Among the people whose lives are being turned upside down by the coronavirus are many pregnant women.
As they prepare for one of the most intense and emotional experiences of their lives, they face the possibility of delivering babies in hospitals filled with COVID-19 patients — and plans they've made for where to give birth and who will be there with them are often now in question.
That's the situation confronting Lauren and Daniel Herriges of Sarasota, Fla., whose first child, a daughter, is due April 3. For assistance during childbirth, they hired a doula, a support person who helps laboring women. The Herrigeses had planned to have their doula with them in the delivery room at Sarasota Memorial Hospital, but they recently got crushing news: To reduce the risk of coronavirus infection, the hospital is limiting delivery room visitors to just one person.
"That's a bit gut-wrenching," Lauren Herriges says, "because I like my doula and wouldn't have gotten one if I didn't think it would be very helpful."
Then came an even more startling update from the hospital: "That I should be prepared to not be permitted to have any support person at all — so no husband, which has really kind of rocked my world," Herriges says.
The prospect of going through childbirth without her husband by her side has Herriges considering an option her doctor recommends against: being induced early. That's left Herriges with a dilemma: Should she go to a different hospital with an unfamiliar doctor?
"Or do we suck it up and stick with the same practitioner I've been with for years ... but then maybe not have my husband?" Herriges says. "That's one we're still trying to figure out. And we're running out of time."
As hospitals cope with the widening coronavirus pandemic, many pregnant women are having similar debates, worrying about how the disease could affect their babies, and wondering if maternity wards may experience a shortage of beds, staff or supplies as the coronavirus spreads.
"As you can imagine, our phones are ringing off the hook from folks that have questions about coronavirus and pregnancy, and other effects of coronavirus on their health," says Dr. Jeffrey Ecker, Chief of Obstetrics and Gynecology at Massachusetts General Hospital in Boston.
Because COVID-19 is so new, definitive answers are hard to get. So far, there doesn't seem to be evidence that women are more likely to contract the virus when they're pregnant, and limited research suggests that the coronavirus cannot be transmitted during childbirth or breastfeeding, although the preliminary studies are sometimes conflicting.
"The reality is we don't have a lot of data related to outcomes in pregnancy in women who have COVID-19 or their risk of contracting COVID-19," says Maureen Phipps, chief executive officer of American College of Obstetricians and Gynecologists, "and that does put us at a disadvantage."
Pregnant women are considered an "at-risk population for COVID-19" because they're generally at higher risk from respiratory infections, so numerous hospitals nationwide are minimizing childbirth visitors and doing more prenatal visits by phone or online, as recommended by the American College of Obstetricians and Gynecologists.
The organization is not advising early deliveries solely because of the coronavirus. But the M Health Fairview system in Minnesota is offering that option to some women at least 39 weeks pregnant (a full-term pregnancy is 40 weeks). Through "elective ripening of the cervix," the hospital can prepare those women to be induced before their due dates.
The purpose of that, according to Dr. Laura France, an OB/GYN at Fairview, is "to try to have women come in and be delivered and go home again before we really start to see a surge of COVID-positive women in our maternity units."
Other hospitals, including Mass General, are not offering early inductions to women concerned about COVID-19 unless they have a medical reason that justifies it. Several physicians interviewed by NPR cautioned that early inductions can fail, forcing pregnant women to have cesarean sections. Inductions can also pose health risks to babies and cause mothers to spend more time in the hospital.
"In many of the conversations I've had, patients have asked if it might be better to have their baby quickly now, regardless of their gestational age, before there is a rush of sick patients in the hospital," says Dr. Maya Zapata, an OB/GYN at UCLA Health in Los Angeles. "My advice has been that that's probably not necessary."
According to multiple hospitals and health systems contacted by NPR, if a pregnant woman were COVID-positive or suspected of having the virus, she would be put in a separate part of the maternity ward to lower the risk of infection spreading, and women who have the virus may have to be separated from their newborns for 14 days. They also said they have plans in place to try to ensure that all needed beds, staff and supplies will be available.
Some pregnant women are wondering if they should avoid hospitals entirely and instead opt to give birth at home or in a birthing center. But France, of Fairview, advised against that, noting that with nonhospital births, "we never know when something might go wrong" and require a hospital trip anyway. She considers hospitals a safer option, even if delivery room visitors will be limited.
"This is really a time to let technology be your friend," she says. "One of the patients up on the maternity unit today is Skyping with her doula, and that's been a big push with a lot of the doulas. So use that Skype and FaceTime technology to try to stay in contact."
Like Fairview and Sarasota Memorial, Mass General and UCLA Health are also limiting delivery room visitors to one person.
"If a woman wants her whole family in the room with them, we typically are OK with that if that's what the patient wants," Zapata says. "But in the setting of coronavirus, we are trying to limit the risk for the patient, her baby, her support person, her family, our staff and the public in general."
Ecker noted that MGH has no plans to require women to give birth alone "because we recognize that, boy, it would just seem so different and in some ways unkind to not have one's partner or support person there during labor and delivery."
Added Ecker: "I have two children and can't imagine not being there for the birth of my two children, but we recognize that these are unimaginable times."
Research also suggests that support during childbirth can improve health outcomes for women and infants.
Sarah Laskow recently gave birth to her first child — a 7-pound, 7-ounce daughter named Miriam Louise born March 22 at NYU Langone in Manhattan — and is grateful that her husband, Ben Furnas, was with her in the delivery room.
"While I was having contractions," Laskow recalled, "we were seeing all these emails from other frantic parents-to-be who all of a sudden had to deal with the fact that they probably were going to have to deliver the baby alone or go to another state entirely in order to have their partner with them."
That's because earlier this month some New York hospitals told pregnant women they couldn't have any support person during childbirth. Within a week the state health department had prohibited that policy.
As she and her husband now shelter in place in Brooklyn, Laskow says they don't mind being confined to their home because "we keep talking about how we would have been in our apartment not leaving anyway because we have a newborn baby."
Now, she says, "Everyone else is stuck in their apartment not doing anything, so we're not really missing out."
As for their baby's arrival, she joked, "We're kind of convinced that she's maybe a little bit psychic because she came right on time."
Noting that their daughter was actually born two weeks early, Laskow added: "Well, she came right on time for the circumstances that she was born into!"
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