Pregnancy, Home Birth, Postpartum & Newborn Care in the times of Coronavirus COVID-19 (*this article reflects a point of view in 3/20)

Coronavirus is present and spreading rapidly in Michigan. As of 3/20/20 there are at least 549 cases. There is a chance that pregnant mamas are more at risk of developing complications if the virus is contracted. There are 4 cases internationally of newborns contracting COVID-19 currently . There is also a tiny study reporting 9 babies born by cesarean in China testing negative for COVID-19. COVID-19 appears to not be present in amniotic fluid and breastmilk. Some information is conflicting.
This situation is new and there is a huge lack of evidence. I am trying my best to stay current with data and contact with colleagues that I associate with on a national/international level. What is known is that it is highly contagious and can live on surfaces for hours or days depending on the surface.
Symptoms of COVID-10 are:

• Cough
• Fever
• Shortness of breath
• Sore throat
• Body aches
• Runny nose

If you or anyone in your household has these symptoms, please advise your midwife.
There are drive up COVID-19 testing sites in Jackson and Ann Arbor. 
I apologize in advance for some of what I suggest or ask, as it may not be very midwife like.
Practice social distancing. Avoid groups of 10 or more.  Generally any person near you is a potential risk. Stay at home (its beneficial to go outside in your yard, for a nature walk or hike. Try to remain 6 feet away from others).  Social distancing means no play dates, less physical contact with others than who are in your household. Postpone or space out non essential visits including dental, chiropractic and hair appointments.  Avoid travel. 
Wash your hands often for at least 20 seconds with soap (foamy soap may be less effective). Wash your hands after touching any surface that may be contaminated, and before eating. Consider wearing gloves and/or face mask when going out of the home. Avoid sharing drinks and food with others. Avoid touching your face. Avoid handshakes, hugs & kisses.
Avoid touching high contact surfaces including doorknobs, handrails, faucet handles & light switches . Frequently wipe down surfaces including your phone, computer and/or tablet.  
Reduce shopping trips for food & essential items. Consider shopping for groceries and essentials online, grocery pick up, delivery or curbside.
Prepare by thinking ahead about things that you may need within the next 2 weeks-2 months. There is a shortage already of some items and shipping is delayed in general.
Eat as many nutritious, natural foods as possible including fruits and vegetables. Keep hydrated and be sure to have extra water on hand if you drink bottled water. Aim for ample sleep, at least 7 hours nightly.
Also these supplements & foods support a healthy immune system and are safe in pregnancy:
Vitamin D 4000 IU daily
Fish oil (discontinue at 37 weeks)
Vitamin C 1000-2000 mg daily 
Garlic (always a great immune booster)
Zinc 5-10mg daily
Additionally, there is some evidence that gargling for 15-30 seconds 2-3 times daily with salt water prevents respiratory illness.
These times can provoke anxiety. Try to incorporate self care and relaxation into your daily life. Some options are prayers, mediation (Expectful is a great pregnancy related app) , yoga, pilates, sun bathing (when we have sun here in Michigan), walking in nature. Magnesium and chamomile tea can help with stress, anxiety and sleep.
As your midwife, my family and I are practicing social distancing. The only time I am out is for essential midwifery clients or necessary shopping. 
I am sanitizing my equipment and surfaces with Sani-wipes before and after client contact.. I am checking my temperature before client contact and monitoring for symptoms of COVID-19.
Before midwifery visits, please don't have visitors at your house. Take your temperature and others in the home. If you or others in the home have traveled within the last 14 days or have any symptoms including a fever, runny nose, sore throat, shortness of breath, body aches or cough, please let your midwife know.
Midwifery care may look different and I may wear a maskl. For your birth, I suggest very limited people to be present. If you want others to be included in your birth, we can set up for FaceTime, Skype, or video. Any person present can pose a risk.
Home visits will be reduced or postponed.  I am available for texts, phone calls, FaceTime and emails. We can also meet on FaceTime and/or Skype for prenatal & postpartum visits. An option to maintain social distance is to have a virtual visit. You can check your blood pressure with a cuff and I can provide a fetoscope to listen to the baby’s heartbeat or you can use a doppler. For necessary in person visits, I will be spacing visits out, so that I can sanitize and clean everything between visits. 
I will be modifying my prenatal schedule based on WHO guidelines (additional visits can be added as needed) :

• Initial visit after 12 weeks
• Prenatal visits at weeks 20, 28, 34, 36, 38, 39, 40 & 41 weeks
• Postpartum visits will be performed in person at 24-48 hours, week 1 and will be mutually determined as needed as in person or virtual.

Prolonged contact is not recommended, therefore midwifery visits and time at labor and birth may be shortened.
In case of hospital transport, I will not be staying at the hospital to avoid exposure. I will be sure that you are taken care of, records are transferred and the situation is well articulated.
I will not have an assistant present at births, unless the benefit of having an additional person present outweighs the risk of exposure.
If I became sick or had known exposure, another midwife may attend your birth. 
Your midwife is trying to be mindful of what is needed for your prenatal and birth care, months ahead including  purchasing potentially necessary medications.
There may be more changes with this developing situation. I am trying to adapt the best practices to keep everyone healthy & safe. This document will evolve as there is so much uncertainty. 
All the while please know that I love and care about the health and well being of you, your baby and your family. This is temporary, but will last for an unknown period of time. Please stay healthy and reach out anytime. 


Love, 


Celeste