Kathy West works from home while also taking care of her two daughters during the coronavirus pandemic. She’s expecting a third child soon, in less than a month.
She usually feels tired throughout the third trimester, she said, and this pregnancy is no different. West also has no time for boredom while staying at home as she balances family life, work, and being pregnant.
West is one of many pregnant women doing their best to stay physically and mentally healthy during the coronavirus pandemic. She’s taking life one day at a time but acknowledges that the pandemic adds a layer of uncertainty to her pregnancy.
“Anxiety levels are a little higher than they might have been otherwise,” she said. “I’ve spoken to a few friends who are pregnant now, and there is a lot of uncertainty with hospitals rolling out different restrictions and people not knowing how it’s going to go.”
Some of those restrictions include a limit on visitors and screening people before they enter the hospital. Health care providers have also been preparing to deal with the new coronavirus by canceling elective procedures and promoting greater levels of cleanliness and social distancing. Dr. Kate Holloway, an obstetrician who delivers babies at Methodist Hospital Stone Oak, said she has been asking patients to come in less frequently than they would have pre-coronavirus.
“We’re limiting our patient interactions in the office to try to reduce risks for patients that maybe don’t need to be seen right away,” she said. “So we’re delaying annual exams, pushing them out a few months – you don’t have to get your annual exactly at 12 months.”
Holloway is still seeing her pregnant patients, but the Society for Maternal-Fetal Medicine issued new guidelines on how often to follow up with those patients, she said. Typically, obstetricians see patients every four weeks until they are 28 weeks pregnant, then more frequently as the pregnancy progresses.
“We’re spreading that out a little bit to help reduce exposure and allow patients to socially distance,” she said.
Like other health care providers, Holloway’s office screens patients by asking questions about travel history and any upper respiratory symptoms. Patients with temperatures higher than 99.6 degrees must reschedule their appointments for a later date. Other physicians have made the switch to telemedicine to reduce their patients’ contact with the outside world.
“Connecting directly with the patient at home, I think patients really like that,” said Dr. Patrick Ramsey, a maternal fetal medicine specialist at UT Health San Antonio. “They don’t have to worry about transportation or exposures and still have clinic visits.”
Ramsey’s patients might not have the same equipment he has at their homes, but there are other things he can monitor from a video call, he said.
“We fall back on other things, like fetal movements, or if they have a home blood pressure monitor,” Ramsey said. “We’re doing everything we can to minimize the need to come in, to alleviate some of those anxieties [about coronavirus].”
Julie Hatfield, a midwife at Westover Hills Birth Center, also moved to telehealth visits for many of her clients. She has ordered equipment for patients to use at home, such as Doppler fetal monitors to check the baby’s heartbeat in utero, she said.
“If things are going normally, then most of the time pregnancy just happens and doesn’t need to be interfered with,” she said.
Some still visit her birth center in person if they’re later in their pregnancies or have troubling symptoms such as headaches or vision changes, Hatfield said. Pregnant patients also have to visit to get routine blood work done. But like other health care providers, the birth center takes patients’ temperatures and limits the number of people inside the clinic to promote social distancing.
Hatfield isn’t presiding over home births in order to minimize the exposure for birth center staff and for expecting moms’ families, she said. Westover Birth Center requires staff to wear masks when seeing clients and allows each pregnant patient one support person (husband, mother, friend) and a doula at their deliveries. University Hospital has the same guidelines, Ramsey said.
“We were very adamant that making sure a support person could be there,” Ramsey said. “We felt pretty strongly that a certified doula should also be allowed. [But] if dad’s symptomatic, he can’t come in.”
Hatfield acknowledged that the limit on support people may be hard on new moms. Some pregnant women say they need all the familial support they can get, but the birth center can’t allow it, she said.
“We’ve had births before this where there were a dozen people in there, and that’s what mom needed,” she said. “That’s not an option [anymore]. It’s not responsible because you don’t know who’s sick.”
University Hospital typically delivers 250 to 300 babies a month, Ramsey said. The hospital’s labor and delivery procedures have not changed much, but there are coronavirus-specific rules in place now. For instance, if the mother tests positive for COVID-19, she and the baby will be isolated from each other for 14 days, Ramsey said. She also would not be allowed to have a support person with her in the room if she had COVID-19.
“That is a discussion doctors have with moms if they are going to proceed with that decision, but we’re trying to limit exposure to the baby,” Ramsey said. “Mom can still pump breast milk and have another family member feed the baby.”
Pregnant women are no longer considered high risk for coronavirus by the CDC, and initial data shows that the pregnant population does not seem to be contracting COVID-19 at higher rates than the rest of the population, Holloway said. But she still cautions her patients to take extra care; the United States only has weeks’ worth of COVID-19 data, which is not enough to fully understand the disease, she said.
“I can tell you when we recommend [inducing labor] for patients with gestational diabetes or high blood pressure, that data is vast [and was collected] over many years,” she said. “Even those recommendations have some clinical scenarios you look at.”
Either way, pregnant women should continue to ask physicians for the most updated guidelines on how to prevent contracting coronavirus, Holloway said.
“I wish I could tell you more confidently about guidelines and recommendations, but we don’t have them,” she said. “I would be really strict. If you’re getting groceries delivered, don’t put the bags on the counter in the kitchen. Throw the bags away, wash your hands – you never know where things could be transferred.”
West, who is due in early May, has plans to deliver at a birth center but also understands that if she had to be admitted to a hospital, most would block her husband from being in the delivery room if he had been exposed to coronavirus. She consequently instituted stricter rules about venturing outside of the house. Her husband Christopher used to leave the house to get groceries, but no more, she said.
“We’re very lucky that I work from home and my husband is a teacher and he teaches online,” she said. “I know everyone in this situation is not able to do that, but I put our whole family in pretty serious lockdown. It’s just delivery – we’re not going in or out and we’re just going on walks around the block at least until the baby comes because I want [Christopher] to be there at the birth. I’ve heard some people have not been able to have that experience because of coronavirus.”
For now, West is treasuring her time at home with her two daughters and husband. Every day, she wakes up and gets some work done – she teaches writing online and works as a copywriter for a small company – before waking up her kids. Her 10-year-old does school assignments at home while her 3-year-old runs around on the front porch, she said. They have family dinner every night.
“It’s weird because usually, you have the baby and then don’t go anywhere for a month and a half,” West said. “It’s been a strange experience doing that beforehand and having everyone at home nesting with me. The anxiety has been there, but it’s also been lovely for our family to connect before a big new change enters our lives. I’m trying to take advantage of this time with my kids and added time with my husband that we honestly wouldn’t have had otherwise if this hadn’t happened.”