March 30, 2020

While some patients can reschedule their medical appointments in the face of the global coronavirus pandemic, pregnant women have little flexibility, so OB-GYNs have had to change how they approach pregnancy, birth, and postpartum care.

3 ways COVID-19 is changing pregnancy for patients and providers

How COVID-19 is affecting prenatal care and childbirth

One change some providers have made is to conduct more prenatal appointments through telemedicine, Vox reports. According to Denise Jamieson, chair of the department of gynecology and obstetrics at Emory University School of Medicine, "People are looking broadly at what the role of telehealth can be in this era." As part of that, doctors are also sending pregnant patients home with blood pressure cuffs and training them on how to use them, Vox reports.

When it comes to delivery, pregnant patients have little control over when their baby is born. However, in light of growing concerns about the new coronavirus and hospital capacity, some OB-GYNs in the United States and abroad have started offering induced labor for women who are at least 39 weeks. Induced labor is typically available only for medical purposes, according to the New York Times.

Julia Belluz, a reporter for Vox, in mid-March had an induced labor, at her doctor's advice, five days ahead of her due date. She gave birth to a healthy baby boy. When the doctor recommended the induction, he told Belluz, "Things are changing by the half hour."

At the time, cases of COVID-19 were doubling every two and a half days in Austria, where Belluz and her husband live. That means every day, "the probability of an outbreak in our hospital increases, as does the chances that it'll have to shut down."

Still, some have raised concerns that calls for induced labor could have unintended consequences. Jhoanna Galvez, a licensed midwife based in Los Angeles, explained that induced labor can sometimes increase the amount of time a pregnant woman has to spend in the hospital. Research shows induced labor is associated with a longer birth process than non-induced labor. 

Meanwhile, concerns about COVID-19 and hospital capacity may be spurring some patients to consider home birth.

However, experts say that patients don't need to plan for a home birth unless they were already planning one, Vox reports. "I don't think COVID should change women's choices about where the safest and best place to deliver is," Jamieson said. "Hospital systems are taking appropriate measures to ensure the safety of their patients."

According to Jamieson, when it comes time for delivery, hospitals "are making plans to ensure that healthy pregnant women are separated from ill pregnant women" and following CDC guidelines to evaluate pregnant women for symptoms of COVID-19. "I think pregnant women should be reassured that the health systems are taking these issues very seriously," Jamieson said.

Many hospitals are also limiting the number of people who can be in the delivery room, Jamieson said, typically just one or two people.

However, that can mean pregnant women have limited support in the delivery room. When Latoyha Young was taken to a California hospital to deliver, restrictions on visitors meant her doula couldn't come with her.

How COVID-19 is affecting the postpartum period

Another concern for mothers and health care providers is how to keep babies safe once they're born. As of now, there is no evidence that a pregnant person can transmit COVID-19 to their baby during pregnancy or as part of the birthing process, Jamieson said. However, an infected mother—or anyone—could still transmit the virus to a baby by exposing the baby to infected respiratory droplets. Illinois on Saturday announced the first infant death in the United States. The infant tested positive for COVID-19, but the exact cause of death is not yet known.

According to Vox, there are differing recommendations on how to best protect babies from infected parents. The Royal College of Obstetricians and Gynecologists in Britain recommends that parents consider wearing a facemask while breastfeeding, while CDC recommends potentially pumping milk and having someone else feed it to the baby.

"I don't think there's any one answer" for breastfeeding while infected with the new coronavirus, 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."

Social distancing protocols can also have an effect on the postpartum period, as social distancing can limit visits from doulas and family members who would otherwise help new parents out.

While a number of hospitals are postponing elective surgeries to clear 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" (Belluz, Vox, 3/18; North, Vox, 3/19; Guo, Fuller Project/New York Times, 3/26; AP/Los Angeles Times, 3/29).

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