As we enter the Passover and Easter Holidays, it is a time – like spring – reserved for renewal and rebirth. Religion aside, we have come face to face with a new pandemic that continues to evolve and affect our society in so many ways. As a health practitioner, my colleagues and I continue to risk our well being and health to ensure that other individuals stay safe and healthy. With coronavirus taking a toll on patients globally and locally, a sobering reality comes to perspective: Am I doing everything I can to stay safe?
In the last couple of weeks, many patients, family, and friends have asked: how can I keep myself, my pregnancy and my loved ones safe?
As an OBGYN, it is such a thrill to have patients and their loved ones present to witness the miracle of birth and life. I chose a field that is supposed to be immune to the harsh realities of life. Yet, with COVID-19 knocking on each of our doors, we need to continue to be vigilant about our health, that life continues to change and evolve around us. One of the more difficult experiences is telling both my pregnant and non-pregnant patients what they can and cannot do during this time. It has been especially challenging guiding my pregnant patients with so many unknowns associated with this virus.
Just a couple of weeks ago, my patient at my new practice delivered her new baby girl. It was nine months or personal care and focus, ensuring that after all the challenges my patient had to get pregnant, that we reached the finish line together. And despite all the restrictions associated with COVID-19, her partner was there with an incredible team of nurses to help her deliver. All the fears and chaos that came with COVID-19 disappeared the minute she delivered this incredible baby girl. And at this moment in this photograph (allowed with permission from the mother), I was able to hold this newborn after being all gowned up and protected with PPE, she held my finger, a reminder that we find purpose in the smallest things in life. I was reminded that I love what I do. I was reminded that there is hope for our future.
I wanted to take the time to answer a few frequently asked questions that I have encountered during the last few weeks. Many of the answers will be vague; many will be upsetting or directionless. I hope that I can create some clarity. I hope that we can overcome this “Egypt” known as coronavirus and travel through a desert, to a promised land that is filled with life, happiness, certainty, growth, and prosperity.
Frequently Asked Questions
Does the number of visits during my prenatal care matter?
This depends on whether your pregnancy is high risk or low risk. High-risk pregnancies, such as those women with diabetes of pregnancy, high blood pressure, twin pregnancies, may require some more in-person appointments along with telemedicine appointments. Spacing out the appointments to minimize the number of visits is a valid and appropriate method to decrease the spread of the virus.
For low-risk patients, visits every 4 weeks may be appropriate (one recommendation is in-person prenatal visits at 12, 20, 28, and 36 weeks of gestation, which line up with ultrasound and laboratory visits).
Can I be induced earlier because of the COVID-19 Virus?
In general, the guidelines for delivery have not changed. If a mother is tested positive for COVID 19 and is exhibiting symptoms that are threatening her well being, which in turn can cause fetal distress, then there may be a reason to deliver earlier. However, these decisions should be made between an OBGYN, the patient and the high-risk pregnancy physicians who are available in these difficult decisions.
Can my loved ones be a part of my birthing experience? Can my loved ones see me after I deliver, in the maternity ward?
Each hospital can enact certain restrictions to their labor and delivery and maternity wards to ensure the well being and health of their patients, staff, and visitors.
Before delivery, support partners should be screened for symptoms including fever, cough, shortness of breath, whether they have been in contact with someone who is COVID 19 positive in the prior 14 days, etc. If any of these are positive, the support person should not be allowed to participate.
Many hospitals have adopted a policy of allowing partners to be present during the actual delivery of their child, however, must depart from the hospital during the post-delivery period.
This is to limit the spread of the virus, especially in asymptomatic patients. It is difficult to not have your loved ones present during this momentous occasion. I have done deliveries were the patient had their partner present but had to leave after. In the larger picture in this pandemic, the 24-48 hours after a normal delivery, mothers are generally well taken care of by the available staff at the hospital. Limiting the number of visitors and loved ones, allows hospitals to ensure their patients go home safely and with minimal exposure to the virus, especially in a high risk setting such a hospital.
Should expedited discharge be considered during the COVID-19 pandemic?
Per ACOG: Yes. To limit the risk of inadvertent exposure and infection, it may be appropriate to expedite discharge when both the mother and the infant are healthy. For example, a discharge may be considered after 1 day for women with uncomplicated vaginal births and after 2 days for women with cesarean births depending on their status.
Can I still get an epidural for pain management during labor?
Yes! An epidural is the recommended method for pain management in comparison to IV medications for pain management during labor.
After my delivery, should I still go to my doctor’s office to follow up?
Yes! It is critical to continue to maintain adequate and responsible care. The frequency should be at the discretion of the physician as well. Your OBGYN may use telemedicine, a new and innovative way to communicate with patients, to assess your well being and health.
Any Breastfeeding precautions?
While no data indicates breastfeeding should not be performed, new mothers should make it a priority to frequently wash hands before touching their infant, and wear a mask while breastfeeding. If using a breast pump, wash the pump and/or bottles before using the pump
With these questions, many more will arise and many will remain unanswered. As always, OBGYNs are doing their best to better understand this virus and protect their patients and loved ones. If you continue to have questions, feel free to contact me or your OBGYN with questions.
As always, stay home, continue to practice social distancing, maintain a healthy lifestyle, and stay safe.
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*The following information is derived from multiple resources, including UpToDate, ACOG, and the CDC. Some of the opinions held here are my own.