‘Babies are still going to be born,” even during a pandemic, said Sonya Niess, a Maui doula who helps parents prepare for birth and acts as a guide during labor. Faced with this reality, mothers-to-be and childbirth professionals like Niess are adjusting to meet a new set of challenges.

The thought of giving birth in a hospital where a cluster of at least three dozen COVID-19 cases was detected has made some so nervous that they have turned to home birth. Others with risk factors that could cause problems during labor are suffering extra anxiety because they know they need to have their baby in the hospital.

Still, Maui Memorial Medical Center’s obstetrics unit continues to welcome an average of 30 to 35 new babies to the world each month, and the hospital says there have been “no notable changes” to that number.

“Our OB unit is completely secluded, with no shared space with COVID patients,” hospital spokeswoman Lisa Paulson said.

Longtime Maui childbirth educator Nancy Irvine credits the obstetrics nurses with running a tight ship, and said “that floor is probably the cleanest part of the island to be.”

Ivana Sain, who had twin girls by Caesarean section April 10, said she was reassured by the care the OB staff showed in keeping things clean and wearing masks and gloves. “I thought they were very diligent,” she said.

The hospital has established a process to detect the new coronavirus and keep it out of the OB unit. Arriving patients undergo an admission assessment that includes signs and symptoms of illness, recent travel and/or exposure to COVID-19-positive individuals. Those who are asymptomatic are not tested for COVID-19, but all are given a mask and transported directly to the OB unit.

Laboring women are allowed only one support person. Many women are having to give up long-standing plans to have a doula, the dad or other supporters in the room.

“We have to really work together with hospital staff and policies and try to make the best of this,” said Niess, who, with the sudden change of rules, is able to attend only as a “teledoula” instead of being in the hospital during labor.

The challenges begin long before the baby is due.

“It has certainly thrown a wrench in my pregnancy experience,” with her husband not allowed to attend the ultrasound session that reveals the baby’s sex, said Terese Wormser, who is four months pregnant. Because she is 39, her insurer wants her to travel to Oahu for extensive ultrasound, something she is reluctant to do.

“It’s hard enough enduring pregnancy, birth and postpartum issues,” Wormser said. “The pandemic adds a level of detrimental stress.”

Obstetricians, midwives, doulas and childbirth educators all are adjusting procedures to ensure the best care with the least chance of transmitting the virus. Dr. Stacy Ammerman, owner of Maui Lani Physicians and Surgeons, said her clinic’s patients have fewer office visits, relying on telemedicine to check in with their doctor. When they do come to the office, patients go through a triage process outside the office, then wait in their car until staff is ready to check their vitals in the lobby before taking them directly to an exam room.

Everyone on staff wears a mask, patients are encouraged to wear masks for office visits and the clinic staff take their own N95 masks to deliveries. “We’re pretty comfortable” with the process, Ammerman said.

Childbirth educators also are finding new ways to connect with expectant mothers, with hospital orientations and group classes canceled. Irvine said her classes were small and individualized, but with the possibility of asymptomatic COVID-19 carriers, she has switched from face-to-face meetings to online connections with her clients.

Pacific Birth Collective, a local organization of childbirth professionals, has started offering classes via Zoom videoconferencing. Alesha­nee Akin runs a Friday afternoon online class to educate mothers-to-be about the birth process.

“The more we know about these processes, the less anxiety,” she said. “It’s pretty tough now because a lot of women are without support” because of the quarantine.

Akin also is concerned about the mainland trend of babies being removed from mothers who show possible symptoms — for example, if the mother’s temperature is elevated, which Akin says is normal during labor.

In general, removing the baby immediately “is not safe for either the baby or the mother” because nutrients and antibodies found in the mother’s first milk are essential to the baby, and a hormone released by skin-to-skin contact helps the mother dispel the placenta.

The initial emotional bonding between mother and child also is vital, Akin said.

Another potential problem is the isolation many mothers will face after birth, said Heather Milo­vina, a certified nurse midwife at the Malama i ke Ola Health Center.

“It’s hard on the postpartum moms who may not have family nearby and aren’t able to have relatives fly in due to the two-week quarantine, as well as those who have family on island and can’t get the help they need due to social distancing,” she said.

At Malama i ke Ola, the community clinic on Maui, “Our patients, along with 99% of birthing families on Maui, go to our only Maui hospital to give birth,” Milovina said, referring to Maui Memorial Medical Center.

But with uncertainty about the virus and concerns about hospital birth, Akin said a growing number of women are requesting home births who hadn’t even thought about it before.

One of them is Zeena Fontanilla of Kula, who decided at 37 weeks — two weeks before her due date — to switch to a home birth. Fon­tanilla had no risk factors and good test results throughout her pregnancy, and had a normal birth at Maui Memorial with her son Maverick, now 2-1/2. She managed to find a midwife willing to help, even at this late stage, who will deliver her baby in the Fontanillas’ tiny house, with assistance from a doula and a retired OB nurse.

Like other childbirth professionals on the island, all have been carefully practicing social distancing.

NOT EVERYONE has the option of a home birth. Katie McMillan of Kihei is due with her first child May 29. She and her baby’s father both are at higher risk for COVID-19 complications, and McMillan is at higher risk for a difficult childbirth. So her original plan to have her baby at Kapiolani Medical Center for Women & Children is on hold because they don’t want to travel.

Her mother had to cancel plans to come for the birth because of the post-travel quarantine. McMillan worries about having her partner in the hospital, due to his risk factors. And she’s wondering, if she labored alone, whether she and the baby would then need to quarantine alone at home for 14 days to protect her partner.

McMillan said she’s trying not to worry. “It’s more than likely that I won’t have any problems. But I can’t do this on my own. I’m in a risky category, so what is the greatest risk? I just want us all to be healthy.”

Kimberly Naylor of Haiku, due May 30, faces similar concerns. Her first pregnancy went to 42 weeks and her delivery of a 10-pound son required some intervention.

Naylor had always assumed she would give birth at Maui Memorial, and she’ll have to be there if she needs emergency help. She’s missing the comfort she gained in her first pregnancy from acupuncture and chiropractic visits and had to forego the baby shower that would have provided many of the things her newborn will need.

“This is a very different pregnancy because of the unknowns,” she said. “I don’t feel as emotionally strong. But you can’t go down a rabbit hole.”