Labor and Delivery During Coronavirus (COVID-19): What pregnant women need to know

Labor and Delivery During Coronavirus (COVID-19): What pregnant women need to know

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It's natural to feel anxious about labor and delivery when you're pregnant, and now the coronavirus (COVID-19) crisis is adding a new layer of worry. Hospitals are changing policies around prenatal care, labor and delivery, and postnatal care, including barring extra people from the delivery room in an effort to keep moms and babies safe. This is an evolving situation, but know that your and your baby's well-being is always top priority. Here's an overview of these changes to date.

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Are fathers, doulas, and visitors allowed in the delivery room?

That depends on where you're giving birth. Policies vary from place to place. They're also changing quickly: In San Francisco, for example, the Department of Public Health issued an order on March 13 that instructed hospitals to bar all "visitors and non-essential personnel." But on March 24, labor and delivery nurses at both Zuckerberg San Francisco General and the UCSF Birth Center confirmed that laboring women are allowed one visitor in the delivery room and during the postpartum period. That person can be anyone – a sister, a husband, a wife, a partner, a friend, a doula – but only that person can be with the laboring or new mom; they can't switch out to allow another person to visit.

This "one visitor, no switches" rule seems to be catching on. In Maryland, the Greater Baltimore Medical Center allows one "professional support person or post-partum helper of a patient." In Los Angeles, Cedars-Sinai Medical Center allows one visitor for patients admitted to labor and delivery. Chicago's Northwestern Memorial Hospital's coronavirus policy allows one person, age 18 or older, to visit a laboring mother.

After initially barring all visitors, including partners, New York Presbyterian Hospital's current COVID-19 policy was changed and now states, "Starting immediately, one birthing partner or support person will be allowed to be with our obstetric patients during labor and delivery. At this time, no visitors are permitted in the postpartum units. We understand that this will be difficult for our patients and their loved ones, but we believe that this is a necessary step to promote the safety of our new mothers and children."

Will visitor policies change soon?

Policies change quickly as new information about COVID-19 emerges, and your experience will depend largely on the rules at your hospital, clinic, or birth center. You can find out what the current policies are by calling the place you intend to give birth when you're close to your due date, as well as checking its website to look for a COVID-19 visitor's policy.

As of press time, professional associations have not issued formal recommendations on visitor policies. "We don't have guidelines and those decisions are local to the hospitals," says Society of Maternal-Fetal Medicine (SMFM) President Judette Louis. "Typically, the hospitals take into consideration the burden of disease, community spread, the local resources, and other relevant factors. This is a public health crisis, and the attempt is to decrease exposure to the patients and healthcare workers. SMFM would not be able to make broad-based recommendations." SMFM has issued updated recommendations on ultrasounds for practitioners, however.

Christopher Zahn, vice president of Practice Activities at the American College of Obstetricians and Gynecologists (ACOG), says that "ACOG understands that addressing this public health crisis has required hospitals to implement additional infection prevention control protocol, as well as other procedures to maximize the capacity for patient care and safety."

However, ACOG encourages hospitals to consider the well-being of the laboring mother, too. "We also recognize that these measures can have a significant impact on a laboring mother's support in the delivery room. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by a partner or support personnel such as a doula is associated with improved outcomes for women in labor," says Zahn.

"As hospitals move forward with measures and policies in the face of this crisis, ACOG urges them to consider innovative solutions and localized, collaborative approaches that ensure laboring patients have the support and stability they need through this chaotic and stressful time," Zahn adds.

How is COVID-19 affecting prenatal care?

In addition to impacting who's in the room during labor, you're probably learning firsthand that the coronavirus is having significant effects on prenatal care.

Parents-to-be like you may find that their practitioners replace office visits with remote checkups, send them to an offsite laboratory for blood draws, or delay or cancel glucose tolerance or non-stress tests. Hospitals are also canceling birth center tours and other nonessential visits. (If you're looking for an online birth class, see BabyCenter's Childbirth Class.)

What will it be like in the delivery room?

Decreased access to caregivers and hospital staff may make some women especially anxious about labor. But Rebekah Wheeler, a certified nurse midwife and member of midwife discussion groups in New York and the San Francisco Bay Area, says, "the laboring person is not being treated all that differently. Nurses and staff are going in less, they have to scrub, your provider will wear a yellow gown and a face shield. But the labor room still looks the same, and the care is the same."

Could I catch the coronavirus when I'm at the hospital?

Wheeler says new moms and moms-to-be are also expressing a lot of anxiety about potentially catching COVID-19 in the hospital. "The way hospitals are set up, when you're in the labor and delivery unit, you're not next to a sick person. The nursery is a very sterile environment, too. Use the same social distancing you use anywhere," she advises.

She also notes that many hospitals are allowing women in labor to bypass the emergency room instead of checking in there, as they would have in the past. If you're not sure where to report, call your healthcare provider and hospital to make sure.

Will I have to wear a face mask during labor and delivery?

Having to wear a mask in the delivery room is a possibility. Boston-based Brigham and Women's Hospital's policy, effective as of April 6, states that "patients in any clinical setting will be supplied with a procedural or surgical mask, which must be worn as part of our continued efforts to protect our health care workers and our patients and to combat community spread. Dr. Laura Reilly, Obstetrician and Gynecologist-in Chief at Weill Cornell Medical, reported in an online Q & A that "all women who arrive at the hospital in labor will be tested for COVID-19 regardless of symptoms, and the staff will provide masks to women in labor to wear when they arrive." Wasatch Midwifery and Wellness Founder, Adrienne Brown said "So far we are wearing masks as a staff at all patient interactions. We ask those in the clinic to wear a mask, and the birth partner, but not the laboring person. If a patient were presumed positive or known positive, they would be sent to a hospital to give birth."

That said, ACOG (American College of Obstetrics and Gynecology) cautions "Although a person with suspected or confirmed COVID-19 would normally be instructed to wear a mask, active pushing while wearing a surgical mask may be difficult and forceful exhalation may significantly reduce the effectiveness of a mask in preventing the spread of the virus by respiratory droplets."

What else can I do to prepare and calm my fears?

Take a deep breath, literally and figuratively. You'll be well cared for and protected during delivery, and you'll soon have a gorgeous newborn to distract you from the news of the day. You can also:

  • Learn the signs of labor so you can delay heading to the hospital until it's really necessary.
  • Stay upright and walk around during early labor to potentially shorten your time in the delivery room.
  • Get tips on managing labor pain so you can stay comfortable at home longer.
  • Watch this quick video on what labor is really like so you'll know what to expect.
  • Raising a baby, toddler, or young child
  • Rarity of infection in babies, toddlers, and young children
  • Parents' concerns
  • Pregnancy and the coronavirus (COVID-19): Symptoms, social distancing, and staying calm
  • Coronavirus (COVID-19): No baby formula at the store? Here's what to do
  • Coronavirus (COVID-19): How not to touch your face from the experts

You can also see our baby, toddler, and young child FAQs, pregnancy FAQs, or visit our dedicated group discussing COVID-19.

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