Before the COVID-19 shut down much of society, Austin Midwifery Services received one call a week from women inquiring about alternatives to giving birth at a hospital. These days owner Laurie Fremgen averages two queries a day, although at the start of the outbreak she was receiving 15 calls.
“It’s tapered off,” Fremgen told Lone Star Standard. “I was turning business away.”
National credentialed midwives are one segment of small businesses that have flourished during the coronavirus pandemic shutdown due not only to fear of exposure but also hospital restrictions.
“Women fear giving birth in the hospital where they may be exposed to COVID-19 and also because hospitals have instituted policies that limit support to one person,” Fremgen said in an interview. “Some women want their partners to attend as well as their doula but they have been eliminated as essential workers in almost every hospital I am aware of.”
A doula is a child birthing professional who supports and empowers expectant mothers during labor or women who have just given birth, according to the American Pregnancy Association.
The difference between a doula and a midwife is that the doula is present purely for emotional and physical support while a licensed midwife is an alternative medical provider and can be covered by some insurance carriers, such as Aetna, Cigna and United Healthcare, according to Alexandra Wyatt, founder of a birthing center in Lubbock, Texas, called Heritage Births LLC.
Some 80 percent of Wyatt's clients, who will drive from as far away as two hours for her services, opt for a birthing pool rather than a hospital bed and additional services such as placenta encapsulation.
“A doula does nothing medical,” said Wyatt, who has been licensed for seven years. “They are an extra set of hands to rub your back, give counter pressure or provide continuous support whereas a midwife does all that plus medical things like monitoring blood pressure and medication with physician support.”
Also causing pregnant women to seek midwives for care is the possibility that coronavirus-positive women will be separated from their newborns upon birth.
“The determination of whether or not to separate a mother with known or suspected COVID-19 and her infant should be made on a case-by-case basis using shared decision-making between the mother and the clinical team,” states the CDC website.
A recent JAMA Pediatrics study announced that three babies were found to have the coronavirus of 33 born to mothers who tested positive at Wuhan Children’s Hospital in China, according to Texas Monthly.
As of April 30, there were 27,054 reported coronavirus cases in Texas and 732 fatalities statewide, according to the Department of Health.
As a result of the pandemic, Fremgen has adjusted her protocols to include telehealth visits and the use of masks and gloves.
“I have shortened the time for each prenatal visit to 30 minutes,” she said. “I don’t have people waiting in the waiting room. They wait in their cars and they arrive alone. They used to come with their kids or partners.”
On April 2, Gov. Greg Abbott ordered all Texans to stay home to prevent coronavirus infections, according to the governor’s website.
Since then, he has eased restrictions, allowing all retail stores, restaurants, movie theaters, malls, museums and libraries to reopen with a 25 percent occupancy limit, according to media reports.
Despite the easing Wyatt continues to err on the side of caution.
“I am concerned with everything opening up so quickly that there may be a false sense of security,” she said. “We may get another COVID-19 surge in a few months or later this year. So, I am still taking the same safety precautions, including masks and gloves.”
At 35.8 mortalities per 100,000 live hospital births, the medical profession in Texas could take a lesson or two from Fremgen, Wyatt and other midwives across the state because the Lone Star State is worst in the developed world when it comes to deaths during pregnancy, including the U.S., according to media reports.
“There exists a racial component to birth mortality and when you add rural hospitals are shutting down, it's no surprise that women are highly underserved,” Fremgen said. “It’s the fault of the Texas Medical Association.”
Critics of the Texas Medical Association (TMA) complain that the behemoth organization supports scope-of-practice limitations for non-physician health professionals, such as midwives, chiropractors and massage therapists, as well as tort reform legislation, according to BallotPedia.
“Texas has always had good laws that support a woman’s right to giving birth at home but, at the same time, the TMA refuses to see midwives as professionals even though we have excellent training with good outcomes,” Fremgen said. "TMA is only out to protect the practice of medicine by physicians and the people who are employed by it. Even nurses have had to fight off the TMA. They are an extremely underhanded organization with a lot of money and influence."
Although there is no legislation currently pending that would prevent midwives from fully practicing their craft, Fremgen is always on the lookout as chair of the Texas Midwifery Board upon which she has served 13 years.
“I collaborate with our lobbyist and legislative chair, encouraging, supporting and, in some cases, working to get rid of legislation,” she said. “The TMA was trying to limit the scope of a few professions and we got pulled into it. They wanted to limit standing orders, which permit us to use medication in an emergency to keep women safe while enduring childbirth but Gov. Abbott vetoed it. He supports businesses.”
