The summer baby boom in San Antonio has come with a mix of joy and concern as patients infected with the delta variant have filled local hospitals, including an increase among those expecting.
After a decline in births over the past six months, June and July saw an increase in the number of women delivering babies, said University Hospital’s Dr. Patrick Ramsey, medical director of inpatient obstetrics.
Then about four weeks ago came a surge of expectant mothers testing positive for COVID-19, he said. The increase, from having about three to four patients in the unit at a time over the past year to more than a dozen recently, reflects the overall rise in hospitalizations of patients seriously ill with the virus.
Almost all of the women now in the hospital are not vaccinated, he said.
What to expect
It’s not unusual for expectant moms to start “nesting” near the end of their pregnancy — an instinctual need to stay home and prepare for a new baby. At 33 weeks, Crissy Lutz is spending most of her time at home, but as much trying to avoid a pandemic as nesting.
“I would have loved to have been celebrating our pregnancy with the people we care about and we would have loved to have like, a little ‘babymoon’ and gone on a trip, but it’s not worth the risk,” Lutz said.
Soon after she and her husband Tyler found out they were expecting their first child, a boy, Lutz became vigilant about face masks and social distancing, and got a COVID-19 vaccination during her second trimester. She worked remotely last year and while she’s now back in the four-person office this year, all employees are vaccinated and wear face masks.
“We’ve been really lucky and haven’t gotten COVID in our household, so we’re hoping to avoid that,” she said.
The CDC updated its guidance on Aug. 11 stating that based on the data, it is safe and recommended for pregnant people to be vaccinated against COVID-19. The agency also reported that vaccination when pregnant helps women build up antibodies that also might protect the baby.
At least 2,000 people in a “Pregnant with Covid-19” group on Facebook have not been as fortunate at Lutz, and are now navigating the resulting fevers and coughs, preventions and remedies, fear and trepidations with one another. For them, what to expect while expecting has a new layer of concern for their own health and their baby’s.
One San Antonio mom shared that she was exposed to the virus through her school-age son in February and spent nine days in the hospital before delivering her baby six weeks premature. He is healthy but her own COVID-19 symptoms have lingered.
“This is far worse than we’ve seen at any point in the pandemic so far and that has been relayed by other obstetric providers across the state and the country,” Ramsey said. “It seems like the delta variant may be affecting pregnant women worse than we’ve seen with the other surges we’ve had.”
Women are tested before being admitted to the maternity unit, he said. Those who test positive, even if they are asymptomatic, are placed in an isolation room and allowed only one visitor.
At University Hospital, between six and eight pregnant women have been sick enough to be admitted to the intensive care unit in recent weeks, and though they all recovered, one woman’s baby was born prematurely and died. (In September 2020, local health officials reported a woman 35 weeks pregnant died of COVID-19.)
“So definitely a virus to be reckoned with,” Ramsey said.
Special delivery team
The increase has prompted University Hospital to form a four-person obstetric COVID response team made up of a maternal-fetal specialist and fellow, two residents, plus nursing staff. Specialists in pulmonology and infectious disease are called in as needed.
The Centers for Disease Control (CDC) has stated that although the overall risk of severe illness during pregnancy is low, the risk is higher than for non-pregnant people. Those with underlying health conditions, including advanced age, can contribute to the likelihood a pregnant woman will develop severe illness.
The concern for the mother’s health extends to the baby, Ramsey said. “If the mom doesn’t do well, the baby, by default, may not do well.”
People with COVID-19 who are pregnant also have a greater chance of going into labor prematurely, earlier than 37 weeks gestation, according to the CDC.
In some cases, doctors induce labor early in order to reduce the pressure that the uterus puts on the patient’s diaphragm, which makes it harder for the lungs to fill to capacity.
“Obviously, if mom’s critically ill and there’s a consideration that mom’s respiratory status might be improved by her not being pregnant … we might err toward doing a Caesarean delivery,” Ramsey said. “If mom is stable … we’re going to keep her pregnant as long as we can, then wait to induce labor until after the illness is abated.”
The virus is rarely transmitted from mom to baby during pregnancy, and the virus does not cause birth defects like the Zika virus did, according to Ramsey.
Like the CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine, Ramsey strongly recommends pregnant women be vaccinated against COVID-19. The vaccine is safe for people at any stage of pregnancy.
But some pregnant women are choosing to wait to be vaccinated, increasing the odds they become very sick if infected.
“We know that moms who are pregnant and get COVID-19 can have a worse respiratory course, higher risk for intubation, higher risk for needing to be in the ICU, and all those things can lead to your pregnancy being more complicated and put your baby at risk,” Ramsey said.
Lutz isn’t taking any chances. A healthy fear of the virus is keeping her home until she can bring him home and to a small room already overflowing with gifts for the baby.
“For the most part, we’re pretty ready for him to make his arrival,” she said.