Home birth during COVID alert level 4

ALISHA CLAYTON  

Community LMC Midwife

Home birthing in a time of a world wide pandemic became more of an option for women across New Zealand in 2020. During COVID 19, alert level four, women in Counties Manukau DHB were restricted to one support person in a labouring room, and in alert level three, it was restricted to two support people. Although a necessary move to keep our team of five million from spreading the virus, it also produced several barriers for term women birthing in our facilities.

Maaori and Pacific families were most affected as they have huge cultural expectations within the birthing room that involve several family members being part of that experience, Whanaungatanga. Hua Ora promotes the spiritual and emotional well-being of both the wahine and her whanau and for Maaori women in particular this aspect of Turanga Kaupapa, was affected by the pandemic alert levels.

My experience within the home birthing practice, prior to the COVID19 pandemic, was limited to seconding my team on several occasions so I hadn’t yet provided care for a woman choosing to home birth. I had offered it in terms of being part of a home birthing midwifery team and the intention was always there but in my first two years of practice I was not actively discussing this as an option for woman. I felt I wasn’t yet ready to move purposely to that way of practice. However, had a woman suggested home birth as an option, either during the booking visit or throughout her pregnancy journey, I would have provided this for her and her whaanau.

Mia and James, whose names I have changed for confidentiality reasons, booked with me planning to birth at Pukekohe Birthing Unit. They were a young couple of Maori ethnicity experiencing their first pregnancy. We developed a wonderful partnership and the pregnancy remained normal. COVID alert level 4 hit New Zealand in March 2020 and her estimated date of birth was in April 2020. Mia and James attended an antenatal appointment and as they were over 36 weeks gestation this visit was face to face. It was here they first raised the matter of whether having a home birth was an option for them.

I was taken aback but embraced this decision. We began discussing home birthing in more depth and it became clear that should their options be between birthing in a facility with only her partner present and birthing at home with all her support system, they would culturally prefer and need that home birth space. Mia and James were very young; this was important for them to have this experience to maintain and acknowledge Mana. We arranged a home visit the following week to prepare the whaanau and space.

I remember talking with my team that same day, explaining Mia and James were wanting a home birth now due to COVID 19; my first home birth! I felt nervous but also excited and really keen to move through this journey with Mia and James. I was all ready. I had an untouched home birth kit in my car boot. The following week I took one of my back up midwives to her home and carried out a home visit at 37 weeks. It was here it all became so real for not only me but Mia, James and their whaanau.

James’ mother was very involved with the planning, providing everything they needed to source for the home birth. We as a team provided a birthing pool which was available for James to collect later that week.

I was very conscious of the remote rural location, as well as my own insecurities about my first home birth. I was worried about not having any phone signal if I needed it as well as the pure remoteness of having to get help if required. In reflection this is something everyone would have been aware of but this proved more concerning for me as a community LMC midwife in my third year of practice, supporting the first ever home birth under my care.

Mia went into labour at 38/40 weeks. Not entirely well prepared with only one home visit, I arrived to find Mia in strong labour and reassuringly with the space so very well set up. The whaanau did such a fantastic job with tarpaulin, towels, a wood fire burning and the birthing pool filling. Everyone was in the space providing Mia and James with such a great environment to be bringing their peepi into.

If they could be this ready then so could I! I was carrying in my un-touched home birth kit as my colleague also arrived. We had PPE gear, dispersed through Counties Manukau DHB, all ready to use during second stage.

Mia ended up having a lovely birth in the pool with James cradled in behind her, just as they had hoped for. They had trusted me to provide them with this safe birth at home and I had been able to support this choice made by Mia, James and their whaanau.

My colleague was fantastic support during my first home birth. The space was filled with love and joy for this wee baby and whaanau were in awe of this experience. Not only was this an incredible birthing experience but this wee girl we were expecting turned out to be a baby boy. The shock on our faces was captured by family taking photos.

It was important for Mia and James to have their whaanau involved and COVID 19 alert level 4 meant this was not possible in a Counties Manukau facility. In reflection, even though this home birth was sprung on me during a world wide pandemic, it was the best way for me to begin my home birthing journey as a community LMC midwife.

I will always remember this strange journey that COVID 19 provided us with and I am thankful for Mia and James who trusted me to provide this safe space for them. I have since been confident in actively offering this option for place of birth to women under my care and have had further home birthing experiences, with more planned for 2021.

Mia and James have since rebooked with me and are happily planning their second home birth. For Mia and her whaanau home birthing is now very much an option to be considered first because of the experience Mia has had. I am thankful that our profession can bring some joy in what was one of the hardest years we have ever had as a nation.  Alisha welcoming baby into the world.