Hospitals across the country are swiftly adopting new protocols for pregnant women and obstetric departments in an effort to keep up with a virus that stays one step ahead. In-person prenatal classes are moving online. Hospitals are ensuring women in labor will not mix with patients in the emergency room. And, perhaps most controversially, some hospitals are adopting no-visitor policies for women giving birth.
“I’m not a very popular guy in New York City,” said Michael Brodman, the chief of obstetrics at Mount Sinai. Brodman made the decision to bar partners and recognizes it will add stress to an already stressful time. But he could not risk someone endangering the lives of health-care workers, mothers and newborn babies. The virus is already affecting obstetrics: Brodman said eight nurses and four doctors in labor and delivery have been diagnosed with the virus.
Brodman said all women giving birth are tested for the coronavirus, with results in eight to 18 hours. New York City has become the epicenter of the nation’s coronavirus outbreak, with nearly 16,000 confirmed cases, according to Mayor Bill de Blasio.
The protective measures are evolving despite a lack of clear data on whether pregnant and immediately postpartum women or their babies are at increased risk of complications from the virus. But the urgency is clear in a country where there are almost 4 million live births every year, according to the Centers for Disease Control and Prevention.
Bruno Petinaux, chief medical officer for George Washington University Hospital in the District, said hospitals are operating with very little information.
“We still do not know exactly what is the risk of transmission from mother to baby, and because of that we are taking all precautions,” he said.
If a mother tests positive for the coronavirus, the infant will be isolated until the mother is no longer infected or the baby is found to be infected, Petinaux said. She would still be able to pump breast milk, which would be given to the infant by a nurse. George Washington is allowing women delivering babies to have one person accompany them, but that person must remain in the hospital for the duration of the woman’s stay.
In Philadelphia, the city’s five major hospitals are allowing a partner to accompany women, said David Jaspan, chair of the Department of Obstetrics and Gynecology at Einstein Healthcare Network, but worry about seeing an influx of coronavirus patients like in New York. The hospitals have been receiving calls from women in the New York area looking for an alternative place to give birth. Jaspan said they are telling the women not to come to prevent further spread of the virus.
The uncertainty has led many pregnant women to make their own adjustments to long-thought-out birth plans.
Jen Judson Vastola’s parents had planned to watch her 16-month-old while she and her husband headed to the hospital for her scheduled Caesarean section. But Vastola, who is 35 weeks pregnant, became worried that she might bring back the virus after delivery. So she told her parents to stay home.
“We just decided, with the risk of getting infected and coming back and infecting my parents, I don’t want to be directly responsible for my parents’ deaths because they wanted to see their grandchild,” said Vastola, a 37-year-old reporter for Defense News who lives in Arlington.
That led Vastola to a difficult realization: Her husband will watch the toddler, and she will deliver their second child alone.
“It just seemed safer to us,” Vastola said.
Aasta Mehta, women’s health policy adviser for the Philadelphia Department of Health, said many providers are worried that women may respond to the new restrictions by opting for a home birth. If there are complications, a woman probably would be transported to the hospital in an ambulance and risk going through the emergency room.
“We want to emphasize that we are open for business and still consider hospitals to be the safest place to have babies,” Mehta said.
Covid-19, the disease caused by the novel coronavirus, does not appear to have a serious impact on pregnant women, unlike severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), diseases caused by two other coronaviruses that are known to be responsible for severe complications during pregnancy. But scientists aren’t sure why.
The dearth of available data led a team at the University of California at San Francisco to this week launch a nationwide study of pregnant and recently pregnant women who are either suspected or confirmed to have the novel coronavirus.
Eighty women were referred from across the country within the first 48 hours, said obstetrician and co-principal investigator Vanessa Jacoby, who expects that enrollment will exponentially increase.
Because of the urgency of the mission, the project is being supported through crowdfunding rather than waiting for a research grant, which typically takes months to secure.
During flu outbreaks, pregnant women have been shown to be at greater risk of severe illness because of changes in their immune system, heart and lungs.
Researchers at the Johns Hopkins Bloomberg School of Public Health are also providing guidance on including pregnant and lactating women in clinical trials for a vaccine against covid-19.
One of the most worrisome takeaways from recent studies has been that the coronavirus may impact infants differently than other children, most of whom are believed to be either asymptomatic or have mild symptoms such as a runny nose, cough and fever. A paper in the journal Pediatrics published this month found that 33 infants out of the 378 studied had severe illness. An additional seven progressed to critical condition and had to be put on life support. All the infants survived.
New and expecting mothers are also concerned about how the coronavirus will affect their postpartum care. Women typically see a provider six weeks after giving birth, but those who have complications such as preeclampsia or gestational diabetes often visit a doctor days after delivering.
Bethany Chambers Lihwa, who gave birth to her first child Feb. 28, said a postpartum appointment was recently changed from an office visit to a phone call with a nurse. She was told that regular appointments will not resume until at least mid-April.
Despite the change, Lihwa, whose mother is a doctor and husband works at home, felt she was doing well. But she worried about other new mothers who might not have a strong support system, particularly as many states are urging residents not to leave their homes to stem the spread of coronavirus.
“It really does make you wonder who is taking care of those women,” said Lihwa, 35, who said she was content being cooped up at home in Akron, Ohio, with her newborn, David, heeding the state’s stay-at-home order. David’s grandparents have been among the only visitors; his aunts and uncles will have to meet him later.
“I’m a millennial; our generation was defined by the millennium,” she said. “I’ve given a lot of thought to David’s. They’re really going to be the pandemic generation.”
In Chicago, Herminia Chase has accepted what she calls her best worst-case scenario — that she and her husband will be alone in the delivery room, shuffled out after 24 hours and sent home to learn to care for their newborn without the help of family or friends for at least the first month.
Chase, who is due in May, is counting on being able to show her mom the baby through FaceTime and having video calls with the lactation consultant who had once planned to visit her home.
“But at the end of the day, when the camera clicks off, it’ll just be the two of us and this new little girl, just trying to figure it out,” Chase said.