My daughter and her husband are about to celebrate their first wedding anniversary, and they’ll be doing it under coronavirus quarantine. They’ve also been talking about starting a family. They’re both healthy, but I wondered whether getting pregnant right now is wise, so I decided to chat with Dr. John Ozimek, medical director of the labor and delivery and maternal fetal care unit at Cedars-Sinai. It was reassuring.
First, Ozimek says that pregnant women don’t seem to be at greater risk than non-pregnant women of contracting COVID-19. Also, pregnant women who contract COVID-19 don’t seem to be at greater risk of serious complications than their non-pregnant counterparts are. That makes it different from other respiratory viruses, which hit pregnant women harder. “If a patient is concerned that pregnancy itself would put her at higher risk of complications, that really, really doesn’t seem to be the case here,” he says. “So, while nobody wants to get this infection, pregnant or not, there could be a little bit of assurance that pregnant patients tend not to do worse than patients who are not pregnant.”
Yes, the pandemic does add a few glitches to pregnancy and childbirth – including managing doctor visits during social distancing and having fewer support people available during the birth itself. But Ozimek says this isn’t a reason to put off trying to conceive. “We don’t know how long this is going to go on,” he says. “So, if family plans are in your future, you might end up delaying this for two years until things are completely back to normal, if we ever get completely back to normal.”
Prenatal doctor visits can often take place virtually – and in-person visits have been reduced or combined to minimize risk. This might mean, for instance, that a woman has an ultrasound and sees her OB-GYN at the same appointment, rather than making separate visits to the office. Women and their babies will still get all necessary care. “We can’t just put necessary visits on hold,” Ozimek says.
Meanwhile, Ozimek says he talks every day with every patient about the virus and what to do if they experience symptoms. He no longer adds “if you think you’ve been exposed” to his cautions. “You just have to assume at this point that you’ve been exposed. Now we’ve all been exposed,” he says. Pregnant women who develop fever and a cough should call their OB-GYN for instructions – unless they also have trouble breathing. “Because this can progress rapidly, call your OB on the way to the ER in those circumstances,” he says. “Don’t wait around.”
During labor and delivery, major medical institutions in L.A. and nationally are allowing women to have one visitor with them to provide support. If you were hoping to have your husband and your doula and your mom, you’ll need to choose. “And that’s really difficult, and we are not insensitive to that fact,” Ozimek says. “It’s difficult for us. We do not like it.” It is, however, the best way to keep patients and medical staff as safe as possible. And Ozimek notes that families have been getting creative and finding ways to share – including bringing doulas virtually. “You could have 25 people in the room via virtual networking. That is, I think, very beneficial if it is something that could be arranged.”
If a patient is concerned that pregnancy itself would put her at higher risk of complications, that really, really doesn’t seem to be the case here.Dr. John Ozimek
Recent good news is that – at Cedars-Sinai – one in-person visitor (the same one present during delivery) is now allowed to stay with the new mom and baby during their postpartum stay. Patients and visitors are screened on admission to the hospital and must wear masks throughout their stay. Other area hospitals have adopted similar policies.
Ozimek says he is hearing less about home births these days because things here in L.A. seem to have settled. And he says home births don’t reduce a family’s risk of contracting the virus. “Assume everybody’s been exposed wherever you are,” he says. “And in the hospital, we’re taking many, many, many measures to decrease the risk of exposure, which probably are much better than in a home-birth situation.” He also reminds families that, while most patients choosing to give birth at home do just fine, if there is an emergency, trained staff won’t be on hand at home to help. “This is not a reason to give birth at home. I think that’s the bottom line,” he says.
For healthy moms and babies, the length of their postpartum hospital stay is the usual 24 hours for vaginal delivery and 48-72 hours for cesarean section – though a bit more on target at the moment. “Now what we’re seeing is, patients and staff are very motivated to get that mark met,” Ozimek says. “And, the shorter time in the hospital, the fewer people in the hospital, the lower the risk of transmitting disease.”
Once families do get home, they have to follow safer-at-home guidelines including, sadly, not having family and friends come to meet the new baby. This means you’ll need to plan for Grandma to pinch those chubby cheeks via Zoom or FaceTime.
For moms who currently have COVID-19 or have recently had it, CDC guidelines do recommend a period of separation between them and the newborn. They advise that a healthy caregiver feed and care for the baby. If these moms are going to breastfeed, they should be continually washing their hands, washing the breast before and after feeding and wearing a mask. “While this virus has never been shown to be transmitted via breastmilk, the baby’s sitting right there on the breast and right underneath Mom’s mouth, where she’s breathing, so the mask could minimize risk,” says Ozimek.
He acknowledges that these times are tough for all – especially those in the healthcare field – and that everyone is doing their best. “I drive to work in the morning, and I find myself almost in tears,” he says. “These things are hard for me. They’re hard for everybody. Am I keeping the nurses protected? Am I keeping our doctors protected? Do our patients and nurses understand why we’re doing these policies? And then I get here and we start, and all those emotional feelings go away, and there’s nothing more than a great feeling of satisfaction knowing that we’re doing everything that we can.”