and Child Health (RMNCH) Continuum of Care8,” secures the creative strategies most adaptable and safest for families of that community, not just for pandemics but for normal times.
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