A Birmingham obstetrician has a plan to deliver babies at her clinic to avoid bringing otherwise healthy pregnant women into hospitals that are treating COVID-19 patients.

“Patients are worried about their possible exposure to COVID, they’re worried about laboring in a mask, they’re worried about visitation policies and about infant separation policies,” said Dr. Jesanna Cooper, an OBGYN at Simon-Williamson Clinic and chair of the Women and Infant’s division at Princeton Baptist Medical Center. “Not everyone is comfortable with the idea of a home birth. We feel like this could offer another important choice for them.”

Cooper envisions reworking a section of the Simon-Williamson clinic, which sits on the campus of Princeton Baptist, into a five-bed auxiliary maternity unit specifically for patients who test negative for COVID-19. Births would be attended by a nurse-midwife, with the option of transferring care to Cooper at the hospital next door in the event of a birth complication.

“We feel like we’re uniquely set up for this,” said Cooper. “We have nurse-midwives, obstetrics and pediatrics all in the same building.”

And at least one small study found that pregnant women may not show the classic symptoms of COVID-19, but if infected, their condition can deteriorate quickly following a birth.

As Cooper works to line up the permissions, testing and insurance coverage necessary to open an auxiliary maternity unit, her effort could have ramifications that reach far past the pandemic.

In recent months, insurers and health authorities have shown a willingness to relax restrictions in order to help healthcare providers better treat COVID-19 patients. Medicare, Medicaid and other insurers now reimburse doctors for telemedicine visits, for example, and states are allowing doctors to practice with licenses from other states.

But as COVID-19 reshapes the healthcare landscape, birth in Alabama could be altered as well. In other states, women with low-risk pregnancies have the option to deliver at birth centers. These centers offer out-of-hospital births attended by midwives or nurse midwives, with more medical supplies and equipment than would typically be available for a home birth. That option has never been available to patients in Alabama, where nearly all births occur in a hospital and the state only recently legalized home birth with a midwife.

“Right now,” said Cooper, “people think in terms of ‘hospital versus home birth’ because in Alabama, there is nothing in between.”

Cooper considers the auxiliary maternity unit as a temporary measure to safely deliver babies away from potential COVID infections in hospitals, but it would essentially function like a birth center.

Alabama law around the licensure of birth centers is vague. It appears to grant the state the ability to license birth centers but stops short of actually requiring it.

Cooper originally applied to the state health department for a license to open the auxiliary unit under the state’s emergency healthcare order. But, she said, the health department eventually told her she could operate the unit without a license because the state does not regulate private physician practices or birth centers.

That could open the door in the future to other efforts to open birth centers around the state.

Nationwide, interest in birth centers has ticked up, said Amy Johnson Grass, president of the American Association of Birth Centers.

“Freestanding birth centers across the country are experiencing an increase in people wanting to transfer to birth centers to avoid the hospital during COVID-19,” Johnson Grass said in a statement. Her organization is working with the Commission for the Accreditation of Birth Centers to develop guidelines for creating temporary auxiliary maternity units to care for low-risk, non-COVID pregnant patients.

Barriers to opening

Licensure isn’t the only barrier to delivering babies at the clinic, Cooper said.

Access to rapid testing for coronavirus is a biggie; the maternity unit can’t work without it, Cooper said. She’s been working through every avenue she can think of to get access to rapid tests, but doesn’t have them yet.

She and her team are also trying to get Alabama Medicaid and other insurers on board. In other states, Medicaid reimburses for deliveries at birth centers.

“For us it’s important that this is not just something people who have cash can do,” she said. “We want it reimbursed by Medicaid, by Blue Cross and others so it’s a viable option for women who don’t have $3,000-5,000 in cash.”

The third hurdle is making sure medical liability insurance will cover the healthcare providers in the unit, she said. She and her team have been pushing back against some initial resistance on that front.

Still a need

If the unit opens at Simon-Williamson Clinic, it would have three delivery rooms and two overflow rooms for recovery or early labor.

Women would be candidates for the unit if they test negative for COVID-19, are low-risk and do not want epidurals or other medical interventions. The unit would not deliver women with preexisting conditions, would not deliver twins or other multiples, and would not offer labor inductions.

Currently at Princeton Baptist, pregnant patients must wear a mask and healthcare workers wear N95 masks and face shields. Patients are limited to one visitor for labor and delivery. But if rapid testing allowed constant monitoring of patients, visitors and healthcare workers for COVID-19, those requirements could be relaxed, Cooper said.

Ideally she’d like the unit to open in May, but that could get pushed back.

“There’s still going to be a need for this in July,” Cooper said. “COVID’s not going anywhere.”