Laurie Sloan and her husband have always known they wanted to have a big family. The stay-at-home mom, who is now pregnant with her fourth child, didn’t let the pandemic stop their plans. “We were stuck at home and hanging out together and it was kind of fun watching all the kids be close in age and play together,” she said.
Sloan, who is now expecting a son in June, thought being pregnant during the pandemic would allow her to spend more time preparing for his arrival. “I thought by the time the baby was here, life would be back to normal,” she said. “That’s obviously not going to happen.”
For Sloan, pandemic pregnancy has been bittersweet. On one hand, working from their Highland Park home has allowed her husband to help out more. On the other hand, the experience has been isolating. “I just feel like I can’t go anywhere without risking myself or the baby,” she said.
In one important respect, Sloan is not alone: She is one of 60 women who are expected to give birth at The Midwife Center for Birth & Women's Health in June. That would be twice as many as who gave birth there last year in June.
Across the country, experts have predicted a nationwide ‘baby bust,’ or a lower number of births than previous years, due to the COVID-19 pandemic and accompanying economic recession. Yet interviews with doctors and experts in the Pittsburgh region, paired with local birth data, paint a more nuanced picture.
Two hospitals and a birthing center reported an increase in expected births this spring. UPMC Magee-Womens Hospital in Oakland, the largest maternity hospital in Allegheny County, is seeing a trend “paradoxical” to the national numbers, said Dr. Gabriella Gosman, the hospital’s vice president of medical affairs. Magee, which advertises that it delivers around 45% of the babies in Allegheny County, has been seeing about 10% more newly pregnant patients in the second half of 2020 than in 2019, Gosman said. “It’s a little mysterious. I don’t know if it’s a ‘boom,’ but it’s certainly not what we’re hearing nationally.”
However, Allegheny Health Network did see a downward trend that has been consistent with some early reports from a handful of other states. Deliveries in December and January declined by roughly 15% compared to the last year, according to spokesperson Nikki Buccina, though the hospital network expects its March numbers will be comparable to last year’s.
Growing evidence of a national baby ‘bust’
News outlets and research institutions have been insistent on a national decline of new births. A June survey conducted by The Guttmacher Institute, a reproductive health research and policy organization, found that one-third of women surveyed wanted to get pregnant later or wanted fewer children because of the pandemic. Condom sales, as well as Google searches about contraception and pregnancy, have been down almost the entire pandemic. And in June, economists Melissa Kearney and Phillip Levine projected that the crisis will result in 300,000 to 500,000 fewer babies born in 2021 than expected — an estimate that they still largely supported in December.
The Guttmacher Institute’s survey indicated that women’s race, sexual orientation and income level significantly factor into whether the pandemic prompted a change in their fertility plans. Black women and Hispanic women were more likely than white women to state that because of the pandemic, they wanted to have children later or wanted fewer children. Women who identified as gay, lesbian, bisexual or other were also more likely than straight women to report such a change, as were lower-income women than higher-income women.
The five states that have provided monthly birth data through December — Arizona, California, Florida, Hawaii and Ohio — show declines nine months after the pandemic was declared a national emergency, with a total of 50,000 fewer babies born in those states than in 2019, Bloomberg reported in early February.
The Pennsylvania Department of Health projects that Allegheny County’s birth rate stayed consistent from 2019 to 2020, hovering at around 13,000 babies per year. But most babies conceived since the start of the pandemic will arrive this year; the department’s 2021 projection is not yet available. The Allegheny County Health Department was also unable to provide data on the number of births in 2020.
Dr. Jamie Wright, an OB-GYN at Magee, said her practice has 335 patients due in March, up from the high 200s last March. “I think maybe initially people were nervous, not sure what to do, held back a little bit. And then I think people realized, this is gonna be here for a while,” Wright said. “They just decided to kind of move on with their lives.”
In previous recessions, there has been a drop in the number of babies. But the pandemic recession is somewhat different, as it has forced couples to stay home together and has increased the number of people who have been able to save money and pay off their debt.
Gosman didn’t have a clear explanation for the recent bump in pregnant patients at UPMC. “Each locality has really had its own COVID rollercoaster in terms of when and how high cases have risen and when they’ve receded,” she said, “and I’m wondering if each locality, depending on that COVID pattern, is experiencing it in a different way.”
Both Gosman and Wright said the hospital is equipped to handle the additional deliveries. “We’re ready for the chaos. Bring it on,” Wright said.
The Allegheny Health Network had 566 births in January — down from 680 last January. The hospital network is expecting 642 births at its four birthing hospitals this March and had 694 births last March. Buccina said AHN often has more deliveries than it expects, so the numbers will likely even out.
