Thread by @KimLundeen1

1/15

The #COVID19 pandemic has #pregnant women reconsidering their delivery plans.

Here's my first #medtwitter #tweetorial on birth options in the time of a pandemic.

(SPOILER ALERT: #homebirth is NOT a good idea in the US)

#COVIDClassroomUMN @umnmedschool #MedStudentTwitter

2/15

It’s scary to deliver at a hospital during #COVID19, for many reasons.

All hospitals are restricting visitors right now, but most in the Twin Cities, such as @MHealthFairview, allow laboring mothers to have one support person.

cbsnews.com/news/coronavir…

3/15

Another major fear moms have is being separated from their newborn.

Guidelines differ - the @AAP says to separate #COVID19 positive moms from their babies, the @WHO says not to separate them, and the @CDC says to use shared decision making.

thecut.com/2020/04/corona…

4/15

Of course, there is also the very real concern about moms and babies catching #COVID19 while at the hospital.

What have you heard?

Is the data we have so far for #COVID19 infection and mortality in pregnant women and babies:

5/15

Yep, so far there is little data but it appears that #pregnant women are NOT at increased risk of serious #COVID19 infection, and they may even be more likely to be asymptomatic than the general population.

Newborns have also fared quite well.

acog.org/clinical/clini…

6/15

Twin Cities hospitals (@MHealthFairview, @HennepinHC, @northmemorial, @AllinaHealth, @_HealthPartners) have many online resources for expectant families (see end of #tweetorial for links) & are taking extra precautions.

Some US hospitals test all women admitted for labor.

7/15

Some families still want to avoid the hospital at all costs.

Women have autonomy with this choice, but should know the risks involved with out-of-hospital births.

I’ll focus on #homebirth in this #tweetorial.

(Birth centers are also considered "out-of-hospital").

8/15

Who typically provides medical supervision of #homebirths?

9/15

Home births in the U.S. are typically attended by midwives.

Importantly, training among midwives in the U.S. varies considerably.

Women need to be sure to look for a certified and licensed midwife.

healthline.com/health/midwive…

10/15

In countries such as the Netherlands and U.K., #homebirth is just as safe as hospital birth.

This is due to better midwife education, licensing, hospital relationships, and integration of home birth as part of the culture.

smithsonianmag.com/smart-news/us-…

11/15

Unfortunately, in the U.S. #homebirth is just not a safe option.

@ACOG, the leading OB/GYN organization in the U.S., does NOT recommend #homebirth for ANYONE.

There is a well-published increased rate of DEATH for babies born at home. When emergencies happen, babies die.

12/15

The best data we have on #homebirth in the U.S. comes from Oregon, showing TWICE the rate of neonatal death for out-of-hospital births (importantly, this included birth centers).

Sadly, the death rate for babies born at home is likely MUCH HIGHER.

nejm.org/doi/full/10.10…

13/15

While those choosing #homebirth want to avoid other assumed dangers of hospitals - “unnecessary interventions” like c-sections - these are often LIFESAVING for mom and baby.

A good compromise is to give birth with a midwife at a hospital, so appropriate back-up is there.

14/15

It’s frustratingly hard to quantify the death rate of #COVID19 due to lack of widespread testing in the U.S.

That being said, women are much more likely to die, or to lose their babies, during childbirth at home than die from catching #COVID19 in a hospital.

15/15

As always, for any questions about your personal health or delivery plans, PLEASE contact your healthcare provider.

The entire medical community is committed to ensuring you and your baby are safe during the #COVID19 pandemic.

Here’s what Twin Cities hospitals are doing to protect moms and babies from #COVID19:

Allina:
themotherbabycenter.org/your-pregnancy…

HealthPartners:
healthpartners.com/coronavirus/

Hennepin Health:
hennepinhealthcare.org/specialty/wome…

MHealth:
mhealth.org/blog/2020/marc…

North Memorial:
northmemorial.com/covid-19/