*Originally posted 3/13/20, most recently updated 11/19/20.*

There is no doubt that coronavirus/COVID-19 has been on your mind. Our clients’ health and safety is always at the top of our priorities. Keeping our team and our community healthy is also vitally important.

We take our commitment to our clients very seriously. We have been continuingly reevaluating how we can keep our clients the safest and healthiest, which also means keeping us healthy so that we can, in turn, help keep our clients healthy.

It goes without saying, this is a complicated situation, without clear answers. Things continue to change quickly, and we will continue to evolve our plans as needed.

Throughout this situation, our priority is to continue to provide the incredible high quality care that is the standard in our practice, while also minimizing person-to-person contact to decrease the likelihood of unexpected virus transmission. We generally think of homebirth midwifery as high-touch, low-tech, but in this current situation, we have adjusted how we provide some aspects of prenatal care to limit virus transmission so that we can be healthy and physically present at births.

We wanted to let you know what we are doing to help slow the spread of coronavirus and to keep our clinic spaces as areas of health and wellness.

• We are screening ourselves and our clients for symptoms and exposures. We will have another midwife on our team step in to provide care if we feel anyone on our team is at risk of transmitting the coronavirus to a client.
• We are wiping down surfaces, electronic devices, and equipment after every visit.
• We are offering complimentary consultations as web based video calls.
• For prenatal and postpartum visits, our plan is to conduct as much of the visit is possible by by phone or video conference. For the hands-on portion of the visit, such as collecting lab specimens, checking fetal position, etc, we will have a brief in-person visit. For office visits, we are asking clients to stay in their car and to let us know when they arrive by phone. We can then begin the visit by phone or by video conference. Once we have completed the conversation part of the visit, we will have clients come in for the hands-on portion.
• For home visits, your midwife will conduct the phone or video part of the visit from your street in her car, and then come in for the hands-on portion.
• As weather allows, along with client preference, we are doing some in person portions of visits outside for increased ventilation.
• Since clients will already be talking with their midwife by phone or video during their visit time, prior to coming stepping foot into the office, they will be able to come right into the space without waiting in a waiting room or having contact with other clients who are on their way out.
• Other than when we need to be close to collect labs or check on baby, we encourage there be a bubble of space between us.
• Our team members are wearing masks at every in-person contact, following CDC and MDH recommendations.
• Non-essential visits (visits without labs or when it isn’t as necessary to collect certain vitals) can be turned into a fully virtual visit, without any physical contact.  We are providing supplies to our clients such as automatic home blood pressure monitors, kitchen scale to weigh baby, etc, so that those pieces of information can still be gathered during virtual visits. Clients can use these tools at home under the direction and video supervision of their midwife. Decisions on which visits can be virtual and which should be in person can be made with your midwife on a case-by-case basis, taking into account personal history, current pregnancy history, personal preferences, and ability to gather this type of information about your health with alternate methods.
• All of our offices are stocked with hand sanitizer, tissues, and soap to wash your hands.
• We have removed non-wipeable toys from our visit rooms.
• We are no longer hugging or shaking hands with clients or team members.
• The part of our care which requires much more in-person interaction is births. We are taking many precautionary measures in client visits and our personal lives so that when we join families for births we can be as healthy and safe as possible for in-person contact. At this time we do not anticipate any changes to the birth care that we provide.
• As of mid April 2020, it has become standard of care for birthing people in Twin Cities hospitals to be offered universal COVID-19 testing during labor. We are also offering COVID-19 testing at the end of pregnancy so that results will likely be returned by the start of labor.
• Our team is testing themselves periodically so their status is known.
• Any TCM team meetings (midwife check ins, chart review, etc) are happening virtually whenever possible.

Here’s what we are asking you to do:

