Maternal & Infant Health
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Giving birth while social distancing changes everything

May 1, 2020
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For pregnant women and those who have recently given birth, the coronavirus pandemic coupled with the realities of social distancing present a lot of unforeseen challenges, concerns and ambiguity in terms of pregnancy, delivery and postpartum. Being pregnant during a pandemic may mean more than just having to cancel your baby shower and your reoccurring lunch dates with your doula, being pregnant during a pandemic can mean telemedicine prenatal appointments, delayed ultrasounds, new delivery plans and less support after giving birth.

 Being pregnant during a pandemic may mean more than just having to cancel your baby shower and your reoccurring lunch dates with your doula.

And while abandoning baby shower plans in the name of social distancing may seem small in the grand scheme of things, for many low-income families, a baby shower is a crucial event. It may be the first time a family is able to get baby essentials, like diapers, onesies and bottles before birth.  

As telemedicine and telehealth generally have become increasingly popular over the last few years, it has become the standard during this time of social distancing to get remote treatment, fill prescriptions and get medical attention if your condition does not warrant more intensive hospital care. While telemedicine does change traditional doctor-patient interactions, it allows patients to maintain standing appointments, such as prenatal appointments, avoid having to make transportation arrangements, and it also frees up doctors and other front-line providers to deal with the coronavirus pandemic. Telemedicine also gives patients access to doctors and services during unconventional times such as nights and weekends, opening preventive care to individuals who previously may not have had access.

 Telemedicine, however, is nearly impossible for individuals without necessary technology.

Telemedicine, however, is nearly impossible for individuals without necessary technology: email, videoconferencing capabilities, internet and a communication device such as a smartphone or a laptop. Further, telemedicine cannot provide hands-on care which is imperative to pregnant women who require regular ultrasounds, measurements, fetal doppler, gestational diabetes screening and blood pressure tests. Since hypertension is a major cause of maternal mortality and morbidity in the United States, it’s important that women do not go without regular blood pressure testing.  

Although traditional OBGYNs don’t recommend home births under any circumstance, more families may be considering it as women may feel more comfortable at home than in an overrun hospital, despite the fact that there would be no doctor present at home. . Stress and fear during pregnancy may cause health problems like high blood pressure and heart disease which can increase the chances of having a premature baby or a low-birthweight baby among many other issues. Many families may be concerned that equipment shortages may leave maternity wards and Neonatal Intensive Care Units ill-equipped to handle births, that obstetricians will be diverted in an emergency setting and may not be available when they are delivering or that they will be removed from the hospital prematurely and therefore change their birthing plan from the hospital to home. The option of home birthing, while not endorsed by most health care professionals, is also out of reach for low-income families as home-birth midwives are not covered by any health insurance company. The potential health toll of being at a hospital also weighs on parents as they have to try and decide if the safest place for a new family is a place with a contagious virus.  

Some families and physicians are choosing delivery dates, by way of induction, to avoid being at the hospital during predicted COVID-19 peaks in their areas. While the American College of Obstetricians and Gynecologists hasn’t issued official guidance on elective inductions in the age of COVID-19, it does have broad guidelines around the use of inductions generally. The most important of which states that elective inductions should not occur prior to 39 weeks.

 Many hospitals are imposing strict delivery room and visitation limits to enforce social distancing, even during childbirth.

Many hospitals are imposing strict delivery room and visitation limits to enforce social distancing, even during childbirth, allowing no more than one to two people in the room at a time and in some cases, like in New York City, zero people in the room. This can mean going without the midwife or doula that you have worked with throughout your pregnancy to provide emotional, physical and educational support before, during and after the birthing experience. This can present a huge obstacle for families who were relying on their guidance, especially since in-person birthing and parenting classes are cancelled until further notice.  

While there’s been no indication that pregnant women without underlying conditions are more or less likely to be affected by coronavirus, there is no evidence that a pregnant person can transmit the virus during pregnancy or birth, and no evidence that the virus passes through breast milk there’s very little data to depend on. It is recommended that new moms with coronavirus, or those who exhibit symptoms, who are breastfeeding do so with a mask. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/) Obstetricians and Gynecologists have thus far been relying on small studies from China and hypotheses based on experience with other illnesses to inform guidance to pregnant patients. Since the data is too limited to answer almost any question with certainty about COVID-19’s effects on pregnant women, scientists at The University of California San Francisco and the University of California Los Angeles have launched a comprehensive new study that looks at the COVID-19’s impact on the health of pregnant women and their babies. The study is based on the compilation of a new national registry of pregnant women and new mothers who have tested positive or are being evaluated for COVID-19. Its intention is to follow the women and babies for up to one year, extracting data about symptoms and outcomes. Until we know more, the most important thing for pregnant women to do during this time is to follow government guidance including washing hands regularly, social distancing, working from home where possible and regular cleaning and disinfecting.

 One in nine American women experience symptoms of postpartum depression.

After birth, new families, especially new mothers face additional challenges as 1 in 9 American women experience symptoms of postpartum depression.[2] Measures that can help mitigate postpartum depression, such as family and friends visiting to help with a new baby and face-to-face home visiting programs, are frowned upon and potentially dangerous during times of social distancing.  

Considering the coronavirus pandemic has tested supply chains like no other event in recent history [3] due to entire communities quarantining and sheltering in place, many major supermarkets and retailers are struggling to keep shelves stocked with certain items such as toilet paper, paper towels and diapers. This poses an immense challenge to new parents who may not be familiar with just how many diapers they will need per child per day, and may have to visit multiple stores before finding the right size in stock. Beyond diapers, families who participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) which provides supplemental foods such as formula, health care referrals and nutrition education for low-income pregnant and postpartum women, may find that disrupted supply chains cause many WIC-approved foods to be out of stock longer than usual. Due to this, it’s crucial that the federal government waive requirements that WIC retailers’ stock specific food products, and a specific amount of those products, to be certified by the WIC program. If approved, retailers can continue to serve WIC families because families eligible for WIC can substitute similar, in-stock items using their WIC benefits which sustains the health of new families.

 It’s crucial that the federal government waive requirements that WIC retailers’ stock specific food products, and a specific amount of those products, to be certified by the WIC program.

The first 15 months of a child’s life are some of the most critical in terms of health, development and vaccinations. Newborns are generally required to visit their pediatricians monthly, and early on, sometimes weekly, throughout their first year of life to assure they are healthy and progressing appropriately. New parents and pediatricians may be faced with tough decisions about these initial appointments, as to whether telemedicine is sufficient and if vaccines can be delayed. Some parents, for example, have to take public transportation to go to an appointment and since once babies are born, they are susceptible to the virus, it may not be worth the risk.  

Babies do not stop coming for anything or anyone but it’s important that families try to plan ahead, stay diligent and prepare for uncertainties.

  1. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/
  2. https://www.cdc.gov/reproductivehealth/depression/index.htm
  3. https://insight.kellogg.northwestern.edu/article/coronavirus-upended-supply-chains-how-companies-can-prepare-disruption
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