NEW PARENTS FACING FEARS, CHALLENGES
Hospitals remaking decades of delivery, labor, postpartum practices in real time
In the weeks before her April 10 due date, first-time mother Christina Johnson looked forward to relaxing in “full nesting mode” with a baby shower, date nights with her husband and a weekend “babymoon.”
But in a country suddenly riven by a coronavirus pandemic, Johnson and her husband, Simon, have been sheltering in place in their San Jose home and scrambling online to find retailers still selling diapers, wipes and even baby formula, in case she has trouble breastfeeding.
“We also don’t know how the hospitals will be impacted,” said Johnson, wondering whether the Kaiser hospitals in San Jose or Santa Clara will even have room for her if the facilities get a surge of COVID-19 patients.
Johnson and other pregnant Bay Area women are now trying to navigate childbirth in a surreal landscape of lockdowns and social distancing.
On Monday morning, Holly Ross, of Dublin, was in early labor, but she could only talk by Zoom to her doula DeAnna Aschwanden. Her hospital’s new coronavirus visitor policy meant Aschwanden could not be there. Major Bay Area hospitals confirmed they are limiting women to having just one support person with them during labor and delivery.
Ross recalled how calming the doula had been during her now-3-year-old daughter’s birth, encouraging her through three days of labor to move around and reassuring her and her husband, Steven, that the otherwordly pain was normal. “That’s something that’s underestimated,” Johnson said in a phone interview, breathing heavily through five-minute-apart contractions. “The doula isn’t just there helping the mom. It’s scary for the partner, too.”
Other mothers wonder if it will even be safe to go to the hospital, given reports about shortages of masks and other protective equipment. They also are grappling with other
“It’s normal and real for expectant mothers to feel overwhelmed, but you add COVID-19 to it, what’s that going to mean for them and their families?”
— Sabrina Freidenfelds, executive director of Then Comes Baby, an Oakland-based resource center
unsettling questions: If I get COVID-19, will it hurt my baby? Can I get tested? Will my baby be separated from me? And they’re trying to wrap their heads around managing with a new baby at home without relatives coming in to help care for older kids, or do the cooking
and laundry, so they can eat, take a shower, sleep.
“It’s normal and real for expectant mothers to feel overwhelmed, but you add COVID-19 to it, what’s that going to mean for them and their families?” said Sabrina Freidenfelds, executive director of Then Comes Baby, an Oakland-based resource center for new parents. She worries about parents like Johnson, Ross and their husbands, isolated in their homes during the vulnerable postpartum period, cut off from the support that usually comes from being with family or by attending new-parent support groups.
There is good news: There’s no evidence so far that pregnant women are any more susceptible to contracting COVID-19 than average healthy adults. The Centers for Disease Control and Prevention said it’s unclear whether an infected woman can pass the virus onto her fetus or baby during pregnancy or delivery, though JAMA, the Journal of the American Medical Association, reported that a study in China found that three of 33 women had given birth to babies with COVID-19. The virus has not been detected in breast milk and appears to cause, at most, mild symptoms in very young children.
But with worries about hospital safety, Berkeleybased midwife Renée Lepreau said she and other midwives are receiving calls from women wanting to switch from hospital to home births, “many late in their pregnancies.”
Hospitals are assuring patients they can maintain the highest safety standards. Still, concerns about spreading the disease have forced doctors, nurses, doulas, midwives and other providers to cancel some routine in-person checkups and birth classes. They are moving these visits online, scheduling telemedicine appointments on applications such as Zoom.
Doctors also are trying to time necessary in-person visits around other procedures such as blood tests and ultrasounds, hospital officials say. Meanwhile, women can learn to use a blood pressure cuff themselves to detect preeclampsia, a potentially life-threatening condition that can develop after the 20th week.
For Rebecca Mildwurm of Alameda, COVID-19’s impact on her pregnancy has been decidedly stressful. In late February, as alarms rose about the coronavirus, the mother of a 2-year-old son went into the emergency room at Kaiser in Oakland with a serious cough that left her dizzy and short of breath.
Some eight hours later, an ER doctor and infectious disease expert in special protective gear told her she couldn’t leave until they ruled out coronavirus. The hitch: They had no COVID-19 test available. Fortunately, overnight tests for other viruses showed she had a common cold virus.
Still, the experience left Mildwurm shaken enough that she agreed to let her doctor induce labor a few days before her March 15 due date so could get in and out of the hospital as soon as possible. “I cannot speak for how wonderful these doctors and nurses were,” said Mildwurm, as her week-old son Leo cooed by her side. “They are trying to navigate uncharted waters and do everything in their best ability to be safe for you and for themselves. However, there is just not enough known about the virus or resources for testing.”
It’s not unusual for women to have their labor induced at 39 weeks for medical reasons, but conversations between doctors and patients about inductions have been ramping up in recent weeks, said Maliya Rubio-Mills, a San Francisco-based doula.
Rubio-Mills also has been hearing from other doulas that hospitals are encouraging women to take their babies home sooner than normal, sometimes fewer than 24 hours after a vaginal delivery, which normally involves a 48-hour stay. Some women also have left hospitals just two days after a Csection, a major surgery that usually involves a four-day stay.
Perhaps most distressing for some mothers, Bay Area hospitals are following CDC guidelines that say babies born to women with even suspected COVID-19 should be separated for up to 14 days due to concerns the virus could be transmitted from the mother’s respiratory secretions. If no isolation room is available, babies can stay in their mothers’ rooms as long as they are separated by 6 feet and a curtain.
Some hospitals may ask mothers to pump milk, but others may allow breastfeeding if the mother scrubs her hands and wears a mask.
Freidenfelds, a lactation consultant, worries these guidelines may hinder tiny newborns from getting the documented health benefits of immediate and sustained skin-to-skin cuddling with their mothers. Such contact is known to release hormones that regulate a baby’s temperature, heart rate, breathing and blood sugar and hormones that lower a mother’s stress.
Katie Ralls, of Concord, and her husband, Stephen, are facing other challenges in staying connected to their newborn, Harper. The little girl is in the neonatal intensive care unit at John Muir Medical Center after being born at 33 weeks, weighing just 3 pounds, 2 ounces.
Ralls visits Harper for six or more hours each day, holding her and trying to breastfeed her. But her husband can’t join her because John Muir, like other hospitals, limits NICU visitors to one person at a time.
As much as parents are worried, and providers are rushing to adapt, some are getting through the coronavirus crisis somewhat better than expected. Ross and her husband’s doula coached them through labor with an iPad propped up near her bed. “We were basically face to face,” Aschwanden said. “Basically anything I would have done if I were there, I was able to do.”
The labor also was much shorter than expected, with the Ross’ 7-pound, 13-ounce girl arriving at 1:10 p.m. Monday. “We’re all healthy and happy to be back home in our little isolation bubble,” Ross said.