Update March 23, 2020: Over the weekend, one hospital system in New York City made the decision many feared would come: banning ALL visitors, including the partners or support people for people giving birth, beginning on Monday, March 23.
“At this time, no visitors including birthing partners and support persons are permitted for obstetric patients,” New York-Presbyterian Hospital announced on its website and via Twitter. “We understand that this will be difficult for our patients and their loved ones, but we believe that this is a necessary step to promote the safety of our new mothers and children.”
New York has become the epicenter of the coronavirus pandemic. As of Sunday, there were almost 17,000 confirmed cases of COVID-19 in the state, and at least 150 patients had died, the New York Times reported. Research also showed last week that infants and young children are more vulnerable to the virus than was previously thought.
Still, this move was met with immediate, and understandable, protest from expecting parents.
“I am having my baby in a weeks time,” Sonam PY wrote in response to the hospital’s tweet. “My husband and I have been in self quarantine for almost 3 weeks. We wanted to be extra cautious and not get sick AT ALL for the birth of our first child. I am besides myself and have been crying since I heard this news.”
I am having my baby in a weeks time. My husband and I have been in self quarantine for almost 3 weeks. We wanted to be extra cautious and not get sick AT ALL for the birth of our first child. I am besides myself and have been crying since I heard this news.
— sonam PY (@justsaying_99) March 22, 2020
There is already at least one Change.org petition asking New York’s Department of Health to step in and protect patients’ right to having a support person present.
Many wondered why the hospital wouldn’t take other measures, such as testing potential visitors to clear them for being in the room. But with testing capacity still limited and slow, this won’t be an immediate solution.
According to the New York Daily News, other major hospital systems in the city are still allowing one visitor for obstetric patients. We will update this story as more information becomes available.
Original story, published March 20, 2020:
The last few days before mothers give birth are usually a special time. Though they’re anxious about what’s to come, they can calm down by getting a manicure or massage, going to the movies, visiting with friends and family, shopping for last-minute baby items, or going out to eat. For women giving birth in the midst of the coronavirus pandemic, none of that is happening. What’s more, it looks like a lot of mothers’ birth plans are completely moot in light of new hospital rules.
To contain the spread of the COVID-19 virus, hospitals in some regions, such as San Francisco, have reportedly banned all visitors. That means even spouses and partners are getting barred from the hospitals, let alone the delivery room. Elsewhere in the country, hospitals have decided to allow obstetric patients only one support person to accompany them during birth.
That means if they’re going in with their partner, they won’t be able to have their own parents or a doula present.
“I’ve been kept pretty much in the dark,” Stefanie, who is 39 weeks pregnant and lives on Long Island, N.Y., told SheKnows this week. “Just now, in my OB appointment, a doctor casually said how a local hospital is allowing no visitors. So I went to my hospital’s website, and it says ‘no visitors.’ So I had a full-blown mental breakdown thinking that I’m going into the hospital alone.”
In tears, Stefanie called the hospital, which informed her that spouses were allowed… for now.
“My mom can’t come and be with me at the hospital when I welcome my first baby — it’s just so heartbreaking,” she told us. “They said, this is what it is for now, so by next week, who knows?”
Hospitals vs. doulas
As nerve-wracking as that sounds, it’s not exactly the hospital’s fault that the rules keep changing day to day. COVID-19 is a new virus, and scientists are discovering new things about it every day. Just this week, there were new findings about how long the virus survives in the air and on certain surfaces (longer than was previously thought). This might mean that hospitals are riskier places than anyone presumed. There has also been a steady flow of dire projections of the shortages of medical equipment and hospital beds, should the number of cases spike too soon.
“A huge [factor] is the personal protective equipment, there’s not enough,” Jessica Madden, MD, a board-certified pediatrician, neonatologist and Aeroflow Breastpumps medical director, told SheKnows, explaining why hospitals might limit mothers to only one support person during labor and delivery. “They’re running out at hospitals just for the surgeons and the doctors. That support person has to also be in it.”
This has meant mothers who were previously planning to have their doulas and their partners with them, are facing difficult decisions in how to proceed with their new birth plans.
“I attended my last hospital birth on Friday, March 13,” Rebecca McKeever, a doula in New York City, told us. By Friday, “Major doula leaders of organizations in the city are really encouraging doulas to do everything virtually, because the risk of transmitting [COVID-19] when you don’t know that you have it is really high. And it seems like newborns can get sick from it, so they’re just encouraging us to try to do everything digitally.”
Doulas are figuring out ways to communicate with their clients before, during, and after labor from afar.
“You can have them on FaceTime, you can have in in the room on Zoom with you, you can Skype with them — there are a lot of things you can do to still have a presence,” doula Latham Thomas, the founder of Mama Glow, told SheKnows. “I do these audio recordings on my iPhone of visualizations, affirmations, and meditations for my clients that are personalized.”
But Thomas suggested that expectant mothers may still try to negotiate with their OB-GYNs and hospitals to let their doulas in. It seems like this might be a possibility as many hospitals consider making exceptions.
