August 2021 Clinical Policy Updates

As we head into fall and a return to school for many families that coincides with increased COVID infection and transmission rates due to the Delta variant, I would like to share some updated clinical policies and guidelines that will take effect immediately until further notice. After lots of consideration of the current infection and hospitalization rates locally and nationally, data on infection complications in pregnant and postpartum clients, and my own personal and family needs, I have made the decision to enact the following clinical policies to help ensure the health and safety of my clients and their families:

Vaccination and Testing Requirements for Pregnant Clients

All pregnant clients seeking prenatal care and home or birth center services must be vaccinated in order to receive in-person care, or undergo regular on-going regularly scheduled COVID testing (more on this below).

For those clients declining vaccination:

  • Monthly COVID testing to occur in the week prior to scheduled prenatal appointments, with a negative test within 72 hrs of appointment time required for in person care. 
  • Weekly COVID testing will be required after 28 wks of pregnancy (beginning of the third trimester), and any clients with active infections, whether symptomatic or asymptomatic, will lead to automatic transfer of care after 28 wks. 
In-Office Masking
  • All clients, family members, and clinical staff are required to wear masks during office visits, regardless of vaccination status. All clinical staff will be vaccinated and family members are strongly encouraged to get their vaccines, too.
  • At this time, partners, support people, young children and babies are still welcome to attend visits if they show no signs of cough, fever, nausea, chest pain, etc. Adults and children over the age of 5 will be asked to wear a mask at all times during in-person clinic visits.

Active Symptoms of Infection

Any client who is either showing symptoms themselves or has been exposed to anyone with either active symptoms of cough, fever, etc. OR known COVID infection in the previous 5 days will be asked to:

  • Reschedule their in-person appointment to telehealth unless absolutely clinically necessary
  • Get COVID testing done that day and notify the clinic of their results
Vaccination and Testing Requirements for Non-Pregnancy Related Care
  • All clients seeking in-person care for non-pregnancy issues will also be required to show either proof of vaccination, or negative COVID test results within 72 hrs of their appointment time.
  • Telehealth visits are a viable option for many visit types, including UTI and mastitis evaluation, contraception consults, initial fertility care, and others. 

I understand that vaccination is not necessarily something all my clients will want or be able to do, for a variety of reasons. This decision was not made lightly and is multi-faceted. In part, I’m the sole income earner for my family and want to protect my own safety and that of my family as best I can. If I get sick and can’t work, it will be a serious hardship for me and for the sustainability of my practice. My five year-old son is not able to get vaccinated yet, is in theory starting kindergarten this fall, and I am concerned about both his and my increased risk of exposure with him being in public school. The reports coming out about kids with COVID and increased NICU/PICU admissions, cases of kids with long COVID symptoms, etc. are very concerning for me. 

But beyond that, because I am providing very personal, intimate, and in-home care, I feel the best way I can protect my clients, their families, and their chance of a healthy pregnancy and successful community birth is to encourage universal vaccination. I want to be able to keep providing the compassionate, quality, high-touch midwifery care you deserve, especially during this time of uncertainty in hospital policies regarding visitors and support due to the increased COVID rates. Keeping clients with healthy pregnancies out of the hospital makes good sense from a public health perspective.

I understand the many reasons why people decline vaccination and have no hard feelings about it…but for the safety of my clients and the community, I will be asking all clients to either receive vaccination or agree to the testing schedule, and agree to the plan that care will be transferred to an OB/GYN with any active infection in the third trimester. Failure to comply with these policies will be ground for dismissal from the practice.

My hospital-based midwifery colleagues are seeing increased rates of pregnant clients, even early in pregnancy, in the ICU. Unvaccinated pregnant clients are really struggling, many needing to be put on ventilators and even vaccinated clients sometimes need hospital care, which speaks not to the safety concerns of the vaccine and what it is intended to do (prevent death), but to the severity of the Delta variant. The long-term sequelae of infection are still uncertain in pregnant clients, even in those whose initial infection resolves prior to delivery. I understand the vaccine will not prevent all cases of infection or transmission–but it significantly reduces both and is the best tool we have right now to prevent large outbreaks in our community. 

On-Going Clincal Policies and Resources

Midwife and Birth Care team

  • Lena has been fully vaccinated with two doses of the Moderna vaccine in February 2021 and will continue to follow all CDC and state guidelines for PPE, social distancing, vaccination recommendations, etc.
  • All current back up midwives and assistants Lena works with are also vaccinated. Client requests for a fully vaccinated birth team will be respected.
  • If Lena has any symptoms or have potentially been exposed, I will immediately get tested, notify any exposed clients, and reschedule in-person visits until I am cleared to return to work.

Home Visits/Homebirth

  • Prenatal homevisits will be minimized for the duration of Covid-19, and some in-person visits may take place via phone or telehealth instead. These adjustments will be individualized to your needs and situation.
  • All resusable equipment will disinfected before and after each birth.
  • Single use birth tub liners will be included in your birth kit as usual.
  • Your midwife and any assistants present will wear masks while in your home. We ask that if you have a doula they also wear a mask.
  • Birthing individuals and their family are not required to wear mask during labor, but any other attendees will be asked to confirm they are symptom-free, have not been exposed to Covid in last 2 weeks, and asked to wear masks per CDC guidelines.

Clinic Visits

  • Clients and their partner/s and children will be required to wear masks per CDC and Washington DOH Guidelines. We recognize the systemic barriers to childcare and will continue to allow children during visits, but encourage clients to minimize the number of people they bring with them as best as possible.
  • Clients and their guests will be screened at the beginning of their visit about any symptoms or exposure. Individuals with positive screenings will be directed to a Pierce County Covid testing site and their prenatal appointment will be rescheduled in-person or via telehealth per test results. At-home covid testing kits can be ordered here.
  • Office space will be cleaned and disinfected between each patient visit.
  • A medical-grade (H13) HEPA air purifier runs during clinic hours.
  • Patient visits will be scheduled with ample space between appointments to allow for adequate cleaning.

Covid-19 Vaccine & Pregnancy

  • None of the three vaccines currently available in the US contain live virus, so pregnant and lactating parents cannot contract coronavirus from the vaccine, nor pass it on to their babies.
  • Pregnancy is considered a “high-risk” medical condition by the CDC. As of 4/2/2021, the Covid vaccine will be available to any Washingtonian age 12 and up. This includes pregnant and lactating parents.
  • ACOG Clinical Guidance for Covid-19: Read the latest recommendations on vaccination during pregnancy.

Think You Might Have Covid-19?

Take the CDC Self-Checker assessment to assess your risk and get guidance on next steps.

Already Vaccinated?

We still need more data on the outcomes of vaccination in pregnant and lactating individuals.

Consider participating in the v-safe pregnancy registry so researchers can learn more.