• Let us know if you have any symptoms (cough, shortness of breath, fever, loss of taste or smell, etc) and stay home. Call your midwife to determine if additional assessments would be recommended.
• Also let us know if any family members or anyone else in your household is showing potential signs of illness. If you are potentially exposed to coronavirus, let us know prior to arriving at a visit.
• For any in person prenatal/postpartum contact, consider coming by yourself, without children or partners when possible. Partners can join via video or phone for virtual and in-person visits.
• As you’ve been hearing, wash your hands regularly. Considering washing your hands or using hand sanitizer at the start and end of your visit with us.
• Cover your cough or sneeze with your elbow or a tissue.
• Avoid touching your face (especially your eyes, nose, and mouth) with unwashed hands.
• Do what you can to support your immune system. Stay nourished with healthy, whole foods. Stay well hydrated. Keep up with your vitamins, including Vitamin C and D. Continue to move your body and exercise (for example going for a walk outside or joining Blooma for a yoga class from your living room). Prioritize sleep.
• Do what you can to support your emotional and health health. We’d encourage you to stay home, but still have a mental health specialist on your team, using telehealth visits which are web based. Also consider balancing reading the news with positive activities that bring you joy. Make time to focus on your breathing, meditate/pray, keep up with your self care routines.
• Do not travel. If you do travel, talk with your midwife before your next visit about it in case you need to wait a certain amount of time prior to coming into our clinic setting.
• Let the rest of your birth team (doula, photographer, grandparent, etc) know that if anyone is showing signs of illness they should not attend your birth. We expect anyone attending the birth to be practicing very careful social distancing (minimizing any non-essential person to person contact) and we expect doulas/photographers and anyone outside of your household to wear masks. Clients and others in client’s household are not required to wear a mask during the birth, but may do so if desired.
• As far as additional people at birth, sometimes hospitals are limiting additional support people to one person. Generally, that would mean for people birthing in a hosptial setting, they can only have their partner with them, not a doula or photographer. We want our clients to be aware that this means if a situation develops that indicates we would transfer to a hospital in labor, only the partner will be able to join the birthing person in the hospital. We plan to continue to be a part of the support team via phone and/or video-conferencing so that we can still be present as much as possible as we normally would in a transfer scenario. We recognize our hospital colleagues are needing to limit the number of people they come in contact with to protect themselves and to limit the spread of disease. We want our clients to be aware of this possibility. We will continue to do what we can to safely keep our clients out of the hospital system. In our practice, we consider doulas and photographers as part of the care team, not as visitors. We would recommend considering keeping the birth team small, to include your partner, and to consider others on a case-by-case basis. This limitation does not extend to a doula or or photographer, we recognize their vitality on birth teams.
• Our midwives are taking careful precautions to limit potential exposure in all areas of their life. We encourage our clients and families to do the same. Please do not have contact with anyone outside of your household if it is not necessary. We would encourage you to get regular exercise and fresh air, but that it would be a solo activity or would only include people already in your household. We can provide a note to your employer and/or partner’s employer that you should be working from home if your place of business is not already recommending it.
• As always, we are committed to informed choice and making decisions together with our clients, instead of making decisions for our clients. We are setting these guidelines to protect our clients and to protect our team, but we welcome dialogue from our clients about what makes the most sense for their care. Please do not hesitate to be in touch with your midwife about what you’d like your care to look like. 

We’ve had a lot of inquires from families wanting to join our practice due to the COVID-19 situation. We have a limited number of openings that we are happy to fill for appropriate candidates. Below is a list of requirements to establish care for late transfer, all must be completed prior to start of labor:

• Criteria: singleton baby, head down, strong desire for home birth (not just wanting to avoid the hospital or birth center policies)
• Virtual consult to determine if pregnancy is appropriate for our care
• Electronic chart started and electronic health history profile completed
• Paper/pdf forms completed and signed, including general informed consent and payment plan, by initial prenatal visit
• Current prenatal records, labs, and ultrasound reports faxed to TCM and reviewed by TCM midwife
• Any required labs not completed must be collected with results received
• Minimum of one prenatal visit completed with a TCM midwife
• Birth supplies gathered prior to labor onset (such as extra towels, trash bags, extra sheets, etc; list provided by TCM)
• Strongly recommend childbirth education classes (available virtually) for families expecting their first baby
• No current COVID-19 infection for pregnant person, any household members, or any birth team members. All must be free of symptoms (cough, shortness of breath, fever), and with no exposure to any presumed positive or positive COVID-19 in the last two weeks.
• We are open to having doulas and children at births, but we expect the client, household members, and any others attending the birth are taking preventive steps to reduce their exposure to COVID-19.

Looking for more info?

• Aviva Romm’s COVID-19: An Integrative MDs Commonsense Approach (Especially check out the pregnancy and breastfeeding article on that page!)
• Evidence Based Birth Podcast and Resource Page
• The Center for Disease Control (CDC) 2019 Novel Coronavirus (2019-nCoV) Situation Summary
• Here is the CDC’s FAQ about pregnancy and coronavirus disease.
• The Center for Disease Control (CDC) recommendations specific to pregnancy, birth, and lactation.
• The World Health Organization (WHO) daily update on the Coronavirus disease (COVID-19) outbreak.
• The Minnesota Department of Health (MDH) coronavirus information page.
• CDC Return to Work Criteria
• ACOG Screening Algorithm 
• AABC Tool Kit 
• Royal College of Obstetricians and Gynecologists Guidance 

Lastly, I know many of our families already have young children.

• This comic may be a helpful tool in talking with kids about coronavirus.
• Here is a follow up comic. 
• AACAP guidance on talking to children about coronavirus. 
• National Geographic Suggestions on Talking To Kids

Please let your midwife know if you have any questions. We recognize this outbreak is evolving quickly and recommendations may shift and change as we learn more.

Thanks for letting us be a part of your team!