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M.A.M.A.S., Inc. Practice Plan During COVID-19 Pandemic

Updated 7/10/2020

It is the aim of all of us here at M.A.M.A.S., Inc. to provide you with safe, personalized, client-centered care, and to continue creating community in this strange and confusing time of social distancing.  In order to let you know about the changes in our way of delivering care, and all the safety precautions surrounding them, we have created this very long document, and we hope that you will read it all the way through right now, and keep it handy to refer to as you approach the different stages of your pregnancy.

First, prenatal care is going to look quite different going forward.  We will continue to be in contact at our usual intervals, but while a few of our visits will continue to be individual in-person visits in our offices or your home, others will be group or individual virtual visits using Zoom or Doxy.me, and some will be a combination of a virtual visit for the talking portion of the visit with a brief hands-on in-person visit.  These visits will take place in the following locations:

 

~ Individual visits will be with alternating midwives in our designated home offices.

 

~ Home visits will be at your house at 36 wks and once each midwife between 36 and 40 weeks, assuming all in your household are symptom-free

 

~ Group Visits will be on Zoom, often followed either by virtual belly-checks done with your equipment, or by in-person belly checks with one of the midwives at the above locations.

 

~ Type of Visit can change if there is any concern about your health, or unforeseen need for an in-person visit (for instance, if you need a lab test for a problem such as UTI or yeast infection)

 

In order to optimize our time and facilitate thorough virtual visits, we ask that you purchase:

  1. A blood pressure cuff, this one or something similar. You will be using your own cuff to take your blood pressure before each visit (including postpartum).
  2. A fetoscope like this or something similar. We will teach you how to use it to listen for and count your baby’s heart tones. (We have also had some luck with clients who purchased this app ($4.99) which uses the microphone on your phone (take the case off!) to hear baby’s heart beat later in pregnancy. You can record the sound and text it to us for assessment.
  3. A fabric tape measure that measures to at least 50 centimeters. We will teach you how to measure from the top of your pubic bone to the top of your uterus (fundus).
  4. A thermometer. We particularly like this one for mama and baby.
  5. A good supply of antiseptic wipes, or paper towels and antiseptic spray—be sure any spray says “kills viruses,” and is safe to use inside! (If you don’t have wipes or spray, it is very easy to make a solution to put in your own spray bottle—just mix water with 10% Clorox, or you can use straight 70% rubbing alcohol.  Vinegar is NOT effective.)  And don’t forget, counters, sinks, toilet seats and hands can be cleaned with hot, soapy water!

Hand sanitizer is only for when you have no access to soap and water!

Gestational age (wks) Schedule of visits
PRENATAL
10-12wks Virtual visit-orientation and health history-taking, (option to go for early genetic testing and dating sonogram, if desired)
15-16wks Individual in-person visit- new maternity/medical intake visit including prenatal panel of labs and physical exam
20wks 1st Community Care virtual group visit and 20wk anatomy scan
24wks 2nd Community Care virtual group visit with individual remote belly-checks using your equipment
28wks Individual in-person visit—gestational diabetes screen and other labs as needed/desired
31wks & 34 wks 3rd and 4th Community Care virtual group visit with individual remote belly-checks using your equipment
36wks Home visit—supply check with 1 midwife, other midwives attend remotely, GBS screen available, schedule weekly visits
38wks Last Community Care virtual group visit + individual weekly visit
36-40wks Weekly visits, mostly at home with the exception of last CC group visit.  Each midwife will try to do one home visit.
41wks Home visit—auscultation acceleration test, discussion of post-dates and labor encouragement options, fetal surveillance options
41+ wks Biophysical profile sono, home/individual visits every 3-4 days
POSTPARTUM
Day 0 Birth
Day 1 Home visit with checkup for birthing person and baby. Critical Congenital Heart Defect test for baby. Rhogam for Rh neg moms.
Day 2-7 Pediatrician appt and virtual visit for birthing person and baby.
1wk, 2wk and 6wk Virtual visit for birthing person.

 General:

For each visit, we aim to reduce the amount of time spent in close physical proximity.  To that end, we will combine each in-person visit with some time on either on Zoom (group visits), doxy.me (individual visits), or by phone on the way to your home visits. We will be sending you a telehealth consent form outlining your rights and responsibilities for remote visits. We will expect that you have prepared your home by disinfecting it just before the visit per the following instructions, so that the midwife come directly in, wash hands, conduct a thorough belly check, wash hands again, disinfect any equipment used, and leave with minimal physical contact with you and your space (if you could open doors on our way out, that would be great!)