“For Labor & Delivery, the policy is one visitor per patient, but for special cases, the clinical team is open to reviewing individual requests,” a rep for Tufts Medical Center in Boston told SheKnows via email.
“Doulas are not visitors, they are they are qualified members of the health-care support team,” Thomas said. “They are non-clinical care providers.”
Though hospitals might worry about a shortage of medical gear, Thomas said they’re not taking into account the fact that doulas often help sanitize the delivery room. Since their primary role is to make a laboring mother feel more comfortable and help her labor progress, doulas arguably increase the chances of a positive outcome. High stress deliveries can have complications such as high blood pressure and a failure to progress, which can make an emergency C-section necessary.
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“We might end up with a higher C-section rate, which should be avoided because it also leads to more people in the hospital for longer periods of time, which means longer exposure,” Thomas said.
Midwives and doulas have reported an increase in interest in home births, as parents-to-be fear going to a hospital in the middle of a pandemic. This is not something that women should do late in their pregnancy, however. According to Thomas, most providers won’t change a mother’s delivery location after 32 weeks, so they’ll need to get a plan in place before then. They also need to be a healthy candidate for a home birth.
“So many women in the United States have pregnancies that are considered risky enough that they would never qualify for a home birth in the first place,” Madden said. If mothers are in a high-risk category and something goes wrong during a home birth, they’re going to wind up in a hospital anyway.
Giving birth with COVID-19
As the virus spreads, the likelihood of women contracting the virus while pregnant goes up, so it might be helpful to know what the protocols are for delivering a baby in those circumstances. The CDC has issued guidelines for health-care providers treating women who have tested positive or who are suspected to have the virus. The patients need to inform their doctors in advance, so that the hospital can implement infection control procedures to prevent further spread to other patients and to the medical staff. Eventually, Madden surmised that women who have the virus may even be directed to give birth in different hospitals from the women who do not.
“This is changing hour to hour at hospitals all over the place,” Madden said of the protocols.
The good news is that the evidence still shows there is minimal risk of mothers transmitting COVID-19 to their unborn babies, and in China babies delivered via C-section to mothers who tested positive with the virus were born healthy. It also appears that the mothers’ breastmilk is free from the virus.
“We still don’t know at this point if babies can get it during [vaginal] labor,” Madden said. This is why many doctors are making the decision to deliver babies via C-section if the mother has tested positive.
After the baby is born, the CDC says that medical providers should decide on a case-by-case basis how and for how long to separate mother and baby to prevent transmission of the virus. In some cases, this means they’ll be in a separate room, but in others, they might be in the same room but at least 6 feet apart. The latest research does show that babies and young children are more vulnerable to the virus than older kids.
Because breastmilk is OK, the mothers can either pump and have their babies bottle-fed by a healthy person, or they may be able to wear a mask, use strict hand hygiene, and breastfeed. In the latter scenario, an uninfected person needs to be on hand to take the infant from their bed to the mother and then back.
The very idea of not getting to hold your newborn baby for 14 days sounds truly painful. Fortunately, Madden says this kind of separation should have no effect on the infant.
“That bonding instinct is there,” she said of mothers and babies who have had to be separated for other reasons in the NICU. “It doesn’t matter whether it’s two weeks, four weeks, two months, four months, six months. It happens. It’s just on a different time schedule.”
Plan and relax, as best you can
Falling down the internet rabbit hole and obsessing over these negative outcomes is probably not the best idea for your final weeks of pregnancy.
“The news definitely gets to you,” Stefanie said. “The constant text messages that I’m getting — it’s really overwhelming. It’s hard to avoid what’s going on in the real world, but I’m trying.”
Thomas had some ideas of what to do instead.
First, you need to be in contact with your doctor and hospital to find out what the rules are, to mentally prepare yourself.
“Think about what it means to release your expectations of what’s perfect, what you’ve envisioned,” Thomas said. “It’s now time to think about expanding your vision for what’s possible because we don’t really know right now.”
Then, you may want to ask about cell phone, Wi-Fi, and ethernet connections at the hospital that would keep you in touch with other family members or a doula. There are small details you can control, even when the big picture is uncertain.
You also may want to take care of your mental health and have tools in place to maintain it after you have your baby.
“There’s all these apps, like Talk Space and other tools you can use so that you don’t have to go in [person] to do talk therapy, and you can actually have access to a counselor who can help to guide you through what you might be getting anxious about,” Thomas said. “Because what we do know about postpartum depression is that when we have interventions, we’re able to mitigate it.”
Finally, you can unplug and try your best to relax. Though you can’t go to a spa or restaurant, you can enlist a partner or close family member to massage you and cook something special.
Stefanie is doing what she can to make the most of these last couple of weeks.
“My options are pretty much: watch TV and try to stay calm,” she said. “I try to get some extra rest in bed, and I’ve been eating a lot.”
That sounds pretty close to what the rest of us non-pregnant people are doing right now too. It’s all in solidarity with you, Stefanie!