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It's so great to be working with you.

-Shannon Mitchell, CPM, LM, CD

Check out these links

https://www.nutritiousmovement.com/moving-well-during-pregnancy/

www.SpinningBabies.com

COVID-19, Coronavirus disease, or SARS-CoV2 has affected us all this year.

Here's some way it impacts pregnancy, homebirth midwifery with Exhale Birth Services and below, how it may impact doula support in a hospital setting.

Ø Pregnancy

○ As a general recommendation, daily walks and Vitamin D are essential to staying healthy and preventing COVID-19, as well as hopefully avoiding a more severe infection. Vitamin D supplementation of 5-6000iu daily is recommended in the Pacific Northwest and testing is available to check your levels if you or the midwife are concerned.

○ Vitamin C helps to support your immune system. During pregnancy, extreme doses of Vitamin C aren't healthy so supplementing 2000mg a day is an upper limit.

§ Suggested foods: citrus, tomatoes, peppers, (and more!)

○ Zinc also helps support the immune system and recommended supplementation is 11mg daily.

§ Suggested foods: oysters, beef chuck roast, crab, baked beans

○ There is also some evidence that deficiencies in glutathione may result in more severe COVID-19 infections, so be sure to eat some of the following daily:

§ Suggested foods: avocado, asparagus, spinach (and more!)

○ It is vitally important to remember that the best way to get nutrients is food! If you are looking for more food options, please contact your midwife!

○ Pneumonia is a risk for mothers in pregnancy so avoiding exposure is important. Stay home or stay physically distant if possible. Encourage those coming to visit to isolate themselves for long enough to adequately assume neither of you is infectious.

Ø Home Birth Midwifery

○ Every midwife and homebirth practice has their own policies based on how they meet their clientele's needs. If you have any concerns, please bring them up with your midwife.

○ Telehealth appointments are available upon request of the midwife or the client.

○ Masks and gloves are available at every appointment, should you prefer to wear them and do not have one.

○ Midwife and birth assistants will wear a mask to enter to your home, wash their hands and may wear gloves during any hands-on procedures during appointments. Should you come to the office, the bathroom and any door handles or surfaces will be cleaned to help prevent transmission. Masks, hand sanitizer and soap will be available.

○ Six-foot physical spacing and outdoor appointments (except for physical exam) will be offered or accepted if space is provided.

○ Clear face shields will be provided for the midwife and the birth assistant during active labor.

○ An effort will be made to keep additional attendants to a minimum.

○ Clients are encouraged to have the support that they need, with an adequate safety discussion and steps to prevent transmission.

○ Any client suspecting exposure and/or symptoms may request an antibody test or text for active infection upon request. Ask your midwife.

○ At this time, every hospital has a distinct policy that may change rapidly based on their concerns, staff, and infection controls. As amidwife who may need to facilitate transfer, I try to keep up with the latest policies for the hospitals my clients may need to transfer to. This may result in some differences from normal care:

§ I may be unable to accompany a client transferring into the hospital.

§ I may be able to accompany a client transferring but not be allowed to stay, return if I leave, or attend the OR if a client is only allowed one support person.

§ All clients transferring for any reason will be asked to wear a mask, the hospital may require COVID testing and may require masking for both client and support person during labor or active labor or until testing is negative.

§ Some hospitals have a policy for separation of a newborn from a mother who tests positive. You DO NOT have to legally agree to this and can request isolation together WITH your baby. For more information, there is a sample refusal form on this page: https://evidencebasedbirth.com/covid19/

Ø Hospital Labor Doula

At this time, every hospital has a distinct policy that may change rapidly based on their concerns, staff, and infection controls. As a doula who provides care in a hospital, I try to keep up with the latest policies for the hospitals my clients attend. However, I cannot always know exactly what the policy is. I suggest you be in contact with both the hospital and your provider on a regular basis, perhaps asking at every appointment what the policy currently is.

○ If I am unable to accompany you, I can offer you support via videoconferencing/calls, either continuously or as needed. We can also have an intense "planning for support" meeting that helps your partner really get how to best support you during labor if I cannot attend.

○ I encourage you to discuss any special needs with providers. Clients planning VBAC, or who have a history of difficult labors may be forced to make the decision on picking the support provider they need the most. Addressing letters to staff, care providers and the hospital about how necessary additional support is for some births may be helpful. Your needs matter for a healthy birth.

○ Some hospitals have a policy for separation of a newborn from a mother who tests positive. You DO NOT have to legally agree to this and can request isolation together WITH your baby. For more information, there is a sample refusal form on this page: https://evidencebasedbirth.com/covid19/

○ The World Health Organization (WHO) does not recommend separation of mother and baby.

More Information:

Breastfeeding and Coronavirus: Dr. Jack Newman talks about breastfeeding and Coronavirus (Covid-19) https://www.youtube.com/watch?v=LZ12jYyJPtQ