How a global pandemic has upended — and boosted — Vermont Midwives

Midwife Sienna Flanders holding infant after delivery (Courtesy Sienna Flanders).

As hospitals filled with COVID-19 patients and lockdown orders became the norm, expecting mothers started to see midwives and home births as an increasingly attractive option to deliver their children.

For the midwives who provide these services, adapting to the surge in demand wasn’t easy.

Midwives Sienna Flanders, Katherine Bramhall and midwife and medical student Kalin Gregory-Davis witnessed the dramatic shift in birth service during the pandemic, they said. Each professional evidences Vermont’s continued prioritization of women’s health and well-being, though COVID-19 has posed certain challenges.

Certified Professional Midwife Sienna Flanders owns her own midwifery practice, 8generations, in South Burlington. Flanders provides exclusively home births and works with women across the state.

When COVID-19 hit, Flanders pivoted her approach, doing prenatal check-ins virtually and as temperatures increased, she conducted some visits outside, she said.

A week ago, someone in Flanders’ home tested positive for COVID-19 and she had to follow standard quarantine procedures. When one of Flanders’ patients went into labor last Thursday, she was able to call on one of her fellow midwives to assist the labor. The patient had met this midwife previously and was comfortable; she ended up having an easy birth.

“She is a repeat client of mine,” Flanders says. “And one of the two midwives I sent had been at her previous birth. She knew and felt really comfortable with the other midwife.”

Cooperation like this is not uncommon in the field of midwifery — the community is tight-knit, and close relationships make last-minute changes like this possible.

 Katherine Bramhall is a Certified Professional Midwife and former president of the Vermont Midwives Association. She is licensed in both Vermont and New Hampshire, and recently opened the freestanding midwife-led Gentle Landing Birth Center in Lebanon, New Hampshire, which serves women in both states. Bramhall is based in Barre and also provides home birth services across Vermont.

 During the national PPE shortage last spring, Bramhall had difficulty accessing necessary equipment for her increasing client base. Out-of-hospital birth practitioners adhere to different regulations than hospital birth practitioners, and as such don’t necessarily have access to the same provisions.

“The problem is we’re so under everybody’s radar, that when we all tried to get PPE, nobody would sell it to us,” says Bramhall. “Trying to get PPE under the rules of the Department of Health and therefore the Office of Professional Regulation and keep other families safe was proving to be a second job.”

 Bramhall was able to access PPE and antibody tests for her patients. No one in her practice has contracted COVID-19.

 Like other out-of-hospital birth providers across the country, Bramhall saw a spike in people seeking her services when the pandemic hit Vermont. Although business was booming, she says many folks suddenly seeking homebirth services were motivated more by fear than genuine preference. 

Initially, Bramhall said yes to many requests, although she says she would not do the same in the future.

“People who left the hospital to have a home birth because of COVID were not good candidates for home birth,” Bramhall says. “There’s a partnership in care, it’s a whole mindset-heartset. We’ve learned to screen people for why they are having home births now during COVID.”

 Kalin Gregory-Davis occupies a unique space between the worlds of midwifery and obstetrics. She is a licensed doula with experience in abortion services as well as birth and often works alongside midwives assisting births. She is in her third year of medical school at the University of Vermont and wants to become an OBGYN.

Gregory-Davis says her work in midwifery is very different from her work in obstetrics; the entire approach is different. Over the past year, she has received valuable experience in both.

“I was also working with the home birth midwives, so I would do home birth prenatals the day before and then go in and do OB prenatals and it was a really wild juxtaposition for me,” Gregory-Davis says. Unlike in-hospital prenatals where strict rules prohibited partners from accompanying birth persons, many home birth midwives allow patients’ partners to attend these appointments.

 At both the UVM Medical Center and the Central Vermont Medical Center, people in labor can only have one guest in the room. Sometimes, this means patients must pick between having their partner or parent there when they feel they need both.

Gregory-Davis says the biggest change she’s witnessed during COVID-19 is family involvement, for both birth and other medical services.

“I think the visitor policy has been huge,” she says. I think it’s hard in all fields of medicine, but I think it's really hard in birth. It’s just such a special time and you don’t get to relive it,” Gregory-Davis said.

 Fittingly, the World Health Organization has dubbed 2020 the “Year of the Nurse and the Midwife,” in honor of the 200th anniversary of Florence Nightingale's birth. Nightingale is widely considered the founder of modern nursing.