For expectant parents, COVID-19 brings changes, uncertainty

Brittany Lackey’s joy over finding out she was pregnant — and then discovering she was having triplet girls — was overshadowed quickly as the new coronavirus began to spread.

“We’ve always imagined our parents and friends being there to hold the babies, meet them and share our joy,” she says. “But that’s not going to happen now.”

Bryan Lackey will be  in the delivery room when his daughters are born, most likely in early July, but no one else — no grandmother, aunt or even doula will be allowed, and no one knows what the rules will be in the neonatal intensive care unit, where the babies likely will spend at their first few weeks, by July.

“We don’t even know whether it will be safe for friends and family to come help us when the babies come home,” says Brittany Lackey, who lives in Black Mountain.

The virus, which causes the illness known as COVID-19, reached pandemic levels more than a month ago. Hospitals are trying to cope with the illness, about which much remains unknown, by limiting exposure. To anyone expecting a baby, that means just one person can be present to support a woman in labor at Mission Health.

Some hospitals are allowing only the woman in labor and hospital staff to be there, although most are allowing one other person, says Dr. Arthur Ollendorff, an obstetrician practicing at Mountain Area Health Education Center Ob/Gyn Specialists.

“It’s scary,” Ollendorff says. “There’s so much we don’t know. We know very little at all, actually. … We don’t want to overreact. We don’t want to be delivering babies in hazmat suits unless it’s proven necessary.”

Many unknowns

Doctors don’t know yet whether there are any long-term effects on a developing embryo because the disease hasn’t been around long enough. “We need to be nine months out before we know for certain whether there are effects,” he says.

Ollendorff was a resident during the early days of HIV and he says this reminds him of those days. “It wasn’t airborne like the coronavirus, so the analogy is limited, but our lack of experience with it is the same,” he says. “We’re only beginning to learn what we’re dealing with.”

So far, the CDC says pregnant women face no more risk than others for getting the virus. However, pregnant women have had a higher risk of severe illness when infected with viruses from the same family as COVID-19 and other viral respiratory infections, such as influenza. 

Among the unknowns are whether having the virus conveys immunity and if so for how long; whether someone who tests positive with no symptoms will get sick; or why some people don’t get sick and if they do, why some have mild symptoms and others die.

So care providers are taking measures to limit exposure to the virus.

Plus one

At Mission, maternity patients should arrive at the Labor and Delivery entrance (Entrance 9 at Mission, located on Rose Chapman Drive off Biltmore Avenue). All maternity rooms are private, so patients’ exposure is limited, and only one support person is allowed.

That means no doula, or birth coach, for mothers who want their partners present.

But doulas are finding ways to offer virtual support, using computer tablets to offer encouragement and advice, says Cindy McMillan, a doula practicing with Sistas Caring 4 Sistas at MAHEC. “It’s not the same, we know that,” McMillan says. “We know it’s not easy for a woman in labor to use technology while trying to concentrate on breathing, but it’s better than not having a doula, and we have to cope with what we can do for women during this.”

Support people must stay with the mother until she’s discharged, which means at least 24 hours after birth, so most doulas are working via technology.

McMillan has helped one mother through labor online, and all went well, but it would have been easier if she had been physically present, she says: “I want to be with my moms, walking with them, comforting them, encouraging them. It’s different to have to do it on an iPad.”

Mission’s website for maternity patients states, “We ask patients and their named visitor to be particularly vigilant with respect to social distancing in the 14 days prior to admission. No children or additional visitors will be permitted.” In addition, if a support person is in isolation because of exposure to the virus or shows symptoms, that person will not be allowed to accompany the patient.

Virtual visits

MAHEC also has implemented changes for women who are pregnant. Expectant moms are asked to come to their appointments alone. If they have other children and no child care options, exceptions can be made, but the children will have to go through the same screening procedure as adults — checking for fever and respiratory symptoms and questions probing whether the person has had close contact with someone who has tested positive for the virus.

All waiting and other common areas are closed. Patients wait in exam rooms or in their cars until they are seen.

MAHEC also is seeing women via computer for some appointments, says Dolly Byrd, a certified nurse midwife. “We started preparing in January to be doing more appointments by telehealth,” she says. “We know it isn’t as thorough as seeing someone in person but we can get a good idea how a mom is doing.”

Medicaid provides blood pressure cuffs so women can keep track of their own blood pressure. MAHEC is also seeking funding for scales so women can keep track of their weight, since rapid, unexpected weight gain is an indication of excess fluid being retained, one sign of preeclampsia, which can be dangerous to both mother and baby.

“Telehealth appointments are a good time for answering questions and planning,” Byrd says. Women come in at 12 to 13 weeks into their pregnancies for an intake appointment then are seen face to face about once every six weeks, with a telehealth appointment between in-person visits.

Exploring birth options

Another trend Byrd is seeing is women coming from areas with higher levels of infection to second homes in Western North Carolina, hoping to have their babies in a safer place. But they’re coming midpregnancy, some with complications.

Although some women want to opt for a home birth with all these restrictions on who can accompany a mother into labor and delivery, that option isn’t open to most women in North Carolina, say Byrd and Ollendorff. State law requires a person doing home delivery to be supervised by a physician who has admitting privileges at a hospital, and few midwives have that arrangement in the state.

“There was one in Asheville, but they’re not there anymore,” Ollendorff says.

Since no one knows how long these restrictions will last or what might change in the weeks and months to come, practitioners and hospitals can’t predict when restrictions will loosen or whether they may have to be tightened even more.

In addition, Byrd worries that some women who don’t have computers, or enough data on their smartphone service to do telehealth, could fall through the cracks and not get the care they need during pregnancy.

“Our key is to figure out sustainable ways to function through this,” Byrd says. “How can we provide care better? How can we address inequities, perhaps even better than we did before? Can it possibly be that we find ways to provide better, more effective care than we did before this pandemic? Now is the time to work on this. Maybe we can develop strategies; maybe we can be innovative.”

“We’re fixing the plane as we fly it,” Ollendorff says. “We just won’t know more until we have experience.”