First Heather had to cancel her baby shower.
She lives in Seattle, one of the first cities in the US to be hit by the coronavirus pandemic, and scrapping the planned event seemed small in the grand scheme of things — just another side effect of social distancing recommendations in place across the country, she told me.
But with the pandemic still raging around the world, she’s not sure what’s coming next for her pregnancy, or the birth of her first child, due June 24. For now, almost all of her prenatal appointments are done by telemedicine, though she’s still waiting for guidance on what to do about her next ultrasound. And she’s not sure what will happen to the hospital where she’s slated to give birth if the pandemic becomes even worse.
“I think they’re anticipating keeping the delivery wards open,” she said, “but if the hospital is overrun with sick patients, I also don’t think they really know what that would look like.”
Heather joked recently with a friend who had a home birth: “At this rate, I may need some tips.”
Experts say that as of now, people don’t need to plan a home birth if they weren’t already doing so. “I don’t think Covid should change women’s choices about where the safest and best place to deliver is,” Denise Jamieson, chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine, told Vox. “Hospital systems are taking appropriate measures to ensure the safety of their patients.”
Still, the many uncertainties around coronavirus, as well as the realities of social distancing, are changing everything about pregnancy, childbirth, and the postpartum period, from how doctors test blood pressure to what role family members play during delivery. Hospitals, doctors, doulas, and others are stepping in to make sure pregnant people and new parents have as much support as possible. But as Heather put it, for people giving birth during this time of worldwide crisis, “there’s just still a lot of unknowns.”
Hospitals are taking precautions to help people give birth during the pandemic
While much remains uncertain about coronavirus and pregnancy, there are some hopeful signs. “To date, there’s not evidence that pregnant women are either more susceptible to coronavirus or are more likely to have severe disease” if infected with coronavirus, Jamieson said.
But people who are pregnant right now are having a new and unprecedented experience, even if they won’t be delivering for months. Heather isn’t alone in having some of her prenatal appointments take place remotely.
“People are looking broadly at what the role of telehealth can be in this era,” Jamieson said. That includes efforts to send blood pressure cuffs to pregnant people’s homes and train them on how to use them, since hypertension is a major cause of maternal illness and mortality in the US.
Heather said she will have to go to her doctor for her gestational diabetes screening. This test requires a patient to drink a glucose solution and have a blood test about an hour later. Heather’s doctor told her she could drink the solution and then wait in her car until it was time to have her blood drawn, minimizing her exposure to other patients and risk of infection.
When it’s time to come in for delivery, hospitals “are making plans to ensure that healthy pregnant women are separated from ill pregnant women,” Jamieson said. Most hospitals, she said, are following CDC guidelines to evaluate pregnant people for Covid-19 symptoms. Anyone who exhibits them should be given a mask and should deliver in an area set aside for pregnant people with possible Covid-19, she said. “I think pregnant women should be reassured that the health systems are taking these issues very seriously.”
Another precaution a lot of hospitals are taking is limiting the number of support people allowed in the delivery room, Jamieson said. This week, two hospital networks in New York City, where the US outbreak is especially severe, announced they would bar all support people — including partners and spouses — from delivery rooms, meaning pregnant people will have to give birth on their own. Other hospitals in the area continue to allow a support person, however, and some have criticized the blanket ban, according to the New York Times, arguing that it could put laboring patients at risk if doctors and nurses cannot be in the delivery room at all times.
Aside from partners, doulas could also offer support virtually during labor and delivery, Nicole JeanBaptiste, founder of the Bronx, New York-based Sésé Doula Services, told Vox. When doulas are talking to clients now, she said, “we have to be upfront with them regarding the fact that things can change by the day.”
In general, hospitals will have to continue doing what they can to help people give birth safely, even during this crisis. While many hospitals are canceling elective surgeries to make room for Covid-19 patients, “pregnancy is one of those issues that’s not elective,” Jamieson said. “We can’t slow down; the babies keep coming.”
A lot of people are curious about home birth right now
JeanBaptiste says questions about home birth are “a very big hot topic” among clients right now. As a doula, she says, “I would feel more comfortable supporting someone in their home rather than going to a potentially overrun hospital.”
However, home births aren’t an option for everyone. Patients who are carrying twins or have a history of C-sections or certain medical conditions are typically advised to avoid home births. Meanwhile, JeanBaptiste said, “all home birth midwives are out of network” for insurance purposes, meaning patients must typically pay out of pocket, putting the procedure out of reach for many low-income parents-to-be.