If you, anyone in your house, or anyone you have been in recent contact with, is sick, please call your point midwife.  We will help you make a plan based on the situation and current recommendations. If you have any symptoms of illness (fever, cough, shortness of breath) as you go into labor, we will follow American College of Gynecology (ACOG) recommendations and transfer your care to the hospital for appropriate monitoring or interventions (ACOG management of pregnant women with suspected or confirmed COVID).

If we need to transfer in labor, your primary midwife will accompany you to the hospital to give report and transfer care.  At this time, we are unable to stay past that point, as it could increase our chance of exposure, making us unable to serve the other families in our practice. However, we will remain fully available to you by phone and/or video call to support you, offer suggestions, and help with decision-making. After a transfer and hospital birth, we encourage you to ask for early discharge.  We will conduct your postpartum visits as outlined above.

 

Infection control:

Midwife office visits (individual visit):

Our midwives have office spaces in our houses, with separate entrance and bathroom, which we will use for individual visits, disinfecting all high-touch surfaces and our equipment before and between visits, according to current CDC recommendations.

We ask that you text us from your car to let us know you have arrived.  We will text you back when we have finished disinfecting and preparing the space for you.  Please STAY IN YOUR CAR until you receive the text saying it’s okay to come in.  Consider bringing only your driver’s license, a credit card, and your phone when you go out, and leaving them in the glove box of your car (we will text you the info for your trifold card). When you come in, please leave your shoes by the door and go directly to the bathroom to wash your hands.  While we love involving children, partners, and families in our visits, we ask that only the pregnant person come for visits, and others are welcome to join remotely.

 

Home visit:

Before our scheduled appointment time, please go through your space and disinfect all high touch areas.  Start at the front door and walk through to a main level kitchen or bathroom, disinfecting surfaces (bookshelves, tables, doorknobs-inside and out, and light switches), toilet handle, faucet, etc.  Please provide a fresh washcloth or paper towel for drying hands, and some wipes or a washcloth and Clorox solution to wipe our equipment before we leave.  We will leave shoes and outerwear at the door, wash hands on arrival and again before we leave.

 

Birth:

When you go into labor, please have your single asymptomatic support person disinfect the house as instructed for the home visits and include surfaces on the same level as the birthing room. Based on the current recommendations at the time of your birth, we will don personal protective equipment (PPE= surgical gown or jumpsuit, gloves, goggles, face shield, and N95 masks) while we remain in your home. We know it seems surreal, but we just want to keep everyone as safe as possible.

Ordinarily we are happy to follow the birthing person all over the house, kitchen, living room, bedroom—wherever.  However, these are not ordinary times, so we ask that, to the extent possible, you prepare ONE room for your birth and sanitize it well, and we will try to stay just in that room. In addition, all other support people (family, friends, or doulas) will remain outside the home in order to decrease exposure risk for the midwives and the birthing person (they can happily join virtually).  We require a support person for other children in the home and ask that the care provider take kids to a designated area (in or out of the house) away from the midwives.

 

Birth tub:

After much research and consideration, M.A.M.A.S., Inc. has decided to offer birth tub use as an option once again when specific requirements are met.

Requirements:

  • Individual risk factors related to self-isolation precautions leading up to your birth will be reviewed with individual clients (those working outside the home in the three weeks before birth will not be eligible).
  • Antibody testing at 38wks and viral test at testing center with negative results.
  • Partner (or designated support person) uses a fish net for stool removal if needed during 2ndstage.
  • A plastic sheet should be available to cover the pool after use.
  • Support person is responsible for pool clean-up after midwives leave.
  • Tub used will be the client’s bathroom tub or purchased by client specifically for first time use. (NO RENTALS.)Yourwaterbirth.com has great options for tubs and accessories (water and air pumps, fish net, tub liner) and if you tell them you are a M.A.M.A.S. client, you could get a discount.
  • Add 2 tablespoons of bleach to the water an hour before use to sanitize the water and evaporate within that hour. (per Waterbirth International recommendations)

Evidence:

Evidence Based Birth

Waterbirth International

Royal College of Gynecology

 

Midwife protection:

The midwives of M.A.M.A.S., Inc. make a commitment to staying healthy for our clients, our families, and ourselves, and will

  • disinfect our offices before and after each individual visit.
  • use a washable cover for our car seat and disinfectant wipes which we will use to wipe down high touch surfaces (steering wheel, radio, gear shift, door handle, and seatbelt).
  • Upon returning home from a home visit or birth, we each have a designated doffing area where we remove our clothing and clean it, and ourselves, according to CDC guidelines.

