Wisconsin Licensed Midwife, Stacy Vandenput, CPM, owner and founder of Green Bay’s Oak Grove Midwifery, LLC, is committed to preserving the unity of families during the Covid-19 crisis.
“I have spent the past two weeks studying and updating our protocols for safe home birth during pandemic and am ready to serve”.
The following protocols have been updated as crucial steps toward reducing exposure to Covid-19 for clients, newborns and midwives.
I. Reduction of traffic inside of the clinic and birthing suite
- All non-essential office visits will be rescheduled.
- Visits that are not crucial will be rescheduled to either telehealth appointment or phone call
- All on-site classes will be canceled until further notice. Video classes are in development.
- Clients will be instructed in self-monitoring and provided with equipment to do basic prenatal self-care which will be witnessed and interpreted by the midwife via telehealth.
- All clients who are at term (37-42 weeks gestation) are encouraged to have office visits provided that the client is well enough for visits.
- Office appointments should be brief, focused mainly on physical examination.
- Entry to the clinic is limited to the client only except in labor or when there is a complex antenatal condition to be managed.
- Lengthier discussions should be managed through phone calls and Zoom meetings; other support people are encouraged to participate fully in the virtual meetings to whatever degree the client is comfortable.
- The exam table has been moved into the kitchen and the door to the bedroom/birthing room is closed off to all prenatal traffic. Under no circumstances will clients be allowed to physically go in or look inside the bedroom/birthing room at prenatal appointments. We will provide a video tour of the bedroom/birthing room for those who are planning to birth at our facility.
- The office/birthing suite will be closed as much as possible to reduce the amount of traffic over the period of social distancing and shelter-in-place orders.
II. Admission to the clinic for office visits
- Before entry to the clinic/birthing suite for an office visit, a midwife or other staff person will screen each person (CLIENTS AND STAFF) for signs, symptoms and exposure to COVID-19, Coronavirus or SARS-COV-2.
- All persons will be required to wash hands with soap and water upon entry. (If the client is experiencing a complex antenatal circumstance, we will admit the client’s partner or support person if they pass the screening).
- If any person does not pass the screening the client will be asked if rescheduling is possible. If not, we will request that the client wear a mask and follow hand use hand-sanitizer before the visit.
III. Providing visits to clients who pass the screening
- Clients who pass the screening, will be seen in the regular office exam room.
- Clients should wash their hands thoroughly upon entry into the clinic.
- Midwife should wash hands prior to physical examination of the client.
- Client and midwife should sit across the room from each other for the duration of the appointment except for clinical assessments/exams.
- Physical assessment should be as brief as possible.
- Upon client departure, all equipment will be disinfected and replaced for the next client’s use.
IV. Providing clinical examinations to clients who fail the screening
- Clients who fail the screening and have need of an essential antenatal examination will be briefly seen in the hallway entry. Appointments will be very brief, limited to assessment of vitals, fetal heart rate, and general antenatal exam.
- Visits should take no more than 10 minutes and will be followed up with a virtual visit via phone or Zoom.
- Midwives conducting clinical assessment to clients who fail the screening should wear gloves during the exam and upon completion, disinfect the equipment used and any furnishings or fixtures that the client touched or sat on. Since there is no exam table in the hall entry way, we will attempt to hear fetal heart tones with a doppler while you are sitting or standing.
- Midwives and staff should not touch the client in any way except to provide the exam. There should be no hugging, handshaking, or other expressions of affection.
- Once completed, the midwife should wash hands and arms thoroughly for 20-30 seconds.
V. General hygiene of the clinic/birthing suite during period social distancing
- All rooms that are used for clinical visits or labor/birth should be cleaned with disinfectant between each client.
- Door handles should be disinfected each hour with a running log to verify.
- There will be no client access to the birth suite during period of social distancing and shelter-in-place orders unless in they are in labor.
- Regular cleaning of both the office and birthing suite will occur on schedule.
VI. Admission to the clinic/birthing suite in labor
- One visitor is allowed inside the clinic/birthing suite with the client. No children, no babysitters, no other friends will be allowed in the clinic/birthing suite during labor. A doula may be admitted if they pass screening.
- Weather permitting, it is acceptable for supportive friends and family members to congregate outside the building in the parking lot for prayer or distanced emotional support. They will not be allowed inside the building for use of bathroom or any other reason. We will set up a table and chairs near the parking area.
- Upon client’s arrival at the clinic/birthing suite for labor, client and visitor shall wash hands with soap and water.
- Please minimize the number of bags and other items that you bring from home. Leave bags and supplies in your vehicle and take out items at the time of need.
- Provide screening to each person who enters (client, visitor, primary midwife, assistant midwife)
- If the client is in labor and fails the screening, client must wear a mask for the course of delivery. Midwives must wear a mask and will glove in and glove out each time they enter the room and utilize hand sanitation upon entering and exiting the room that the client is in.
- If the client fails the screen, waterbirth is not an option due to transmission issues.
- After delivery, client and baby will be monitored as normal, and discharged with plan for follow up within 36 hours at the client’s home.
- If a person accompanying the client fails the screen, they may not come into the clinic/birthing suite for the birth, this includes the other parent. If the other parent fails the screen, and the client wishes to have an alternate support person with them, they may, if the alternate person passes the screening.
- Upon discharge room will be disinfected and cleaned as usual.
VII. Midwives’ attendance at home birth
- If the client has elected for a home birth, once the midwife arrives at the home, the same screenings must be provided for the client and all people in attendance at the birth.
- Guests at the home should be limited to the other parent/primary support person whenever possible. If there are extenuating circumstances that require additional guests, we will decide on a case by case basis about whether they can attend.
- Other children are not permitted to attend labor and birth to the extent that is possible. Please do everything in your power to secure off-site childcare because the risk of the midwives contracting the illness from an asymptomatic child is very high. If you have sick children at home, we will have to consider an alternate birthing site because children cannot be expected to follow prevention protocols with the degree of constraint needed.
- If the client fails the screening, they must wear a mask for the duration of the birth.
- Waterbirth may not be utilized for transmission concerns.
- The client should choose a room or rooms of the house that are designated birthing areas so the amount of traffic can be reduced in those areas.
- Midwives should glove in and out of the designated birthing area.
- If other friends or family members fail the screen, they should not be allowed in the home unless they live there.
- If the other parent does not pass the screening, they should limit their time in the birthing area as much as possible.
- If the client is giving birth at home and the other parent fails the screen, the other parent may be present for the birth with restrictions.
VIII. Midwife responsibility
- Midwives, assistants and support staff should inform the clinical director immediately if they suspect they have become sick.
- If the midwife suspects they have become sick, they should inform clients and arrange for appropriate back up plans for the client’s care.
- Oak Grove Midwifery, LLC has arranged with other local midwives to cover call if our midwives become sick or more than one client is in labor at the same time.