The playbook for what to expect when you’re expecting has changed dramatically for women who are pregnant during a pandemic.
At age 49, Wendy Krugman is expecting to give birth to twins in the next week or two. She and husband, Lou Reed, 37, are experiencing the unbridled joy that comes from being prospective new parents. But planning for childbirth during the COVID-19 crisis has brought unique fears and challenges.
Krugman’s greatest worry is that her supportive husband won’t be allowed in the hospital when she delivers. “That is terrifying for me,” she said.
During the outbreak, Meriter Hospital, where Krugman is set to deliver, is allowing pregnant women one support person during delivery.
“Obviously if he gets sick, he can’t be there,” Krugman said of her husband, noting that they’ve been strict about their “lockdown” under Gov. Tony Evers’ stay-at-home order.
Krugman, a firefighter and paramedic for the Madison Fire Department who’s delivered four babies while on duty, is 35 weeks pregnant, and said that twins, on average, are born at 36 weeks.
Because she’s having twins, she needed more ultrasounds, and has been getting one every month. At this stage in her pregnancy, she’s been seeing her doctor every two weeks.
Across the country, hospitals and clinics have transitioned to telemedicine for much of their prenatal and postpartum care. Krugman attempted a recent phone checkup after ordering a blood pressure cuff online. But she found that the reading from the cuff wasn’t accurate, so she still went in to have her blood pressure checked.
Krugman said she finds comfort in seeing her doctor because she’s been experiencing swelling in her hands and feet and increased blood volume. “It’s just nice being there and seeing her and touching base with her. But it does make me nervous because I don’t want to get sick.”
Dr. Jasmine Zapata, a pediatrician and UW-Madison public health doctor, said that even during the pandemic, in-person visits are important, especially to listen for the baby’s heartbeat. “Each individual clinic and obstetrics and prenatal provider is working on their own different systems and policies. But there are lots of efforts to do things as much as possible over telehealth, which I think is pretty amazing.”
And while labor and delivery may be different than couples had imagined, Meriter is doing everything it can to create a safe but still welcoming environment, said Carla Griffin, the hospital’s director of perinatal care.
“We continue to have dedicated nursing and physician resources for moms and babies, including breastfeeding support, though our teams are wearing more PPE (personal protective equipment) than patients may have previously experienced,” Griffin said.
Citing privacy concerns, Meriter spokeswoman Leah Huibregtse said the hospital cannot provide information on whether anyone giving birth at Meriter tested positive for the virus.
Sarah Mattes, a spokeswoman for Public Health Madison and Dane County, said the agency has had a few pregnant women test positive as well as some infants under the age of 6 months but declined to give further details.
Limited data on risk
Two New York City hospitals recently began screening every pregnant woman for COVID-19 who was admitted to give birth and found that about one in eight women tested positive, but the vast majority showed no symptoms.
“It’s only two weeks of data and we’ll certainly continue to collect and further publish on that data, but it really did show that 13.5% of women showing up feeling well to have a baby were coronavirus positive,” Dr. Dena Goffman, chief of obstetrics at New York-Presbyterian Hospital and Columbia University Medical Center, told MSNBC’s Rachel Maddow.
Dr. Susan Davidson, a retired perinatologist at St. Mary’s Hospital, said each Madison hospital has about 12 known COVID-19 patients overall, which she said is “easily handled.”
"'Safer at home' is an apt description for the way many more pregnant people are feeling right now," said one local midwife.
Zapata said that throughout history, mothers and babies are uniquely impacted by infectious disease outbreaks. “Pregnant and lactating women often are overlooked as interventions are developed and distributed,” she said.
She said that during the SARS outbreak in 2003, pregnant women were at increased risk for severe maternal illness and death, as well as miscarriages. During the H1N1 influenza pandemic in the spring of 2009, pregnant women had a higher risk for hospitalization and represented 5 percent of all deaths.
The Centers for Disease Control and Prevention has limited data on pregnancy during COVID-19. However, the March of Dimes, a nonprofit organization trying to improve the health of mothers and babies, said that based on prior outbreaks caused by similar viruses like SARS and MERS, pregnant women and babies may be at risk of becoming sick.
Adverse infant outcomes, like preterm birth, have been reported among infants born to mothers positive for COVID-19 during pregnancy, the American College of Obstetricians and Gynecologists said on its website, although the information is based on limited data and it’s not clear that the outcomes were related to maternal infection.
“Currently it is unclear if COVID-19 can cross through the transplacental route to the fetus,” the college said, adding that in the limited research of infants born to mothers infected with COVID-19 published in peer-reviewed journals, none of the infants tested positive for the disease.
‘Scary and stressful’
Zapata, whose own daughter was born at 25 weeks’ gestation, is advocating for more research into that question. When her daughter was born, she weighed just 1½ pounds and required several surgeries and a three-month stay in a neonatal intensive care unit, despite Zapata having no previous complications during the pregnancy.
“I know how it feels to be a mom with a baby who was born premature and critically ill,” she said. “So that alone is scary and stressful. So I can only imagine what many moms and newborn babies are going through right now in the midst of this COVID-19 pandemic.”
Many pregnant women are taking precautions, with some opting to give birth at home. Area midwives say they are seeing a surge in home birth requests.
Krugman, the expectant mother of twins, is grateful her baby showers were held before social distancing guidelines took effect, and that she and her husband took a Meriter class on having twins in advance.
But plans with friends to help set up her nursery or show her how to use a breast pump once the babies come had to be scrapped. “We just don’t want to get exposed to anything,” she said.
Overall, Krugman said she feels robbed of her joy. While her husband was able to come to her early doctor visits and ultrasounds, now he can’t. “Those are really precious things,” she said.
Jaimie West, 37, and her husband, Tim Patterson, are expecting a baby in July. West, a graduate student in soil science at UW-Madison, said she has mixed feelings about being pregnant during the pandemic, pointing out that the situation is harder for people who have small children at home that they have to entertain. “It could be worse, that’s for sure,” she said.
West knows everything in their lives will change once the baby arrives, so she’s sorry their homebody lifestyle had to come early. “This would have been a last opportunity to sort of have a normal bit of life,” she said.
[Editor's note: This story has been updated to clarify that a doula does not count toward the one support person limit for women in labor at Meriter Hospital.]
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