UnityPoint Health-Meriter, home to the state’s largest birthing center, says it will begin testing all pregnant women heading into labor and delivery for COVID-19, and its hospital will soon expand testing to all admitted patients.
UnityPoint Health-Meriter Hospital and UW Health changed their policy on Monday regarding testing pregnant women heading into labor and delivery after the hospital systems’ expert on high risk pregnancies raised concerns.
Unity Point-Meriter, which has an agreement with UW Health to staff and provide labor and delivery services at Meriter Hospital, had been testing women heading into labor only if they showed COVID-19 symptoms. That approach was problematic, in part, because of the risks surrounding asymptomatic patients, wrote Dr. Igor Iruretagoyena, division director of the Maternal Fetal Medicine Division at UW, in a letter to “Incident Command Members,” the group making decisions about the health care system’s COVID-19 response.
About 5,000 babies are delivered at Meriter Hospital, working with UW Health, each year.
In the letter obtained by the Cap Times and dated April 12, Iruretagoyena wrote that Meriter had tested “upwards of 30” pregnant patients resulting in two positive COVID-19 cases. Both cases were asymptomatic, according to Iruretagoyena.
“If we accept that the positive rate in asymptomatic patients can be as high as 40 percent, we are certainly missing many,” he wrote.
Delaying testing on pregnant women heading into labor until symptoms develop created a great deal of commotion at Meriter, Iruretagoyena wrote, putting the mother, her baby and the doctors and nurses caring for them at risk. Every patient tested becomes a patient under increased scrutiny, resulting in a strain on regular safety processes and introduces a series of new ones, as if the person has COVID-19, Iruretagoyena wrote. This includes separating the mother from the baby and “extensive use of OB and NICU resources to place these babies.”
“This impacts directly in the care that we provide in a negative way,” he wrote, encouraging hospital leaders to consider a newborn as “individuals exposed to unknown positive patients without any mask or PPE [personal protective equipment]. We go through a great deal of preparation to avoid this very specific scenario in our clinic, ED [emergency department], etc. but not for newborns.”
By the end of the week, Meriter will start testing all pregnant women heading into labor and delivery with a test yielding results in four hours, Iruretagoyena said in an interview Monday. He noted he was pleased with the response he received from administrators at UW and Meriter and that the lack of testing was a resource issue.
“The moment that it could be done, it (was) done,” he said.
UnityPoint-Meriter on Monday confirmed the testing change and said that it was recently able to increase its testing ability.
“This was already happening for all laboring women exhibiting any COVID-19 symptoms. In partnership with UW Health, this will soon expand to all patients admitted to the hospital,” Leah Huibregtse, a UnityPoint-Meriter spokeswoman, said in a statement. “Importantly, second stage labor is not expected to generate aerosols to the same extent as other medical procedures, like bronchoscopy and intubation, according to the CDC. Over the course of this pandemic, our Labor and Delivery staff have worn (personal protective equipment) to protect themselves and our patients, in addition to other precautions like limiting visitors to one symptom-free support person.”
The hospital is also mitigating risk by discharging women from the hospital after delivery about a day earlier than normal, if all goes well. They are also using telehealth to connect new moms to a series of services including lactation and hypertension resources.
Though there are no specific directives from the Centers for Disease Control and Prevention or the American College of Obstetricians and Gynecologists to universally test pregnant women admitted for labor and delivery, in his letter Iruretagoyena noted that much smaller health care systems in Wisconsin were already universally testing all mothers.
The change in testing policy at Meriter comes as Gov. Evers announced Monday that the state was increasing its testing capacity, including using National Guard soldiers to test all inmates at the Milwaukee County House of Correction to control an outbreak there. Exact Sciences is providing the state with 20,000 tests and processing capacity each week distributed to health care systems statewide and Promega is sourcing high demand reagents needed to process tests in numerous labs across the state, according to a statement from Evers’ office.
SSM Health, which runs St. Mary’s Hospital, was not universally testing mothers as of Friday, and said it was following CDC guidance regarding testing. On Monday, SSM Health said the hospital was screening all pregnant women prior to delivery, but only testing them for COVID-19 if the mother met CDC testing criteria.
“We have the ability to perform the rapid test at our in-house testing facility,” SSM Health spokeswoman Kim Sveum wrote in an email.
Dee Hall, of Wisconsin Watch, contributed to this report.