 

Pregnancy and breastfeeding during the COVID-19 pandemic:

As this is a novel virus, there remain many unknowns.  The Center for Disease Control,  World Health Organizationand ACOG COVID Guidelines are reliable sources for updates, though occasionally they have conflicting information.  However, so far, we know that:

  • Vertical transmission from mother to baby appears to be low, based on limited data.
  • Current available data does not indicate that pregnant women are at increased risk of developing COVID-19 or life-threatening illness
  • The virus has not been detected in colostrum, breastmilk, amniotic fluid, or cord blood
  • Breastfeeding is considered safe in most cases, especially if breastfeeding person is well

 

We encourage all our clients and the other people in their homes to follow the current CDC and White HouseGuidelines about social distancing.

  • Avoid going out unnecessarily, and avoid inviting others into your home.
  • Avoid groups of more than 10 people and stay 6 feet from anyone.
  • If you must go out, wear a mask, and when you return home wash hands for at least 20 seconds with soap and hot water, when you get home. And also clean your mask!
  • Regularly sanitize commonly touched surfaces such as doorknobs, and light switches.

 

THINGS THAT MIDWIVES CAN CONTINUE TO DO:

The midwives would love to see you and exchange hugs as has been our “normal” for so long, and we will continue to be WITH you in new and different ways while respecting the need for social distancing.  Some things have to change, but not everything.  We can continue to:

  • Offer our respect for the birthing person at the center of care
  • Preserve whatever we can of your birth plans
  • Find ways to create community in new paradigms
  • Hold the space for physiologic birth and breastfeeding
  • Offer our calm and loving presence along with our desire to help
  • Offer our patience and fortitude.
  • Be available by phone 24/7 to discuss any questions or concerns you may have. If you find yourself thinking, “should I call the midwife?” The answer is always YES.

 

 

THINGS THAT YOU CAN CONTINUE DOING:

  • Get good sleep
  • Drink plenty of water
  • Eat a well-balanced diet with lots of fresh fruits and vegetables and minimize processed foods.
  • Reduce stress by creating and maintaining self-care practices, including;
    • Prenatal Yoga—we love Yoga with Adriane but there are so many free prenatal yoga videos
    • Mindfulness (apps like Calm or Headspace are great)
    • Limit time scrolling. It is a survival skill to keep up with the daily news, but it also creates stress.  Limit time spent reading or watching the news—try setting a timer (the new ios has a “screen time” option that can help set limits) and put your phone down or computer away.
    • Special family time. The state of the world is forcing us to SLOW DOWN. Instead of focusing on how restrictive life is these days, try focusing on gratitude—for the health of loved ones, for technology that allow us to connect while maintaining social distance, for lovely spring weather.  Get outside, play with the kids, read a book, play a game, there is so much to be grateful for!
    • Utilize pulsing. We know that working constantly becomes less productive after 90 minutes (or less!).  Set a timer and plan to work for a specific amount of time (work can also be cooking, hanging with a kid, or doing any one activity for a sustained amount of time). Then take a break. Change things up.  Do something else.  Go outside, take a walk, play with the kids if you’ve been on your computer for a while, call a friend, video chat with a loved one, develop your napping skills.
    • Create some structure. Humans feel more secure when we know what to expect in the shape of our day.  If you are working from home, try designating a specific time when the office is CLOSED, and you can stop working without feeling guilty.  Try to wake up and go to sleep around the same time every day.  When you get up, get dressed and go outside for a little while.
    • When you come up with new and different ways for us all to be together, share your ideas on our listserve!
  • Consider following the recommendations of Aviva Romm to help maintain your immune system: (Zinc 30mg/day, Vitamin D 4000 IU/day, Vitamin C 1000mg/day, echinacea tincture 2.5 mL (1 dropperful) 3x/day. Be sure your prenatal vitamin has 400mcg of folic acid as it’s shown to be protective in case of maternal fever.

 

Thank you for reading this very long message—keep it handy so you can refer back to it when needed.  We are all in this together, lets continue to lift each other up and draw strength from our community.  Spread the love and not the virus! 

 

Love,

 

Máiri, Kathy, Miriam, and Leslie