Coronavirus in Context: Pandemic Pregnancy, What You Need to Know

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You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. I'm joined today by Dr. Laura Riley. She's chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine. Dr. Riley, thanks for joining me.

Thanks for having me.

Let's start off with how has the coronavirus epidemic changed labor and delivery?

Um, the-- the virus has changed everything. The biggest changes on labor and delivery are that, because we're in New York City, where coronavirus is widespread, we have, uh, started doing universal testing for all pregnant women. So what that means is that, as a pregnant woman comes in and is admitted, she has a nasopharyngeal swab for, um, PCR--

OK.

--of COVID-19. And, um, based on that information, we then wear the appropriate, uh, protective, uh, equipment for providers. Um, we mask all patients and their support persons. Um, all of us are wearing masks, uh, throughout this-- the, um, labor and delivery. And then if Mom turns out to be COVID-positive, um, we make sure that, you know, if she needs a cesarean delivery, the whole team is aware, and we minimize the number of people who need to be in the room to do the surgery. Um, we take precautions on the off-chance she needs to be intubated, because we know that will aerosolize COVID-19.

Um, and then in terms of the baby, um, if the baby-- if the mother is COVID-19 positive, um, you know, we're all concerned and cautious about, you know, transmission to the baby. But so far, we've not seen that that's a particularly, um, efficient, um, uh, way to get the disease for newborns, thankfully. Um, and so we put the baby in an isolette, um, and ask the mother to stay six feet away, you know, to the extent that she can.

How long do you try to keep them away six feet?

Well, you know, certainly through their whole hospitalization. And actually, because they are COVID-positive, we're sending the family home and asking them to self-quarantine, as well, um, for, you know, public health reasons. And then we want her to stay, um, you know, separated from the baby for, you know, at least six, seven days, wearing a mask and-- and all those precautions. Um, and-- and her partner should do the same, or her support people should do the same, um, because what we want to avoid is the baby getting, um, COVID-19 after birth.

But wearing a mask, et cetera, I mean, how realistic is that in the setting of, you know, a mother and, you know, a partner, um, trying to take care of their child?

Yeah. It's not easy, you know, and I think it's just, you know, yet another stress for families. You know, I think it's hard enough to take home a newborn in the best of--

Sure.

--environments.

Mhm.

Um, taking home a newborn and then needing to do all these, um, different things, and-- and stay quarantined is absolutely difficult. But I can tell you, having had a few patients now with COVID-19 who have gone home, that, you know, they are absolutely doing the very best they can, because they're scared for their children, and they really don't want their babies to become infected after birth. Um, so you know, I think that people do the best they can with the masking, with washing their breast before breast feeding, with keeping that-- that distancing that we've asked them to do.

As much as you can, realistically.

As much as you can, realistically. I would say one thing that is important is that babies are being tested at about 24 hours after. And so far, we have not had any positive babies from birth. Um, so moms are going home knowing that their babies are negative. And so there is a huge motivation to keep that-- um, to keep-- to keep that going. And then they're coming back a week later to be retested. Um, and-- and my experience has been is that my patients have made every possible effort, um, to do that.

Do we know if COVID-19 puts a pregnant mom at greater risk, and do we know if transmission is-- you know, how probable is that to the child?

Yeah. So you know, this is-- this-- this is the biggest question in obstetrics, honestly. What we can say is that, you know, when, um, H1N1, um, uh, was an epidemic, we definitely saw fairly soon after the epidemic got going, we saw that pregnant women had greater, um, severe morbidity following H1N1.

OK. We have not seen that same, um, uptick in severe morbidity. I think what we have to be cautious about, though, is the numbers reported are still small, and the second thing is is that, just because pregnant women may not have more morbidity, pregnant women are still going to get sick.

Sure.

They're like anybody else in the general population. And we see that lots of people in the general population, um, even the younger people who didn't expect were going to get sick, have gotten sick.

Do pregnant women need more precautions?

You know, I think pregnant women need to take the same precautions that everyone is taking. And I, you know, try and go over that at every single visited-- visit that I see patients or that I'm doing my video visits. We're trying to be very, um, I'd say conservative about which-- which times we're doing those video visits. And it's not for every patient. You know, some patients with comorbidities, you know, you've got to weigh the risk of coming into the hospital, because we know people with comorbidities are at greater risk for severe morbidity from COVID-19, but by the same token, those people tend to need more monitoring, more fetal monitoring, more ultrasounds, um, non-stress tests, whatever. And those are not things you can do, um, you know, remotely.

