Expecting in the time of COVID-19

By | April 26, 2020

We are a team of physicians: an OB/GYN, pediatrician, and pediatric and adult psychiatrist, who are primarily concerned for the emotional and physical well-being of you and your baby. The American Academy of Pediatrics released interim guidelines on managing infants born to COVID-positive mothers, and we know this has amplified the anxiety, fear, and worry about the unknown that is common in pregnancy. There is changing information about the COVID-19 pandemic, resulting in rapidly changing hospital policies as the pandemic continues.

We continue to be reassured that COVID-19 does not appear to disproportionally affect pregnant women or young children. However, the high percentage of asymptomatic individuals has made it difficult to reduce the spread of the virus. As we learn more about the virus, hospitals are rapidly transforming their infection control policies, which have dramatic impacts on expecting parents.

Such fluctuating changes are destabilizing to the relationship between doctors and their patients, as when we lose predictability, we lose trust. If you are confused, overwhelmed, and feel unable to process all of the stories and keep up with the policy changes — you are having a normal reaction to a very abnormal situation. As physicians, we want to help empower you to make the best decisions for you and your baby. And we believe that starts with building trust with your physicians.

We encourage pregnant patients to discuss with their physician the plans their community hospital has to reduce the spread of COVID-19 to pregnant women and newborns.

Many hospitals have created separate units for patients with presumed infection or positive test results to reduce spreading the virus to uninfected individuals. Hospital workers may be required to take their temperature twice a day to detect early signs of illness. Hospitals may require masking of all patients, staff, and visitors to reduce the asymptomatic spread of the virus.

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Additionally, universal screening and testing for all pregnant women has become the protocol in some institutions.

There are limitations to the effectiveness of all of these strategies due to the ability of the virus to spread before the onset of symptoms and the potential for negative test results up to 48 hours after symptoms develop.

Additionally, many hospitals have instituted new policies that limit visitation on labor and delivery. However, given that the birth of a child is a uniquely communal family milestone, many hospitals are allowing video conferencing to ensure family members not in attendance at the birth are able to participate remotely.

Many pregnant women are concerned about the risk of COVID-19 to their baby, and while there is no clear evidence to suggest that while in utero babies are at risk for infection, there is a risk for exposure to the virus after birth.

While the infection hasn’t preferentially affected young children, infants are known to have immature immune systems to fight against potential pathogens and a greater likelihood of becoming critically ill when sick.

This is particularly difficult in cases where the mother is showing symptoms of COVID-19 or has tested positive. The American Academy of Pediatrics recommends temporary separation of COVID-19 positive mothers and newborns to reduce the chance of infection during the early days of life when infants are most vulnerable.

Hospitals may move these babies in nurseries where uninfected family members may be able to visit. In some situations, after considering the risks and benefits with their physicians, a family may be able to choose to room-in with the baby — while the mother wears a mask and maintains a distance of more than six feet from the infant. Breast milk is not a source for transmission, and mothers with COVID-19 may elect to pump or breastfeed wearing a mask.

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For pregnant women, particularly vulnerable to anxiety and depression, the uncertainty and fear created by the current pandemic may become overwhelming.

We worry that the possibility of delivering “alone” and being restricted from seeing your newborn may drive women to do unsafe things. We hope that we can shed some light on the changes occurring in labor and delivery units nationwide and encourage women not to avoid seeking out medical care.

We feel called to explain that women who deliver in a hospital environment are never truly alone, and the safety of babies is always prioritized. The physicians, nurses, and technicians in the hospital are willing to put themselves and their families at risk of exposure because they are so passionate about helping your family. The calculus of how a hospital responsibly decides whether support persons can be safely accommodated or a COVID-19 positive mother is permitted to room-in with their newborn is complex.

During this difficult time, there is no “winning” or “losing” in a debate about the best way to safely care for pregnant women and newborns. There is only the goal of keeping the most women, newborns, staff, and support people healthy and well.

Pooja Deb Doerhman is an obstetrics-gynecology physician. Kelly Fradin is a pediatrician. Suzan Song is a psychiatrist.

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