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Expecting? Here’s what you need to know as it relates to COVID-19

Expecting? Here’s what you need to know as it relates to COVID-19

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 5, 2020. Please note facts and recommendations are evolving daily and always make sure to contact your doctor for any personal questions.

What should parents expect when heading to the hospital to give birth?

What I would say to people across the country is not to get too caught up in the details because they're rapidly changing. This week in New York City at Mount Sinai Hospital, there is a four hour test available which is fortunate as some hospitals are offering a 24 hour test. Patients are either tested on admission in labor and their partners are also screened and tested. If a partner is found to be unhealthy on admission, then that partner would not be allowed up and the patient would be asked to find a healthy alternate partner. I’m suggesting to my patients that they have their partner and a back-up partner just in case on admission their partner isn’t well. Currently, if someone is having a C-section or the labor is being induced then the patient and the partner are being tested the day prior, in that case you would know before you come in.

How are you counseling patients on inducing?

The stress of not knowing one’s status and worrying about the baby in the patient who I delivered who was not tested was very significant for the patient, the partner and the nursing staff. I think everyone felt very anxious. With the patient who knew her status, it was more straightforward and so I think these are things to weigh and individualize with your doctor or midwife when the time comes. It’s helpful to know what to expect in the hospital as well. For instance, currently Mount Sinai Hospital is requesting that patients and partners wear a mask to minimize respiratory droplets in the room, even for patients that are negative. They’re asking the partners and husbands to wear a gown and gloves and the hospital is providing this gear. The support person can’t leave the labor room and certainly can’t leave the hospital or walk in the hall. Everything is very locked down right now.

Thoughts on having my 73-year-old mom come to the hospital with me?

I would not recommend having a 73-year-old person come to the hospital as it would be terribly unsafe for that person during this time. NYC Governor Cuomo is stating that people in New York state over 70 should not leave the house and if they are in the presence of any other person, everyone should be wearing a mask.

In what case would you recommend that a baby be separated from their birth parent?

The most recent guidance that I got from my hospital goes as follows: the following measures will be implemented to reduce the risk of viral spread from the ill birth parent to the child. Ideally, the neonate should be cared for by a healthy adult if available, not the COVID-positive or PUI birth parent and the healthy adult should use appropriate PPE. If the birth parent intends to breastfeed, she will be encouraged to express breast milk to establish and maintain milk supply. The birth parent should practice hand hygiene and the expressed breast milk should be fed to the newborn by a healthy caregiver if available. If the ill birth parent wishes to feed at the breast, a face mask should be worn and hand hygiene completed before feeding.

How is the labor and delivery section of the hospital being protected?

At my hospital , labor and delivery is absolutely protected. It's a separate building with its own entrance with a separate staff that don’t go over to the other part of the hospital. I'm sure that will be the case at many hospitals throughout the country.

I’m due July 2nd, what is the best way to prepare for the unpredictable future in terms of birth plan and classes?

In terms of a birth plan, I think we need to acknowledge that it’s really overwhelming. It’s really hard to look forward and have any sense of certainty, I hope and pray that we will be back to normal. On some level, make your birth plan with the awareness that you will only have one person with you. I think birth classes are really important so that you can establish what you want to cover. I think a virtual doula will be tremendously helpful. Once we get out of the shock of this, you can have a device, you can have someone that you’ve connected with and you can have that person help you. If you're going to work with a doula, you want to hire someone who you’ve connected with over the month before your birth and then that person is going to be totally available to you, speaking to you during the birth virtually. That's really what you need is another voice in your ear supporting you and giving your partner support and tools. Practice your technology ahead of time so that you know it’s working.

What are the precautions to take during a C-section in the time of coronavirus?

It's very clear in the data so far that PPE is very protective. It protects the doctors, nurses and midwives from catching COVID-19 and it also protects the patients from catching anything from anyone who is there and that’s why everyone is wearing a mask. The doctors, nurses and staff are going to wear the N-95 mask, covered by another mask and a hat for the whole time they’re in the labor unit. That protects everyone from spreading any virus and the good news is that it’s working.

How serious should we take the stay-at-home order?

A lot of healthcare workers are worried about asymptomatic shedding, because you don’t wear masks when you’re at home with your family. I’ve sent my family to live upstate and haven’t seen them in three weeks. We do a lot of FaceTime instead. That’s the reality right now.

I’m 30 weeks, should I be exploring options to deliver in another city besides NYC?

What I say to each patient is that each of us should look into our hearts and ask, “should I stay here or should I pick up and move my family to, say, Minnesota?” I think that’s a question each person needs to ask but there’s so many life details that are involved in those questions—not everyone can just relocate to Minnesota. If you can’t relocate to a place where there is much less disease in the period of time when you’re having your baby, I personally feel way safer at a major academic medical center in New York City where they have rapid testing, they know everything there is to know about this disease, they know how to protect people versus a small hospital in upstate New York. I think you need to individualize that answer—if there’s an excellent hospital upstate or somewhere else that you feel comfortable at then that’s where you should go.

What are thoughts on visitors after giving birth?

Right now, if I were having a baby this week, I would have nobody over for a couple of weeks until I knew that everybody was healthy, my baby was safe and I was safe. I would shelter inside for the two week period and then I would have to think about whether each of those people were healthy.

What are the essential visits that you’re requiring in-person right now?

It's been suggested to all but OBGYN doctors to space out and decrease the number of visits in order to help people stay home more. In my own practice, I’m essentially offering telemedicine visits as often as my patients would like and depending on their circumstances. There are certain sonograms and blood tests that need to be done and either I have those done remotely or they come into the office for them.

What sort of extra precautions should be taken with a newborn?

I’ll put aside doctors working in ICUs as that’s a heavier exposure, but for everybody else take your temperature twice a day. As long as you’re not coughing or sneezing or have a fever, I feel confident that we’re safe. Now I know that there's an inconsistency there because we talk about asymptomatic shedding. I think that we’ll just need to learn more about that but as of now, we’re not seeing a lot of it. What we’re seeing is that people get sick and you can tell when someone is sick.

Is there any data available about newborn infections and recovery?

I have not yet read any reliable medical information about newborn infection. I'm not aware of any newborn infections, although there have been a couple of cases so I can't really comment on that right now but I don't think it's common. We’re not seeing it. They didn’t see it in China and we’re not really seeing it here. What we don’t know is if those babies were exposed to someone who was very critically ill. If you look at the data in China, mostly it was elderly people with underlying conditions that died except for the doctors who were on the front lines caring for patient after patient with heavy viral loads. I think that’s why this social distancing works. If somebody is critically ill and coughing all over a baby, that baby is at far greater risk versus just catching a virus in the air.

What are your thoughts on early release from the hospital after giving birth?

There’s been a lot of discussion of this at my hospital . You could release a pregnant woman post-birth at six hours. If it were appropriate, I'd be happy to do that; however, currently pediatricians are not willing in New York City to discharge the baby until at least 24 hours post birth. Things may become more flexible down the road but the pandemic may be over by then. I recommend talking to your pediatrician.

About Dr. Jaqueline Worth

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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

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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!

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