Article Written by: Tina Crum, MSN, CNM
Pregnant women and those contemplating pregnancy during the Covid-19 pandemic understandably have questions about what they can expect in hospital labor and delivery, and postpartum units across the country. Speculation and misinformation abound, and no wonder, considering that policies can change in the blink of an eye. It can feel overwhelming to know where to turn for accurate information.
My goal is to clear up some of the mystery surrounding the new policies on the labor and delivery and postpartum units throughout the United States during the Covid-19 pandemic and to help you understand what to expect during your prenatal care, labor and delivery, and postpartum experience. As a Certified Nurse-Midwife that has been caring for pregnant women throughout the pandemic, I know there are many women out there just like you. Women who are wondering and worrying about how to safely navigate pregnancy during a public health crisis.
Prenatal Care
During the Covid-19 pandemic, your prenatal care will still look much the same as it would have prior. You will have regular prenatal care visits to monitor both you and your baby’s health. Whether or not your partner can accompany you during prenatal visits and ultrasound appointments can vary between practices. This is a good question to ask when you make the first prenatal appointment if this is important to you. Keep in mind that policies change very quickly during a pandemic. An increase in local positivity rates can mean additional restrictions that were not in place only a few weeks before.
Your obstetric care provider and office staff will continue to mask and will require you to do so during visits as well. This is to protect you from exposure and to protect other high-risk patients. Pregnancy is considered a high-risk condition for more serious infections.
If you test positive for Covid-19 during pregnancy your provider will recommend that you isolate at home as appropriate. You may be offered telemedicine visits until after the quarantine period. Your provider may discuss treatments that can help to prevent severe infection and will give you instructions on what to do if severe symptoms do develop.
Labor and Delivery
Prior to the Covid-19 pandemic, a pregnant woman could anticipate arriving on the labor and delivery unit with her partner, a close friend, or a family member. Family and friends may have gathered in the waiting room, eager to see the new baby and wish the new family well. Older siblings were standing by, eager to meet their new brother or sister. It was a daily scene in every labor and delivery unit across the country, and then suddenly it all came to halt.
The pandemic has made the labor and delivery experience in hospitals look quite different. While the number of visitors allowed has certainly changed during this public health crisis, there are many things that have stayed the same. To better understand the practices in different areas, I conducted an informal poll of Certified Nurse-Midwives (CNM’s) practicing in various hospital settings across the country. I asked them these questions:
15 CNM’s practicing in the states of Massachusetts, Wisconsin, Idaho, Nebraska, Maryland, Colorado, Ohio, California, Washington, Minnesota, Connecticut, and Alaska responded. Their answers reveal that while there are common policies across the country such as limiting the number of visitors, there are many variations unique to individual institutions and communities.
You will be required to have a Covid-19 test on admission unless you have had a positive test within the past 90 days. In most areas with a high number of cases in the community, this is routinely performed (Up to date, 2022). All CNM’s surveyed confirmed that Covid-19 testing is done on admission at their facilities.
The good news is, while the tightest restrictions were enforced at the start of the pandemic, restrictions are much more manageable now. All the respondents stated their institutions allowed a support person to be present, and many allowed more than one. Only a few reported support persons being required to be Covid-19 tested on admission. A pregnant woman can expect to have her support person by her side, provided he/she does not have symptoms of Covid-19. Minors were not allowed on many units, but on some they were. You may be asked to wear a mask when medical personnel is in your room, and your visitors will certainly be required to.
You can be reassured that you are still able to give birth in whatever way you choose during the pandemic, whether you are induced, or go into labor on your own. While things might look differently with visitation restrictions, it should not impact your birth plan. Pain management options remain available including epidural anesthesia (Berghella & Hughes, 2022). Some women have remarked that having fewer visitors made for a more intimate and undisturbed birth experience.
A support person may still be present during cesarean sections, provided there is not another unrelated reason preventing this. You will still be able to do skin-to-skin and bond with your newborn whether you have a vaginal or cesarean birth.
If you test positive for Covid-19 during labor and delivery you will be placed in isolation for the protection of staff and other patients. Each of the CNM’s that responded relayed that support persons are allowed in those cases. In some instances, a support person may not be able to be present during a cesarean section if the patient is positive for Covid-19, but this was not true of most institutions.
Postpartum
The greatest anxiety for women is fear that they will be separated from their newborns should they test positive for Covid-19 during admission. In that event, mothers without severe illness and their infants are placed in isolation in the same room, and breastfeeding is still encouraged. It remains the best source of nutrition for your newborn and is even more important during a pandemic. Breastfeeding may provide maternal antibodies which may help to protect the infant. Mothers are asked to wash their hands and wear a face mask prior to caring for their infants (Berghella & Hughes, 2022).
Since the beginning of the pandemic, the postpartum length of stay has been decreased for low-risk women. This change occurred for many reasons. Women who could have few visitors were anxious to get home to their families and other children. They were also fearful of being exposed to Covid-19 while in the hospital. Hospital resources were best utilized during this public health crisis by discharging patients as soon as they were able. Studies have concluded that earlier postpartum discharge does not increase the risk of complications or readmissions in low-risk women who have vaginal births or cesareans (Gulerson et al, 2021).
What does this mean for you? If you are a low-risk woman you can anticipate being discharged from the hospital at approximately 24 hours postpartum with vaginal birth, and around 48 hours postpartum with cesarean delivery.
The Covid-19 pandemic has been an ever-evolving situation, with hospital policies changing from one day or week to the next. I encourage you to discuss your birth plan with your midwife or obstetrician to determine if any current policies will affect your goals. Take the recommended steps to protect yourself and your unborn baby from infection. Despite the additional challenges in these times, women continue to have fulfilled and empowering births in the hospital setting, and you can as well.
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