As hospitals around the nation are transformed into coronavirus battle stations where overwhelmed medical teams with limited supplies fight a new, incurable disease, more expectant mothers are deciding it's safer to give birth at home.

Soon-to-be moms aren't just worried about themselves and their newborns. They also want to keep extra beds and resources free for sick people who need them.

"Hospitals may soon, like in Italy, run out of beds, and they are running out of supplies," said Erika McBee, a nurse in Rockville, Maryland, whose first baby is due in the summer. "They are likely to soon be crawling with disease, which is not the best place to bring your newborn with no immune system into the world."

In its updated COVID-19 guidance, the American College of Obstetricians and Gynecologists maintains that hospitals and accredited birth centers are safe places for delivery.

"Although recognizing that many patients are experiencing new concerns because of the COVID-19 pandemic, ACOG continues to recommend following existing evidence-based guidance regarding home birth," the group's statement says. "Each woman has the right to make a medically informed decision about delivery."

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ACOG notes planned home birth is associated with fewer maternal interventions than planned hospital birth but also is associated with a more than twofold increased risk of infant death immediately after birth and a threefold increased risk of neonatal seizures or serious neurologic dysfunction.

About 1% of births in the USA occur at home, according to the National Institutes of Health and Science. It's too early to say whether COVID-19 will change that statistic in any significant way, but anecdotal evidence shows more women exploring it.

In Takoma Park, Maryland, Kathy Peacock, a certified nurse-midwife, has seen a surge of interest at her practice, M.A.M.A.S.

"It’s really blowing up," she said. "Nobody wants to go the hospital. And I kind of think they shouldn't if they have a low-risk pregnancy."

Peacock said four or five people typically take part in in-person information sessions, but by mid-April, 20 people joined a meeting, now held online. Her practice has space for six to eight clients a month, based on due date. The spaces don't always fill up, but they are at capacity through August. New clients are being taken on only if everyone in the practice agrees, Peacock said.

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Layla Swisher, a licensed midwife in Tallahassee, Florida, said she is seeing an increase in late transfers, women who change to midwifery care further along in their pregnancies. She had five women seek her out in one week, which is more than usual.

“It’s the ‘I’m getting ready to deliver’ crew who are calling us,” said Swisher, who screens potential clients to ensure they are a good fit for a home birth.

In Hope, Rhode Island, nurse-midwife Michelle Palmer said she is seeing "an exponential increase” at her practice and is hearing from other midwives in similar situations.

Palmer, chair of the Home and Birth Center Committee of the American College of Nurse-Midwives, said there is an opportunity to bring home birth and midwifery care more into the health care system. Her association collected updated resources for health care workers and patients.

"There are all different kinds of midwives in our country wanting to be part of the solution and be of service to our communities in any way we can," Palmer said.

Midwives say they take additional safety precautions to cut down on possible infections. Swisher changed office procedures at her birth center, the Birth Cottage, so clients don't overlap and intends to cut down on post-birth home visits.

Peacock said her practice "had to redo our entire model of care." She and her midwife colleagues scrapped home visits, as well as in-person group meetings for pregnant women due around the same time. Those are virtual now, as are a good portion of regular checkups.

The women start their regular checkup on video chat in their car outside the midwife's home office and come inside only for a hands-on check. Peacock opens all doors for her clients, minimizing exposure to surfaces, disinfects scrupulously between visits and ensures she and her fellow midwives are not together in person. That way, if one gets COVID-19, it can't be spread to the others.

Peacock asked her patients to have on hand blood-pressure cuffs, a thermometer, a stethoscope to listen for heart tones and a measuring tape to check fetus growth. Clients also are asked to designate a single room at home for labor, so it can be fully disinfected.

"For the majority of women, you don’t need really anything other than someone telling you that you’re doing a good job and to keep at it," Peacock said. "That’s the community that we try to build – that they have the resources they need."

The changes have taken a toll on the midwives, who miss the close physical connections, and on their pregnant patients.

"There's a lot of uncertainty for any woman pregnant with her first baby but especially in a pandemic," said McBee, a M.A.M.A.S. client.

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Star Ulosevich, who lives in Washington, transferred to M.A.M.A.S. She'd planned to have her second baby, due in May, with a hospital-based midwife practice. But as COVID-19 bore down, she and her husband researched home births, buoyed by the uncomplicated, unmedicated labor for their first baby.

Ulosevich finds comfort in the "care and thoughtfulness" Peacock's group shows. Born at home herself, Ulosevich decided a home birth would offer more control, both against disease spread and in the overall experience. Despite the natural fear about a potential emergency during birth, she said the pros of being home outweighed the cons.

"Bringing a baby into the world is more than just a physical exercise, it's quite an emotional one, and we wanted to feel like we had a bit more control over what that experience would be," Ulosevich said. "We’re really grateful that we have this option."

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