Written by Rebekah Wheeler, Certified Nurse Midwife, RN, MPH and Lead Cleo Family Guide
COVID-19 has changed the landscape for pregnant families across the globe. There is some good news: so far it appears pregnant people exposed to the virus do not get more sick than the healthy population. Evidence also suggests that COVID-19 does not pass to the fetus.
This is a huge relief, and normal precautions can also help pregnant women stay healthy. The CDC recommends hand-washing and avoiding sick people, as well as social-distancing. Getting the flu vaccine will also keep your immune system strong and reduce the risk of having both COVID-19 and the flu at once. The flu vaccine will also prevent you from getting the flu, which means you won’t have symptoms similar to COVID-19 and have to seek care in a hospital or deal with possible quarantine.
Still, if you are pregnant or expecting a baby, the rapidly-changing landscape of prenatal care, hospital birth, and the first weeks postpartum is fraught with uncertainty. Whether this is your first pregnancy or your third, COVID-19 is creating a new wave of questions and concerns for expecting parents and families. To help bring clarity and ease worries, here are is some information on the top 3 concerns expecting parents face:
Getting Prenatal Care
Most clinic-based OBs and midwives are quickly changing their parameters for whom they are seeing in person and which patients they are rescheduling or seeing remotely. Every provider is handling this a little bit differently, and the best thing to do is to ask your doctor or midwife what their plan is for your care.
You may want to prioritize the following elements of prenatal care for in-person visits:
- Early ultrasound: This establishes that there is an intrauterine pregnancy, hearing a heartbeat, and setting a due date.
- OB labs: You should check for blood type, infections, diabetes, anemia, and more. These labs can be ordered remotely and done at a blood draw laboratory.
- Genetic testing: Most practices seem to be shifting to remote consultations and blood-draws only (like NIPT/NIPS), but no in-person visits unless a CVS or amniocentesis is needed. Discuss your options with your provider.
- Anatomy ultrasound: This scan looks at all the parts of the fetus’s body and the position of the placenta. It is typically done at 18-20 weeks.
- High-risk care: For those with chronic conditions or pregnancy complications, such as diabetes or hypertension, most visits are being kept in-person.
- Care in the third trimester: After 28 weeks, providers may prefer more in-person visits to help screen for certain complications by paying closer attention to your blood pressure and how your baby is growing. For those with an indication for antenatal testing (ANT), usually higher risk pregnancies, practices seem to be seeing these patients in person and combining those visits with regular prenatal care, so you don’t come in twice.
- Low-risk care: Most practices are not doing in-person visits between about 12-28 weeks in pregnancy. This is a huge change for most pregnant people, and can cause some anxiety. It is helpful to remember that the main purpose of prenatal care is to keep you on track with labs and ultrasounds (which can still be ordered remotely), and to educate folks about what to expect in the coming weeks and months (which can be done over video chat/phone). Importantly, if your practice ends up doing any OB visits virtually, it is wise to ask whether to purchase a home blood pressure cuff and check your blood pressure before each virtual visit. It is important to follow your instincts and reach out to your provider if you have any unexpected symptoms or concerns.
- What might be delayed/not happen: We’re seeing lots of places cancel nuchal translucency ultrasounds, 2 or 3-hour glucose tolerance tests, group visits, hospital tours, “non-essential” non-stress tests, and “elective” inductions. On the other hand, we are also seeing some hospitals encourage inductions on days when they have open rooms and available staff. You may be offered an induction at 39 weeks, especially if this is not your first baby and/or your cervix is “ready” on exam. It is great to have a conversation with your provider about the benefits and risks of these inductions.
Reducing The Risk of COVID-19 Exposure at Hospital/Clinic
Many people are feeling worried that going into their clinic or hospital means risking exposure to COVID-19. There are a few things to note and precautions that can be taken:
At the Clinic:
- Sit at a distance from others in the waiting area. Or, ask to be roomed privately as soon as you arrive.
- Find the hand sanitizer dispensers or sink in each and every room and use them upon entering and exiting.
