08 May Delivering in the World of COVID-19

With everything going on with the coronavirus and the need to minimize exposure to and the spread of the virus, being quarantined at home has brought a lot of changes for people around the globe.  One area that has been impacted greatly is how pregnant people prepare for their delivery.  Birth plan preferences that people were previously able to ask for are currently reevaluated.  To get insight into what this looks like I interviewed a handful of nurses, from both the west and east coast.  They answered a few questions I had regarding how their hospitals have adjusted and implemented new policies and procedures to improve the care of their patients during this pandemic.

***These interviews are intended to provide expectant families with ideas of questions to ask their OB-GYN or healthcare provider prior to being admitted to the hospital.  This may ease some nerves before stepping foot in a hospital.  Every hospital has their own policies and procedures, so it is important to be educated on your own facility’s changes.***

Are there pregnant patients testing positive?

As of right now, there are pregnant people arriving at the hospital who are testing positive.  Not all show symptoms (ie. asymptomatic).   

How are you triaging patients for COVID-19?

Some hospitals simply ask for a temperature check prior to admission.  Other facilities are swabbing all patients who enter the unit. If the patient tests positive, the support person is assumed to be positive.  If that’s the case, some hospitals may ask the support person to leave after the baby’s birth.  

How has laboring a patient changed with this pandemic?

• Patients cannot have multiple support people in the room.  Nor can they ‘switch off’ and have people come in and out while the mother is laboring.  
• The support person chosen at admission is the only one throughout the labor allowed in the room.  
• The support person may not be allowed in the triage area of the Labor & Delivery unit, prior to admission of the expectant mother.
• The patient, in addition, cannot walk the halls, as they could prior to COVID-19.
• Some hospitals are requiring mothers and support people to wear a mask during labor as well.  
• Some hospitals are providing food for the support people (this is not the case for guests during labor prior to the pandemic) to keep people from leaving and walking around the hospital.  
• Some labor rooms have refrigerators, therefore, laboring patients can bring snacks/food from home.  
• Some labor units are limiting the use of oxygen masks for patients, so they are using position changes and more IV hydration if needed throughout the labor process.  
• If the patient tests positive, no skin to skin is allowed between mom and baby.  
  

If the patient tests positive, what is done differently?

Many hospitals are placing positive patients in a specialized room with proper air flow to decrease the likelihood of spreading the virus on the unit.  Some hospitals are using specialized teams that are similar to what you would see on a Code Blue Team.  This specialized COVID-19 team only delivers the COVID-19 patients during their shift.  This team consists of one OB-GYN, one registered nurse and one respiratory therapist.  There is an on-call team for backup as well for deliveries.  This means this team, for their shift, will only enter the room of COVID-19 patients. They do not enter any other rooms for delivery.

After baby is born, how do the first few hours of postpartum look?  Does dad need to leave after a set amount of time?

No visitors are allowed in the room after baby is born, except for the one support person that the patient has brought with them.   Some hospitals are only allowing the support person to stay a designated amount of time, and then they can only return when the patient is being discharged from the hospital for pick up.  This depends on the facility. 

How often are hospitals changing precautions on the unit due to COVID-19?

Health measures are changing daily throughout hospitals.  Keep in mind, if you have a friend that just delivered at the same hospital you are scheduled to deliver, the policies and procedures could change from one day to another.  Nurses check their emails to see updates on their policies and procedures during this time.  

Typically, labor nurses are able to have two laboring patients (prior to COVID).  This ratio changes once the patient is about to deliver.  Have the ratios changed from 2:1 to 1:1 with this pandemic?

The nurse’s agreed they now have 1:1 patient care at this time.  One hospital specifically said they are usually 1:1, even before COVID-19.  

How will this virus affect patients long-term?  Is there an increased risk of postpartum depression?

The nurses all felt that the incidence of Postpartum Depression (PPD) will increase due to the lack of connection with family during and after labor.  These are pivotal moments in a family’s life and mothers are feeling unable to get the support they normally would once they go home.  If you are feeling symptoms related to postpartum depression or have more questions, please contact your healthcare provider to seek proper medical care and support.  

Fever can develop during labor (seen many times when the bag of water has been ruptured for an extended amount of time).  How is the unit handling febrile patients during labor due to the fact that high fever is one of the COVID-19 symptoms?

In the case of hospitals testing all their patients, they would already know if the patient has COVID-19.  If the patient is positive and develops a fever, they would already be isolated in a specialized room and would still receive antibiotics (in case the fever is due to an infection from labor).  But if the patient is negative and gets a fever during labor, they are treated with antibiotics in their current room, as they’ve done in the past.  

How are the safety needs of medical professionals being met during this high risk time?

Unfortunately, not all the nurses felt their health and safety were being taken into consideration.  One nurse said her hospital was providing a new N95 mask every shift.  Other nurses said they were given one mask they had to keep reusing during their shifts.  Some expressed the fact that they felt like they were not being told consistent information.  They also were not having their health needs looked after by their supervisors.  One hospital specifically said wearing a mask was unnecessary during this time.  In addition, some of the nurses were not given any masks to wear and took it upon themselves to bring a homemade mask.  

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