Baby On The Way? Here's What You Need to Know as it Relates to The Pandemic
Expecting or have a newborn at home? You’re not alone. Thousands of expecting and new parents throughout the country are figuring out how to navigate a new world with the presence of COVID-19 in it. And, we all have a lot of questions.
We sat down with New York City-based OB-GYN, Dr. Jaqueline Worth, author of The New Rules of Pregnancy and Jada Shapiro, founder of boober and Birth Day Presence to discuss how our lives have changed in the wake of COVID-19 and what to expect if you’re pregnant or have a newborn at home. Together, they answered your questions and concerns related to C-sections, new hospital protocols and how to interpret the data that is available.
*Recorded via IGTV on April 13, 2020. Please note facts and recommendations are evolving daily and always make sure to contact your doctor for any personal questions.
What are the testing policies at your hospital?
My hospital has the resources to begin offering testing to all pregnant patients and their partners. It’s a huge change that’s been ushered in over the past week. The way it’s working is that when patients come in in labor they’re tested on admission and their partners or husbands are tested on admission. If their labor is induced or they’re having a scheduled C-section, the patients and partners are tested the day before. It’s working really well. Basically for anyone that has a scheduled admission, we know in advance whether they are COVID-19 positive or not. For everyone else, you find out later on.
It’s important to note that things are different week by week, state by state and hospital by hospital. For my patients this week, I found that there was tremendous calmness and reassurance for the patients that were induced because they came in knowing that they were COVID-19-negative. It meant that there was no fear in that room. They knew that they were safe. The nurses and doctors that worked with them weren’t worried about being infected by the patient. On a simpler level, it also requires fewer protective supplies like masks and gowns. So this week in New York City, I would suggest thinking about inducing to make things a little less stressful.
How are patients with unknown status being treated?
Someone who is tested but doesn’t have a reply yet is considered PUI (person under investigation) and is treated with all the same precautions as someone who is positive. The tests take 4 to 8 hours to come back so for my patients who came in in strong labor, in neither case was the test back before they delivered. It’s important to note that in labor whether you are COVID-19 positive or negative, you will have a partner with you until the baby is born.
Who should be wearing a mask?
It is recommended that for all patient and provider interactions both the doctor and the patient should be wearing masks at all times. It is a little difficult to wear a mask while pushing as you’re breathing more heavily during contractions so practice wearing a mask if you can.
Does induction increase your chance for C-section birth?
There was a study about two years ago called The Arrive Trial published in The New England Journal of Medicine that looked at induction of labor in low-risk healthy patients at 39 weeks. This was a study that I spent a lot of time talking to my patients about because it was considered a practice-changing study and it basically said that induction of labor in healthy low-risk patients a week before the due date led to a lower C-section rate and fewer complications with mother and baby related specifically to high blood pressure. It is true that in the past when I would induce patients, they tended to be a week past the due date, so the simple answer is induction of labor is supported by medical literature as an appropriate consideration for patients a week before their due date and so during this time it may be something that you want to consider.
How do I handle visitors post-delivery?
It’s extremely unlikely that in your trip to the hospital you’re going to catch COVID-19 but even so I’m not allowing myself to see my family or my parents just in case I have something I don’t know about.
If a birthing parent’s test is coming up positive, will the parent be separated from the baby?
The official recommendation from the CDC is that if the birth parent has COVID-19, they should consider having a healthy parent take care of the infant during the 7 to 14 days that parent might be contagious. Seven days after your symptoms as long as you're well and no longer have symptoms and you’ve been afebrile for 72 hours without the use of Tylenol, you’re considered to be non-infectious ,so during that period you should consider having a well person rather than a sick parent take care of the baby.
Are patients being discharged faster than normal due to the virus?
Yes. The reason being that the hospital is working to minimize people’s exposure to each other as much as possible. For vaginal birth, patients are discharged at 24 hours of life and for C-section (unless there’s a complication), they are discharged at 48 hours of life.
How are pregnant patients who have COVID-19 faring?
The patients that I’ve seen have all done really well and I think that goes along with some of the data that suggests that 80% of the COVID-19 cases are mild. One reads cases that are pretty serious and I think that reflects the nature of this virus, that most people are fine but from time to time people with underlying issues or just with pregnancy can get really sick.
How are you protecting a hospital room in general?
It’s drastically different. Nobody goes in the room, it’s an entirely different situation. There’s nobody stopping by.
What is the transition to postpartum like?
At my hospital the partners leave two hours after the birth at the time where the mom is transferring to the postpartum room. All babies are rooming in and the mom is there for 24 hours and then she goes home, so it’s pretty straightforward. She’s very cocooned and safe in the room.
I’m a healthcare provider pregnant on the front lines, at what time should I stop working?
I would go back to the British guidelines that suggested if you were a pregnant healthcare worker that you try to step back around 28 weeks. I think that’s wise as you’re more vulnerable and I do think the doctors and nurses on the front lines are much more exposed to COVID-19 than anybody. I think you owe it to yourself to step back if you can.
If antibody testing becomes available and I was proven to have antibodies against COVID-19, would I be safe to treat COVID-19-positive patients or would there still be risk for my baby?
The antibody testing is new. I did see something from the World Health Organization (WHO) that the antibodies may not be permanent, so I think there’s a lot we still need to learn about the antibody testing. Unfortunately this is a brand new virus and we don’t know anything about it but we’re learning a lot every day.
Can you specify what strictly quarantined means?
If somebody has COVID-19, then it’s required that you completely isolate yourself so you don’t expose yourself to anyone else, you don’t share dishes, you stay in your own room, you don’t share a bathroom. The people in your family must do a strict quarantine for 14 days meaning that they don’t go out. If you don’t get sick within 14 days, then you haven’t caught COVID-19.
Thoughts on circumcision given then current climate?
I’ve heard that if the mom is COVID-19 positive that the hospital is not allowing the baby to be circumcised but at this point I’m not sure why. Otherwise, circumcision is an elective procedure that’s done in the hospital.
Are all of the same procedures happening to infants?
All babies are rooming in so no babies are going to the nursery. All procedures are done at the bedside within the 24 to 48 hours of life.
Are they holding off on baby bathing at the hospital?
A lot of my patients like to have the first bath delayed by 24 hours. I don’t think there’s been any change in that.
I’m 6-weeks pregnant, which appointments are essential?
I’m suggesting that patients decrease their number of visits. My patients are mostly sheltering at home and only come out to prenatal appointments that I've decreased in frequency. An initial visit somewhere in the 6 to 12 week period is important. And then another one at 20 weeks. There’s certain things that are recommended. Individualize with your doctor or midwife what needs to be done.
About Dr. Jaqueline Worth
Dr. Jaqueline Worth, MD, is a NYC-based OB-GYN and has been practicing for nearly twenty years and has delivered thousands of babies. Her practice, Village Obstetrics, is dedicated to working with women to achieve a safe birth that meets their individual needs. She is also a co-founder of and co-physician at Village Maternity, a collaborative physician-midwife practice in downtown Manhattan and soon, Brooklyn. She is the proud mother of two young women, lives in New York City, and spends much of her time delivering babies and witnessing the miracle of life at Mount Sinai Hospital. She is the co-author of The New Rules of Pregnancy, available on Amazon.
About Jada Shapiro
Jada Shapiro is the founder of boober and Birth Day Presence, providing virtual classrooms and support systems, childbirth education, breastfeeding, newborn care, infant CPR and safety and doula training. Her teams have served over 20,000 parents in the New York City area. *Make sure to use code VIRTUAL10 for 10% off your first visit to Boober!