Being pregnant in the United States is rarely an easy thing—and that’s when we’re not in the midst of a global pandemic. So if you’re pregnant and coronavirus is all you can think about, you’re not alone.
The U.S. has one of the highest maternal mortality rates in the industrialized world—and it’s the only one where that rate is growing. Our health care system is failing pregnant women, particularly black women, who are three to four times more likely to die during childbirth or the first year of their child’s life than white or Hispanic people. These sobering stats are proof that complications during and after childbirth can always arise and they are always scary, but since the new coronavirus pandemic began earlier this year, being pregnant is— understandably—significantly more anxiety-inducing than it already was.
“I don’t like unknowns. I was OK with the unknowns of pregnancy, but this feels like a lot,” Sammi Sedler, an Atlanta resident who is currently 23 weeks pregnant, tells SELF. “I feel like I went from being nervous about my own little world to now thinking and worrying about all of society,” she says.
For starters, there is a lot that remains unknown about COVID-19 and pregnancy. This is because of the way the immune system behaves in pregnancy: as pregnant people’s bodies adjust to the presence of a fetus, their immune systems change. These changes may, depending on the pathogen and the state of the pregnancy, leave them more susceptible to certain types of infections. This is why pregnant people are so strongly warned about, say, avoiding food-borne illnesses like listeria—pregnant women are up to 10 times more likely to get a listeria infection than non-pregnant healthy adults because of their altered immune systems, and in the example of listeria, the resulting infection can [cause miscarriage or premature delivery. Another concern with infection is that high fevers in the first trimester have been shown to increase the likelihood of birth defects, though [these defects are still relatively rare.
“Pregnant patients are not ‘immunocompromised’ in the classic sense, like we see with HIV patients,” Kellie Lease Stecher, M.D., an ob/gyn in Edina, Minn., tells SELF. “The changes associated with pregnancy can make us more susceptible to different bacteria and viruses, though, as we need to change our physiology in order to protect the growing fetus and not see it as a foreign invader,” she explains. Right now, we don’t know if COVID-19 is one of those infections that pregnant people are more susceptible to. The Centers for Disease Control and Prevention (CDC) does note that “no infants born to mothers with COVID-19 have tested positive for the COVID-19 virus”, but “we still do not know if a pregnant woman with COVID-19 can pass the virus that causes COVID-19 to her fetus or baby during pregnancy or delivery.” “And we do not have any published scientific data on susceptibility to COVID-19 and pregnancy,” says Dr. Stecher. “However, I do look at [pregnant women] as potentially more susceptible and want them to be as careful as possible,” she explains.
This includes practicing social distancing, perhaps to an even more extreme degree than non-pregnant people. While the World Health Organization (WHO) and the CDC aren’t currently recommending pregnant people take any specific additional precautions against the new coronavirus, due to a lack of data and an abundance of caution, some individual obstetricians have suggested their patients continue to act as though they’re at an increased risk.
“My OB basically told me she would prefer that I not even go to the grocery store,” says Sedler. “I have always had mild anxiety, but I had been surprisingly not anxious for the first half of my pregnancy. I’m trying to keep that mindset, but it feels impossible. Just last week, I was annoyed that we couldn’t book a pre-baby trip to Hawaii and now I can’t even go to Publix,” she says.
The practice of prenatal care is also changing—rapidly. Doctor’s offices and hospitals, especially in hard-hit areas, are canceling [medical appointments, procedures, and surgeries deemed “nonessential,” “elective,” or “routine.”. “We have overhauled our office policies: every patient gets a phone screening prior to their visit, asking about SARS-CoV-2/COVID-19 symptoms. We have cancelled all elective surgeries in line with the guidelines from the surgeon general and the joint statement put out by [major ob/gyn societies],” Jaclyn Friedman, M.D., a practice physician in gynecology in Atlanta, tells SELF. That means they have canceled the vast majority of office visits and surgeries, she explains, adding that the doctors in the practice are also decreasing how many hours they spend in the office.
“We want to minimize all contact—patient to patient, patient to staff, patient to provider—to decrease the risk of transmission of this virus,” Dr. Friedman says. Some hospitals are also canceling maternity ward tours, a rite of passage for many parents choosing where to deliver. However, which category prenatal office visits and ultrasounds fall into can be inconsistent and confusing from practice to practice.
Harya Tarekegn, who is 17 weeks along in New York City, says her OB group has canceled all her “routine” visits to minimize exposure risks. “The only reason my next appointment isn’t canceled is because it’s a full-body scan, so it is not considered routine,” she tells SELF. For those offices carrying on with appointments, the protocols have changed. Dr. Sedler says at her last appointment, “there were signs all over the office, including on the front door, instructing patients on what to do if they had any symptoms, and they were Cloroxing the checkout desk when I went [in]”— a constant reminder that a health care office is actually the most vulnerable place a pregnant woman might be going. Ob/gyn offices are also strictly limiting who can enter. “In the past we have encouraged grandma to come in to listen with our patient to the baby’s heart rate, as well as siblings and partners, but we are now trying to minimize the attendance of other folks,” Mary Jane Minkin, M.D., a clinical professor of obstetrics & gynecology at Yale University and founder of MadameOvary.com, tells SELF.