- Try to avoid bringing kids into the clinic unless needed. They touch everything. Clinics are putting policies in place where visitors are not allowed to come with you, much like in hospitals, so be prepared to video chat with loved ones during ultrasounds or visits.
- Use telemedicine instead of in-person visits if possible. This goes for your partner and kids as well. If you need a medication refill or lab orders, try calling your provider to request these without a visit, or check your company benefits website for telemedicine options for primary care and pediatrics in particular. So many of us have them without realizing it.
At the Hospital/Birth center:
- It is best to avoid the emergency room if possible. This means that if you go into the hospital for any reason, go directly to labor and delivery and don’t stop at the emergency room unless required to do so. If you do need to stop, you can ask to be given a private area and separated from the waiting room.
- There are shifting policies on visitors and partners on labor and delivery and postpartum. While early reports indicate that some people in labor were being denied a support person, even a partner, these have turned out to be isolated incidents. Still, the landscape here is changing a lot. Each hospital has a different policy, and policies are changing nearly daily. The new norm seems to be that someone in labor can have only one support person with them. That person may be asked not to leave the hospital, or even the hospital room. It is hugely important to anticipate this and to prepare to labor without a doula, or to consider transferring hospitals in order to be allowed to bring a second support person (many of our families have done this). Also, prep family and siblings for not visiting. Virtual visits are a good option.
- If birth is relatively uncomplicated and the baby is doing well, you’ll likely be sent home earlier. This may mean needing additional breastfeeding support early on. Cleo is offering virtual lactation support to all of our users, and many community lactation consultants are doing the same.
Preparing for a Different Birth and Postpartum Experience
- Many community or hospital-based childbirth education, breastfeeding preparation and newborn care classes have been canceled. Cleo is offering our users virtual group classes, which they can access through our app. There are also some amazing online options for virtual courses (our favorite is here, but there are tons) that have been running for a long time. Carving out time to attend these classes can help folks feel more prepared during this time of so many unknowns.
- The first few weeks postpartum are a time of change and adjustment (and joy and exhaustion) for all new parents. In the time of social distancing, those who were planning to have support from family or friends are unable to host visitors, moms or mothers-in-law have to readjust. This can be a dramatic change from expectations or cultural norms. Take the time to make a postpartum plan that takes into account being home without hands-on help. This might include:
- Hire a virtual postpartum doula. These are professionals trained to help parents take care of newborns and themselves and to build confidence and communication between parents. While they traditionally work in-person, they are transferring their support to virtual, phone, and text support. Having a person to turn to any time of day for emotional and skills support can be a game-changer.
- Find a counselor/therapist that provides teletherapy or virtual sessions. You may have access to this through your company benefits. If not, there are some amazing resources online.
- Get creative. Look for support in new and different ways. This is a good opportunity to download a mindfulness app, podcast, or anything that will help bring you calmness and peace.
- Make a specific plan with your partner/support person, You should discuss what baby and child care, work, and self care will look each day. Break up the day into chunks of time, allowing each partner to have designated “off duty” time each day.
- Rethink parental leave. You may both need to speak to your employers about how this affects the time you can take for parental leave. Extending it now may make quite a difference.
- Order any essential supplies with lots of cushion time. Think: diapers, wipes, formula, bottles, bassinet, postpartum pads, sitzbath supplies, nipple balm, nursing pads, milk storage bags, pumping parts, etc. Keep in mind that regular delivery times and availability may be longer than usual.
- Clear all non-essentials tasks/responsibilities. Right now, your complete focus is on caring for yourself and your baby. The birth announcements, thank you cards, and product returns can all wait.
- Select 7 people that you can reach out to. Select one for each day of the week and plan a standing date. You can also use the same person more than once. It is incredibly important to feel supported and connected as a new parent-and being proactive about it is especially important in these times.
Things are shifting daily, and the only constant these days is change. But don’t forget: so far pregnant folks and newborns do not appear to be severely affected by the COVID-19 virus itself. Expecting families can get through this feeling confident and proud. We can rally our support systems and virtual resources to help us get there.