Dr. Grace Ferguson, an AHN OB-GYN, said her younger patients are showing more interest in birth control, often because they or their partner were laid off or they don’t feel it’s a good time to get pregnant. There has also been an uptick in patients who choose to end their pregnancies, she said. This is consisent with some early research: A study in Great Britain showed an increase of more than 4,000 abortions in the first half of 2020, compared to the first half of 2019. “It’s just not a hospitable world right now for building a family,” Ferguson said.
Ferguson said she believes income is the biggest predictor of whether her patients choose to alter their plans. Many of her patients have been accepting donations from the hospital system’s Healthy Food Center. “I’ve had a lot of patients that say, ‘Yeah, actually, if you guys could offer a food box we would gladly accept it,’” she said. “And that’s never happened before.”
St. Clair Hospital’s birth numbers are largely comparable to years past, said Shawndel Laughner, the director of Women’s & Children’s Services. The Mount Lebanon hospital is expecting a slight increase in March births compared to last year — 146 births, compared to 122 last March — which Laughner said could be due to people becoming more comfortable with the pandemic by August or September and not wanting to further postpone their plans.
“This wasn’t the ideal time for them to have a baby, it was a little bit scary for them, but they had been waiting for so long, it was now or never,” Laughner said of some patients. Overall, the hospital is expecting 26 fewer births between July 2020 and June 2021 as compared to the year prior.
Laughner said St. Clair Hospital’s stable numbers could potentially have to do with its more affluent demographic. “That could be part of the reason why we are staying the same,” she said. “Because maybe our community doesn't worry so much about jobs or employment.”
Birthing centers, doulas provide alternatives to traditional hospital births
At the beginning of the pandemic, birthing centers saw a sharp rise in clients, said Ann McCarthy, clinical director of The Midwife Center for Birth & Women's Health in the Strip District. She said many people wanted to avoid hospitals and possible COVID-19 exposure.
“The pandemic highlighted that sick people and healthy people go to hospitals together and only healthy people go to birth centers,” McCarthy said.
The center has 60 clients due this June — double its 30 deliveries last June. “It’s a combination of more people having babies and more people seeking out an alternative to delivering in a hospital,” she said of the increase.
Sloan, who is a client at The Midwife Center for Birth & Women’s Health, appreciates that the center is more “hands-off” and allows telehealth visits as long as there are no concerns. “I’m very, very comfortable with that. I don’t want to be in a public space right now,” Sloan said.
Some other moms are still opting for in-person appointments. Kelly Carmosino, a first-time mom from Shaler, said going to see her UPMC doctors in person puts her at ease. “I felt really safe at every appointment,” she said, adding that the waiting room is usually empty and the appointments are well spaced out.
Jada Shirriel is CEO of Healthy Start, a nonprofit organization that works to improve maternal and child health outcomes in Allegheny County. She said the organization has seen an increase in demand and a need to diversify its services since the pandemic began.
After hearing from women, especially Black women, who had previous traumatic birth experiences or weren’t satisfied with the available birthing options, the organization created a free doula program. Through the program, mothers can have a doula join them in the delivery room either in person or virtually, free of charge.
“There have been various doula programs in our community that have come and gone because of funding" and other reasons, Shirriel said. "And I think because of that, having doula services is not really normalized unless you can pay for them out of pocket." The program, which is in partnership with UPMC, AHN and Gateway Health, has had doulas at almost 40 births since last March and continues to grow.
County resource providers ramp up for 2021 babies
Dannai Wilson, manager of the Allegheny County Health Department’s Maternal and Child Health Program, said she hasn’t noticed a decline in births in the county.
The department received 450 referrals in 2020 for its programs for new parents, a 25% decrease from its 600 referrals in 2019. She attributed the decline to not being able to connect with families in person. “I think that barrier of not being able to be in face-to-face engagement… it’s been very difficult for us,” she said.
Wilson doesn’t anticipate referrals being down much longer. In September, the health department and other organizations launched Hello Baby, an initiative to support local parents, which has already received referrals for roughly 900 families. The department also recently began partnering with Medicaid plans, such as UPMC for You and Gateway Health, to support families with home visits.
“Between Hello Baby referrals and these [Medicaid managed care organizations], I think we’re going to have our hands full in 2021,” she said.
Free resources for new and expecting parents in Allegheny County:
- Allegheny County Health Department’s Maternal and Child Health Services, including the Nurse-Family Partnership for low-income, first-time mothers and Healthy Families Allegheny
- Hello Baby, a collaboration to support parents and connect them with resources
- Allegheny Health Network’s Healthy Food Center
- Healthy Start’s Doula support
Wilson urged new parents to take advantage of the programs and resources available to them. “While COVID can be very isolating, we think there’s opportunities for connection for everyone,” she said. “Do not think you have to be a new parent in Allegheny County alone.”
Oliver Morrison is PublicSource’s environment and health reporter. His reporting on this story was interrupted by the birth of his son, Jackson Greenbrier Morrison-Brown. He can be reached at firstname.lastname@example.org or on Twitter @ORMorrison.