Women's Health Texas – San Antonio

Giving Birth During COVID-19

Ask a WHT Doctor: Giving Birth During COVID-19

Parents welcoming babies during the COVID-19 pandemic face an unusual new set of challenges, fears, and questions. As your primary ObGyn resource, Women’s Health Texas and its 90 health care providers want you to feel safe and comfortable during this time. We asked Dr. Melodie Zamora of the Institute for Women’s Health to answer some important questions you may have regarding giving birth during COVID-19.

This is already a stressful time for soon-to-be moms, what would you say to pregnant women who are very concerned about giving birth in this climate?

Firstly, congratulations on your pregnancy! Babies are beautiful. I understand that this is a scary time to be pregnant. We are constantly adapting our recommendations to keep you, your baby, your family and ourselves safe. Please know that you and your baby are our top priority and we are doing everything we can to ease your anxiety. We got you!

What are the policies regarding COVID-19 and pregnancy in Texas, can a significant other be in the delivery room with their partner?

It is understandable to be anxious, sad, angry and frustrated about all the unknowns of our current situation. Visitor policies are hospital-system based. This is a very important question to discuss with your ObGyn as they will know the most current hospital policies. Understand that this pandemic is evolving daily and as such our policies will change as well.

We must keep in mind that newborns have a limited immune system at birth, and we can decrease their risk of acquiring this infection by limiting their exposure. In Texas, we have just under 5,000 cases and approximately 68 deaths as of April 2, 2020. As of now, our hospital system allows the obstetric patient to have one support person with them throughout their stay and we hope to maintain this policy for the duration of this crisis.

These are difficult decisions to make where we must take everything into perspective including our patient’s physical and emotional health; it’s a trying time for all of us, but we will be with you the entire time.

What should pregnant women expect and prepare for when they go to the hospital to deliver during COVID-19?

First, be aware of visitor policies. All hospital staff will have a mask on throughout their shift. You will be greeted at the door by our medical staff who will check your temperature and ask you a series of questions regarding travel, possible contacts, exposures, and symptoms. Everyone, including healthcare providers, must undergo this process to ensure that anyone who may be infected is triaged appropriately. You will then be directed to your labor and delivery floor, again you will find everyone wearing masks. Once you are admitted and in your room, all else is as we say, “business as usual”. The labor process is managed according to routine obstetrical indications and ACOG recommendations. The level of support and comfort you need will not be affected.

Can women change their birth plan to a home birth instead of going to the hospital? Is that something you would advise?

I do not recommend changing your birth plan to a home birth. Remember the spread of this virus can occur from asymptomatic patients and it can survive on surfaces as well. We are taking every precaution at our hospital to limit your exposure. The potential risks of home births have not changed. For example, you may have abnormal fetal heart tones requiring emergent intervention, a vaginal laceration that needs repair, or a postpartum hemorrhage that requires a physician to appropriately manage. Additionally, in the case of emergency, ambulance services may not be readily available due to the pandemic. As always, licensed and accredited hospitals and birthing centers are safe places to give birth.

How are prenatal checkups changing? Can a pregnant woman be proactive in monitoring her health during this time?

This is a great question to discuss with your ObGyn. Current recommendations from the Society for Maternal-Fetal Medicine (SMFM) are continuously updated as we learn more about the COVID-19 pandemic. Telehealth appointments may replace some of your in-person OB check-ups. If you have access to a smartphone, computer or even just a telephone you can participate in Telehealth. SMFM has recommended the initial obstetric ultrasound be performed at 11-13 weeks when we could also perform 1st-trimester genetic testing. Other in-person visits must include your 20-week anatomy scan, 28-week visit with labs, 32-week visit with imaging if indicated and finally weekly visits starting at 36 weeks. This is also dependent on maternal or fetal conditions discovered during pregnancy that may require increased surveillance. These may include hypertension, diabetes, mental health disorders, fetal growth restriction or fetal anomalies.

Some offices may not currently allow any support persons at your ultrasound appointments. I know this is very disappointing, but our goal is to keep you, your baby, and our staff safe. However, given these new implementations, some of us are allowing video conferencing or phone calls with your loved ones at the time of the ultrasound. Additionally, ultrasounds done serially during high-risk pregnancies may be spaced out further if appropriate.

As far as monitoring your own health, continue with assessing fetal kick counts daily, persistent contraction patterns, rupture of membranes and heavy vaginal bleeding. Non obstetrically, monitor for symptoms of fevers, cough, shortness of breath or other respiratory distress. If you experience any of the latter symptoms, I recommend you call your ObGyn’s office immediately and schedule a telemedicine visit if available. You may be asked to self- isolate for 14 days and reschedule your appointments if needed. Do not present to your Emergency department unless instructed to or notifying them of your symptoms.

What if a pregnant woman has COVID-19, what can she expect at the hospital?

If you are a person under investigation (PUI) or COVID-19 positive obstetric patient, the process will be different. You will be given a surgical mask at the time of presentation to the hospital. All staff that comes in contact with you will be wearing full PPE (personal protective equipment) including N95 masks. Each hospital has designated isolation rooms including operating rooms for you.

COVID-19 positive vaginal deliveries:

  1. Your care team: physician, nurse and neonatology provider
  2. We recommend an early epidural
  3. We will avoid delayed cord clamping
  4. A newborn will be taken out of the room and separated from mom for a temporary time

COVID-19 positive cesarean sections:

  1. Your care team: Physician x 2 (or surgical assistant), nurse, scrub tech, anesthesiologist and neonatology provider
  2. No support person
  3. We will try to avoid general anesthesia
  4. We will avoid delayed cord clamping
  5. A newborn will be taken out of the room and separated from mom for a temporary time

Post-delivery, you will be transferred to a designated COVID-19 positive floor. Thus far we know that amniotic fluid and breast milk are negative for COVID-19 and you may use a breast pump to express your breast milk which can then be fed to your baby. Breastfeeding is still encouraged.

What precautions can a new family take after giving birth to protect themselves and their newborn during the pandemic?

As of this point, the recommendations remain the same. Practice social distancing, shelter in place, and avoid unnecessary outings.  For example, consider curbside pickup of your groceries if possible or set up Zoom meetings/FaceTime groups for your family members to meet your baby. I recommend if you do have to leave your home, please keep your baby at home and remove all “outside” clothes and shower before touching your baby again.  Wash your “outside” clothes separately as well. Sanitize all doorknobs, light switches and any other frequently touched surfaces in your home several times a day. Wash your hands frequently for 20 seconds with soap and water, use hand sanitizer when soap and water are not available and practice good cough hygiene (cough into your arm).

You should definitely keep your pediatric and postpartum visits as indicated but call the respective offices and ask if a telemedicine visit may be appropriate.

Do you have any advice for your patients or any soon-to-be mothers?

Stay safe, stay home! We will all get through this together and we will care for you each and every day. I know that many of you are anxious, or may have developed depressive symptoms given what is happening around you, so please talk to your ObGyn regarding your feelings. We want happy, healthy moms and babies! I have a 7-month-old baby and I would do anything to protect her from harm; I will do the same for you and your baby. I know my fellow ObGyns all feel the same way.

Feel free to follow me on Facebook, Melodie Zamora, MD, where I post the most relevant updates as we continue to learn more about this evolving pandemic. I am happy to provide telemedicine visits and consults if needed.

Women’s Health Texas is here for you and your ObGyn needs during this time, if you have an urgent question regarding your health, please call your provider’s office. For more resources and information regarding COVID-19, click here.