There was a recent report that said hospitals were still the safest place to deliver a child. But what do you say to those moms who are concerned about going into the hospital, and maybe especially for those moms that were thinking about delivering in the hospital, and now they're looking at other options?

Yeah. You know, I-- I completely understand. Um, and I think that there's so much fear around, um, getting COVID-19, and recognizing that some people do very poorly if they get it. We're making every single possible effort to minimize, um, risk within the hospital. At this point, there are so many permutations on, you know, sort of what's being done. You know, some places, it's happening right when you enter the hospital. Other places, it's happening before you enter the office suite.

Um, we're doing it twice, actually. You enter the hospital, and then you get to the office suite. I think the other thing is is that, you know, we're testing all pregnant women as they walk through the door, um, you know, in labor so that we can understand, you know, who needs to be on this side, um, with this amount of PPE and these precautions, and who needs to be in this room, you know, away from that. Um, so I think, you know, again, I-- I feel like the hospital really is a safe place. I think the other thing that makes it a safe place is that, you know, hospital staff are so, you know, in tune to everything about COVID-19 and all the possible ways that, you know, it could be possibly, you know, transmitted that I think that they're, you know, hyperaware.

What do you say to those pregnant moms who are perhaps affiliated with hospitals that are not allowing spouses and partners in, or limiting, uh, the ability for someone to be with them, or the amount of time? Is that a factor in terms of deciding where to give birth? Because we-- we know that, you know, having a partner with you sometimes can reduce stress and anxiety. They can be someone--

Yeah.

--who could be on the lookout for potential challenges. Should that factor into a woman's mind when deciding where to deliver her child?

You know, we-- we went through a-- a short period, like seven days, where we, uh, restricted visitors. And um, you know, we did that thoughtfully. Um, you know, I've been practicing for 30 years, and to be honest, I couldn't imagine, um, that we'd find ourselves in that situation where we would be restricting visitors. But we really did it out of, um, an abundance of caution and-- and worried about safety. You know, our biggest concern is to protect mom and her baby. So we want--

Absolutely.

--mom to have a mask, provider to have a mask, um, and a support person to have a mask. And at a time when we were a little concerned that there weren't going to be enough masks, we had to make a decision. Um, and the more exposures, the more opportunities you bring into the hospital and the more unknowns you bring into the hospital, there's more exposures. So thankfully, all things have worked out in terms of availability of more PPE, availability of more testing, availability, you know, of-- of just understanding the disease a little bit better. And so we're back to where we, you know, normally would be, which is, you know, a support person, you know, for labor and delivery--

Everyone doesn't allow that still. And then to be fair, that was done through an-- an executive order by the governor.

Yeah.

And he-- so-- so how should women consider that, uh, whether or not they're able to have a support person with them? Is that an important factor in deciding where to give birth?

I think for some women, that is an important factor. I mean, I think, you know, for all sorts of reasons, that that added support, um, you know, is-- is necessary for some women. I think that what we found is that not all women were, um, were completely put off by that, and they, you know, accessed other things that we tried to put in place. So the virtual doula, the-- you know, the-- the support of the team that was there, and, you know, FaceTiming the-- the support person, you know, through labor. So, um, I think that it's an acknowledgment that that doesn't work for all women. Um, and for those women, there are other options. I get it. Any other advice for pregnant women during this pandemic that we're experiencing?

Yeah. I-- I-- I do worry about, um, you know, sort of the anxiety and the stress, um, that this whole situation puts on everybody. Um, and then I think, you know, pregnancy is probably one of the most anxiety-provoking times in a woman's life. Um, and in-- in a family's life, right? That-- you know, for-- for whoever is having this newborn. And so I think that COVID-19 adds a whole new level of anxiety for both the medical concerns, as well as, you know, the social isolation, um, the lack of support once you're home, even though you have your support person.

A lot of us are used to having our-- our mom, our-- you know, whoever. Our friends help us. And so I think that pregnant women who are experiencing more anxiety, um, you know, more depression, more whatever, um, need to speak up, because there are, um, resources out there in a way that I have not seen in the past, um, whether that be psychologists, psychiatrists, um, uh, you know, people really sort of rallying around . Women. And I think that that's super important.

Well Dr. Riley, I want to thank you for taking time to speak with us today.

My pleasure.

And I want to thank you for watching Coronavirus in Context. I'm Dr. John Whyte.