by Christen A. Johnson

Credit: CC0 Public Domain

Before Rachael Stewart gave birth to her second child, a baby boy named Caleb, on March 26, she knew many of the items on her birth plan would not go as envisioned due to the effect of the coronavirus on hospitals.

Stewart wound up not using her doula as much as planned, and her out-of-state mother—who bought a flight to be at the birth in person—was on video until Stewart started pushing. Stewart's husband was there with her.

Her labor and delivery experience wasn't so bad, said Stewart, especially since she was induced. It wasn't until they got to the postpartum unit that "things really got intense," like her husband not being able to leave the hospital room postpartum. And that was before stricter limitations were imposed.

But now, most pregnant patients aren't even allowed a visitor after giving birth. For pregnant patients who test positive for COVID-19, it's more isolating.

Dr. Melissa Simon, an OB-GYN at Northwestern Medicine, said there hasn't been much new information in the last six weeks, but that many of the protocols have evolved, like no visitors in prenatal care or ultrasound appointments, and no visitors allowed postpartum.

"You can have your one visitor during birth, but then they can't stay postpartum," said Simon, who said these measures are in place for all pregnant patients at Northwestern Medicine Prentice Women's Hospital, as well as in many hospitals throughout the country, not only those who test positive for the coronavirus.

All pregnant patients who go into labor at Prentice are tested for COVID-19, with results usually coming in about two hours, Simon said.

If a patient tests positive for COVID-19, they are put in a separate unit on a different floor that has a separate health care team. Those women are completely isolated, said Simon.

The regular labor unit for pregnant patients who test negative for COVID-19 remains mostly the same in terms of nursing and physician support, said Simon, except everybody is wearing a mask, which can make interactions feel less personal.

"You can't really see the smile through the mask," she said, "so it feels a little more sterile in some sense because we're trying to keep everyone as safe as possible."

Physicians and nurses are still regularly making visits to check on pregnant patients who are positive for COVID-19, and are also utilizing phone calls into rooms "if there's a need prior to being ready to push," said Simon.

"We actually have to be more present for (the women who are COVID-positive) than ever before" since they don't have any visitors, said Simon.

But options for patients in labor have changed overall, like not being able to use the inhaled anesthetic, and not being able to walk around the labor floor to help manage pain.

"That (anesthetic) is not allowed right now during COVID because it could actually enhance the spread," said Simon.

The issue around a newborn potentially contracting the virus is still based on contact, Simon said.

"In the world right now, there's a little bit of data that shows there's no transmission (of COVID-19) through breast milk or amniotic fluid," said Simon. "The few newborns in the world who contracted coronavirus likely they got it through contact. That hasn't changed."

Stewart, who gave birth at the University of Chicago Medicine Family Birth Center, had a different experience since her labor was induced before these limitations from the coronavirus and stay-at-home order.

"We really got so blessed because we were right before things really ramped up," said Stewart. "It's really limited right now."

Stewart, her husband and their new baby left the hospital before the standard two-day postpartum stay. The family was discharged less than 24 hours after Stewart gave birth, which is what Stewart wanted.

"I think (the doctors) just realized, because of the fear and caution of everything going on, they weren't going to make us stay at the hospital unless I had a reason to, so that was good," she said. "It was just very, very intense."

It is possible for postpartum patients to feel more baby blues, anxiety, stress or depression than usual because of the pandemic and stay-at-home order, Simon said. "It's totally normal."

"Keep asking questions and reaching out (to your health care provider or your baby's pediatrician) if you're feeling down, anxious, nervous or depressed," urged Simon, who said health care teams "are better poised and a little more savvy" about helping patients through telehealth visits than they were six weeks ago.

First-time parents face a unique challenge of entering parenthood during a pandemic.

"It's OK to not be perfect; everyone right now is feeling not perfect," said Simon, "and it's even more exaggerated when you're a new parent and you're trying to do everything you can for your new baby. You might be reading online more so than ever right now about what you're supposed to be doing for your baby. Being a new parent, is a learning process."

If a first-time parent tested positive for COVID-19 and is on the isolation floor without a support person, Simon said it's "really important to ask your nurses and health care team to help you and be present."

"If you're giving birth for the first time, I think it's important to understand that you can't control anything at this point," said Simon. "The most important thing you can control is if you feel like something is not right or if you have questions, don't be afraid to ask for help or more support. It's important to understand we are all here for you when you come to the hospital, and we will do our best to care for you. But if you need something please let us know."

Stewart's son has gone to the pediatrician twice since he was born: once for the initial check up and the other for a weight check. When he turns 2 months old, he'll go back to get immunizations.

For the first visit, Stewart said she had to call to get in and was asked screening questions. Once she got to the doctor's office, they screened her again and took her temperature. People in the lobby were wearing masks and social distancing, she said.

"By the second visit, it was even more," she said. "The doctor didn't come in until it was time to do exams, she actually called me on the phone while we were in the room just to ask all the screening questions so she didn't have to prolong our time in close contact. The first time I felt was a little more casual, this felt a more like get in and out."

Stewart said her family has received ample support, gift cards and meals from others, but having a newborn in quarantine has been stressful.

"It's hard enough being a newborn mom, and also acclimating to being a mother of two, but adding to that being in the midst of a global pandemic has just been something next level," said Stewart. "Some days it's overwhelming, and some days you can manage it a little bit more. We've just been trying to find the blessing in it."

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