Christopher Tomlinson/The Daily Sentinel

Emily Johnson and her 2-week-old baby, Constance, get a checkup from a certified nurse midwife at Bloomin’ Babies Birth Center,

2241 N. Seventh Street in Grand Junction.

There are some days the midwives at Bloomin’ Babies Birth Center must try hard to convince themselves they work in the same place they did four months ago.

The location is the same and the babies are still sweet even though they insist on arriving at odd hours, but there is a distance between the midwives and their patients that wasn’t there before, coupled with an increased patient load that is exciting, though tiring.

Before COVID-19, the birth center had an average of 10 births a month. That has gone up to about 15 births a month, said Patty Kandiko, a certified nurse midwife and Bloomin’ Babies’ founder and clinical director.

Some of those were transfers, mothers who planned a hospital birth but news regarding COVID-19 “freaked them out,” and they switched to Bloomin’ Babies, Kandiko said.

One mother even transferred at 38 weeks of pregnancy — a pregnancy is considered full-term at 39–40 weeks.

Those mothers had to be brought up to speed with the birth center’s philosophy for natural birth, which has meant more patient appointments and lengthier appointments, she said.

There also has been an increase in calls from women wanting to know more about the birth center. Just last Thursday, Kandiko gave four tours and orientations, two of them virtually. “In the past, we’d be lucky to have four in a week,” she said.

If anything, COVID-19 has pushed natural childbirth and out-of-hospital options into the mainstream, said Jeana Smith, a certified nurse midwife with Bloomin’ Babies.

“I think that this whole COVID thing has really made people’s ears turn in a different way in general,” Smith said. “But when it comes to birth and the location of birth, I feel like COVID has made people kind of think about a non-hospital option more than they did before.”

She described a birth center as a holistic, halfway place for women and families who don’t want to go the hospital route, but aren’t all-in on a home birth.

That said, the birth center attempts to be as home-like as it can be. There are no twin-size beds with stirrups. “We have queen-sized beds,” said Heidi Phillips, another certified nurse midwife at Bloomin’ Babies.

“Midwives catch (babies) in any position,” she said.

Birth centers also are intentionally family oriented while providing care for women. In the past, expectant mothers have brought their young children to appointments to listen to the baby’s heart, and family and friends — anyone the mother approves — could be at the center for a birth, Kandiko said.

With larger families the atmosphere was somewhat akin to a big slumber party. “We don’t have that anymore,” Kandiko said.

These days, no children may come to an appointment or birth. “It’s too much of a risk,” she said.

Some of those children were themselves delivered by one of the midwives. “We love to see those kids come back and watch them grow, and not to be able to see that is sad too,” Kandiko said.

Patients are scheduled for hour-long appointments, and in the past most rarely went that long, but now they are, Phillips said.

Many mothers are anxious or fearful because of the pandemic, particularly first-time moms who in general need a little more hand-holding, she said.

“There’s been a lot of ministering to the nonphysical as the result of COVID-19,” said Karin VanderVelde, a certified nurse midwife and women’s health nurse practitioner at Bloomin’ Babies.

Depression, anxiety, marital disharmony and other personal issues are coming up more often in conversation during an appointments, she said.

“We see the client as a whole person, not just a belly bump to be measured,” VanderVelde said.

Just as appointments at the birth center have changed, so have births.

During the current COVID-19 situation, a mother may have two other people with her during birth other than a midwife, Kandiko said.

For some mothers, that means choosing between having their own mother at the birth or a doula or acupuncturist or best friend, Phillips said.

“No one is really complaining. Everyone understands, but it makes us feel a little sad,” Kandiko said.

There also have been changes to what the midwives wear during a birth. Easily washed street clothes or scrubs are now covered by a gown. Personal protective equipment (PPE) includes goggles and a cloth mask over an N95 mask.

“It definitely feels impersonal for us because we’re so used to being personal,” Phillips said.

“We are very close to our moms when they’re laboring,” Kandiko said. The masks “interrupt communication, smiles and quiet words.”

And the extra layers of clothing and protection are hot. “By the time we get done, we’re all just dripping sweat,” she said.

While they understands the need for “gowning up” given the serious nature of COVID-19, it is still a tough hurdle for Kandiko and the other midwives because this is natural birth, not major surgery.

“It goes totally counter-intuitive to the birth center model,” VanderVelde said. “We are trying to change the way people look at pregnancy, labor, birth, postpartum … Unless there is a problem, this is not an illness, this is not a medical condition to be managed.

“Change is always hard. And when that change gets to the root of the philosophy — we’re medically capable, but we don’t want to appear medical — that gets at the very core of who we are and what we do,” VanderVelde said.

So underneath the layers of PPE, VanderVelde and the other midwives continue to fight to keep birth personal and empowering for women.

“We still love having births. That will never change,” Kandiko said. “We make over the moms and the babies and the daddies and everything. But we kind of have to keep them at arms length instead of giving them hugs.”