Pregnant women are rethinking birth plans
Parents, doctors adapt to new hospital limits
Two weeks before her son was due, Layla Shaikley sat down to repack her hospital bag.
In went the Adidas slides, Glossier blush, washable prayer mat and a new baby swaddle printed with protective nazar eyes. Out went the “Big Sister” Tshirts for her toddler, Kamila, replaced with Shaikley’s iPad — a tool she now fears could be her only source of support in the delivery room.
“They told me, at most your spouse or one visitor will be allowed,” said the 34year-old tech entrepreneur. “I’m waiting for the other shoe to drop.”
More babies are born in Los Angeles County than anywhere else in the United States. But with COVID-19 cases continuing to surge, many fear that the area’s hospitals might soon bar visitors from their maternity wards, as several in New York did briefly last week.
“It could
change within hours of you getting to the hospital,” said Erica Chidi Cohen, cofounder and CEO of Loom, a boutique reproductive health and education center in Mid-City. “You just don’t know.”
Already, hospitals across L.A. have banned anyone not giving birth from the obstetric triage area, leaving expectant Angelenos to labor alone — possibly for hours — while their partners wait in the car. Recovery, too, is off limits: Once the baby is born, new families have just minutes together before the father or partner is asked to leave.
“We understand this is not how people want to be giving birth — it’s not how we want them to give birth,” said Dr. Rashmi Rao, a maternal fetal medicine specialist and an assistant clinical professor of obstetrics and gynecology at UCLA. “All of us physicians, we took an oath, and we are sticking to it. We are going to do our best to keep our patients safe.”
Changes go far beyond restricting visitors. One of California’s largest hospital networks, Permanente Medical Group, has begun offering to induce labor as early as 39 weeks, the earliest point at which a pregnancy is considered full term.
Kaiser Southern California has delayed such inductions, as well as planned caesareans due to the coronavirus. Many providers are telling patients not to come in until they’re at least five centimeters dilated, or halfway through labor — by which point the overwhelming majority of American women would normally have received an epidural.
But the most controversial edict so far comes from the Centers for Disease Control and Prevention, which currently recommends a mother be quarantined from her newborn if she shows symptoms of COVID-19, the disease caused by the novel coronavirus.
“The CDC is recommending a seven-day separation, but it’s a tough one, and it keeps changing,” said Dr. Sarah Kilpatrick, chair of obstetrics and gynecology at Cedars-Sinai and an expert in maternal fetal medicine. “The patient can refuse, but we are hoping to encourage her to accept.”
Healthcare workers emphasized the importance of quarantine after an infant in Illinois died from the virus over the weekend.
“There is still much we don’t know about how COVID-19 spreads to babies,” said Marianna Volodarskiy, regional maternalchild health director for Kaiser Permanente in Southern
California. “When making that decision, we have to recognize the importance of mom and baby bonding and protecting the baby from the virus.”
Such stringent new rules are temporary, experts said. But many in medicine believe more subtle changes are likely to become standard. Inventions born out of necessity — fewer prenatal visits, faster postpartum discharge and a surge in home births — could persist long after this crisis is over.
“Some of the interventions and testing and monitoring that used to be recommended are not being done anymore because of the risk of coming to the hospital,” said UCLA nurse midwife Shadman Habibi. “Our clients are very appreciative. They’re happy not to come to [the] clinic.”
Low-risk patients like Shaikley have begun monitoring their own weight and blood pressure from home instead of visiting the doctor for frequent third-trimester checks.
For higher-risk patients, including those with preexisting conditions that may make them more vulnerable to COVID-19, the American College of Obstetricians and Gynecologists has recommended consolidating care into fewer visits and replacing fetal monitoring with kick counts and ultrasounds with blood tests.
In L.A., many obstetricians are replacing a common early fetal ultrasound with a blood test that can be taken weeks earlier and is far more sensitive at detecting the same chromosomal abnormalities.
“Now we’re saying, just get the blood test,”
Kilpatrick said. “We still are doing the 18- to 20-week ultrasound, but we’re taking out that middle visit, which frankly probably wasn’t really necessary anyway.”
Chidi Cohen, the educator, has moved Loom’s birth classes online and revised its curriculum to include “tactical skills” for laboring alone. UCLA lactation and breastfeeding specialist Genevieve Colvin-Thomas now assesses potentially fatal breast infections via video, while Rao, the obstetrician, manages anxious patients over the phone.
“My version has always been, ‘If you are worried, come in,’” Rao said. “Now I say, ‘If you are worried, call anytime.’”
But the pandemic has pushed some mothers-to-be out of hospitals altogether.
“I’ve been getting at least five inquiries a day” about home births, said Beth Cannon, a licensed midwife in Sherman Oaks. “People want to have their team, and they don’t want to be around the extra germs.”
Ashley Ackerman, 32, an advertising executive at Netflix, is among those looking to opt out.
“The plan was to give birth at Cedars with a doctor, my husband and a doula,” Ackerman said. “But if going to the hospital means that I’m alone, I might choose a birth center.”
Shaikley, on the other hand, said she is ready to labor alone if she has to.
“I love my husband; it’s a very important moment in our lives, but this is a crisis,” she said. “I feel very fortunate I had such a wonderful birth experience the last time, but I’m ready to give it up if that has to happen.”
‘We understand this is not how people want to be giving birth — it’s not how we want them to give birth . ... We are going to do our best to keep our patients safe.’ — Dr. Rashmi Rao, UCLA Health