This change in visitor policy is happening most intensely at hospitals. Many hospitals have reduced their visitation policy to just the partner of the person in labor, while the entire New York City private hospital system has banned any people in the delivery room with laboring people, including spouses, and other hospitals are beginning to follow suit.
“I’ve felt sick over it,” Liza Maltz, a birth doula and the founder of BirthYourOwnWay doula services in New York City, tells SELF. “[To have] no one is horrible.” These changes, while ostensibly for public health, may be really challenging for laboring women: [surveys have found that having support in labor improves how a woman views her experience.
“We understand that addressing this public health crisis has required hospitals to implement additional infection prevention control protocol, as well as other procedures to maximize the capacity for patient care and safety,” Christopher Zahn, M.D., vice president of practice activities at the American College of Obstetricians and Gynecologists, tells SELF in a statement. “We also recognize that these measures can have a significant impact on a laboring mother’s support in the delivery room. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by a partner or support personnel such as a doula is associated with improved outcomes for women in labor. As hospitals move forward with measures and policies in the face of this crisis, ACOG urges them to consider innovative solutions and localized, collaborative approaches that ensure laboring patients have the support and stability they need through this chaotic and stressful time,” he says.
In the interim, Maltz’s company is now offering virtual doula services to laboring women, which she says she’ll customize based on the needs and wants of each parent. “We can set up a virtual conference with your partner while you are laboring, help you communicate with nurses and advocate for yourself,” she says. “But it is a very hard situation.” The potential lack of an advocate can be especially detrimental for black people giving birth, who medical providers can be less likely to listen to due to factors like implicit bias.
Some women are opting to go into labor early via induction, to enter the hospital system—and leave it—as swiftly as possible. “Ob/gyns have always been able to offer elective inductions at 39 weeks, one week before your due date, if your cervix was ‘favorable,’” explains Dr. Stecher. (A “favorable” cervix is determined by how dilated and effaced you are, as well as the position of the baby. Inductions done at 39 weeks or later have a low risk of C-section, though earlier than that may result in complications including infection.) “Now that COVID is here, more patients are opting for these inductions,” Dr. Stecher says.
Marie (who asked that her last name not be shared), is 39 weeks along in Chicago and is one of those women—she didn’t want to risk that she would go past her due date and end up entering a hospital that was potentially even more overburdened than it is now. “I asked my doctor if it made sense, given the unprecedented and very uncertain situation that we’re in, to schedule an induction, and she was supportive of it,” she tells SELF. (Marie’s induction was scheduled for March 20.) Scheduled inductions also help predict the flow of foot traffic in and out of the hospital, which aids in keeping things more predictable for doctors who are under a lot of pressure right now. “Ob/gyn is a unique medical specialty in that we can’t plan for when these patients are going to be in labor,” says Dr. Stecher. “If we can somewhat control when they will be present during a pandemic, it could allow us to allocate staff and resources to better protect them.” Of course, there is also the concern about hospital stores of personal protective equipment (PPE) running low—there is certainly a mentality that it is better to get in to a hospital now before stashes are too low. Dr. Stecher assures women that “during deliveries we will be wearing protective equipment. Pre-COVID, we would wear a gown, mask, shoe covers, and gloves. Now with COVID, physicians and nurses will be more adherent to proper medical protection and equipment.” (As long as supplies allow, anyway.)
While these changes may seem overwhelming to adjust to, to be clear, they are not a reason to avoid the hospital. For one thing, you may not be able to easily have a safe home birth instead. Nuranisa Rae, a midwife in New York, says her phone “hasn’t stopped ringing” with requests to switch to a home birth, but it’s just not possible to accommodate all of the people calling. [SELF reached out to several other midwives who confirmed this experience, and the New York Home Birth Collective issued an open letter advising this influx of women to consider home birth very carefully.]
“I try and only take three people per month,” Rae tells SELF. “We can’t stretch ourselves too thin. The risk of me taking on more people exposes me more and takes away from those who were already with me on this journey.” Additionally, midwives already lack the PPE that even hospitals are running low on, putting them in danger of contracting the virus if they’re called into dozens of new homes. “Being afraid of a hospital birth is not a good reason to have a home birth,” Rae says. Plus, attempting to birth at home isn’t a guarantee you’ll be able to: between 10 and 30 percent of home-birthing moms will still need transportation to the hospital for emergency services. The truth is, no matter your plan, this is a hard time to be pregnant. “I keep thinking about [all these changes] and the disproportionate loss of black mothers we have,” says Rae. “This is, to me, one more demonstration of how we are not paying attention to what women need.”
If you are pregnant, there are some steps you can take to help protect and prepare yourself. “Do your best as a future mother to keep yourself healthy by distancing yourself socially, washing your hands, and getting your flu shot,” says Dr. Friedman. Maltz says she is advising her clients who may have to birth solo to download their birth plans to their phones so they’re not forgotten at home. She also recommends, if you have a vaginal delivery, asking to see if you can be released early. “I also would suggest full isolation for you and partner in the weeks coming up to your birth if possible,” she says. While the situation with COVID-19 continues to change—and rapidly—physicians, midwives, and doulas are doing everything possible to help their patients. “Medicine has never changed this fast,” says Dr. Stecher. “I urge people to have an open mind and be flexible with us. We all want to put our patients and their safety first.”