And Jamieson and others say that at least for now, Covid-19 shouldn’t be the reason someone chooses a home birth. Economist and Expecting Better author Emily Oster, a go-to source for many pregnant people and parents, argues in her newsletter that people currently late in their pregnancies should not switch to home births, especially since around 30 percent of first-time home births require emergency transport, and “if the medical system is overwhelmed, this will be among the worst things to need.”
Having a baby during a pandemic presents its own challenges
Whatever choice a person makes regarding birth, the impacts of the pandemic don’t end there. If a pregnant person becomes infected, for example, there are special considerations for newborn care.
There’s currently no evidence that a pregnant person can transmit the virus to the fetus during pregnancy or birth, Jamieson said. There’s also no evidence that the virus passes through breastmilk, according to the Royal College of Obstetricians and Gynecologists in Britain. Once babies are born, however, they are susceptible to the virus, Jamieson said, and recommendations differ on how to best protect them if the birthing parent is infected. The Royal College says that while parents with coronavirus can continue to breastfeed, they might consider wearing a mask. Another option is to pump milk and have someone who is well feed it to the baby, according to the CDC.
“I don’t think there’s any one answer” when it comes to breastfeeding, Jamieson said. “It depends on a lot of factors, including how sick the mother is, how much coughing and sneezing and symptoms she has, as well as the wishes of the mother and her family.”
Meanwhile, social distancing protocols could affect the postpartum period too, even if parents and baby are healthy. Doulas often make postpartum visits to help with breastfeeding and other issues, but depending on travel and gathering restrictions in a given place, that may not always be possible, JeanBaptiste said. The federal Maternal, Infant, and Early Childhood Home Visiting Program provides home visits to low-income and other at-risk families after a birth, but some states have suspended face-to-face home visits “to protect the health and safety of families,” a spokesperson for the program told Vox in an email.
And it will likely be more difficult for family members, especially grandparents and other older adults, to visit and help out with a new baby during this time. For Heather, it’s not even clear if her husband will be able to help. He’s about to be deployed overseas with the military, and though he’s scheduled to return in time for the birth, he may have to be quarantined, she said.
The coronavirus pandemic could also worsen existing inequalities in maternal health care. Even before the pandemic hit, black women in the US were dying in childbirth at three to four times the rate of white women. Meanwhile, research has shown a general bias against black patients among many white physicians, which can have serious effects on care. One study, for example, found that racism was associated with a greater likelihood that white patients would be treated for heart attacks than black patients. The pandemic “absolutely is going exacerbate those health care disparities,” JeanBaptiste said.
Despite the many challenges posed by the current crisis, though, many doctors, doulas, and others who work with people giving birth are doing their best to make sure families are still supported. The states that have suspended face-to-face home visits through the Maternal, Infant, and Early Childhood Home Visiting Program are replacing them with telephone or other remote visits, the spokesperson said. And “folks within the doula community are really swift in pulling together” to create “tangible tools that can be used in the event that we are called to support people solely virtually,” JeanBaptiste said.
Meanwhile, pregnant people and new parents are working to cope with the new reality. The Cut’s Irin Carmon has written of her own pregnancy during a time of social distancing: “As for the creature that is most depending on me, we’re both sheltering inside for now, and all I can really do is try to make the vehicle of her isolation a little more hospitable.”
Vox reporter Julia Belluz, who had a recent induction in Vienna, Austria, wrote before she went to the hospital that “in the past few days, we’ve never talked more to friends and family. Among all the surprises of the pandemic, this closeness and neighborliness — at a time we’re supposed to be isolated from each other — is the feeling I’ll bring to the maternity ward tonight.” She gave birth to a healthy son on March 17.
For Heather, the past has been some education. A military reservist who has been deployed to war zones, she’s been trained in how to handle being detained for long periods of time, “not knowing when or if you’ll get out and figuring out coping mechanisms for that.”
Today, she says, “I’m not in a cell,” but she is limited in where she can go and what she can do, and “not knowing how long this is going to last” is stressful. But she continues to take walks in her neighborhood, FaceTime with friends, and sometimes have conversations with her baby about timing.
“I’m talking to my unborn child and being like, it’s okay if you stay in there a couple more weeks, just in case,” she said.
Correction March 25: Emily Oster has noted that she cited an incorrect statistic for emergency transport after home births. Around 30 percent of first-time home births require transfer to a hospital; this story has been updated to reflect the correct figure. It has also been updated to reflect the news that some hospitals in New York City have instituted a ban on all support people, including spouses, in delivery rooms.