Amanda Brown was nervous enough about being pregnant with her first child. She was washing her hands all winter — and that was before the coronavirus erupted into a global pandemic.
Now, she has a whole new set of concerns about childbirth. Brown’s due date is April 30, shortly after experts expect the St. Louis region to experience its surge in coronavirus cases.
“I was trying to be prepared, but all those plans went out the window,” Brown said.
Well over a thousand births are taking place in the St. Louis region every month. In St. Louis and St. Louis County alone, about 13,000 births took place in 2018, according to the most recent available statistics from the Missouri Department of Health and Senior Services.
Coronavirus restrictions
But women giving birth, particularly in hospitals, are facing new restrictions in the midst of a coronavirus outbreak that could last several months. They are having to come up with a new strategy for having a baby.
For safety reasons, Brown’s pregnancy checkups have been moved from her doctor’s office to DePaul Hospital in Bridgeton, where she is expected to give birth. She’s required to have her temperature taken every time she enters the building, which makes her anxious.
Her doctor also recommended strict isolation in the weeks leading up to her due date. Brown is not leaving her Florissant house except to go to doctor’s appointments, and her husband, Chris, is having to do most of the errands that she would normally run, she said.
“He actually went out trying to find nursing bras for me,” she said. “This would be so much easier if I could just go out myself and try them on.”
The limitations that Brown is facing are being imposed on pregnant women by most of the major hospitals across the region. There are significant changes to women’s labor and delivery plans.
Local hospitals are only allowing one person besides the mother to come into the hospital for the delivery. Grandparents, siblings and other children can’t wait for the mother and new baby at the hospital.
Even if the mother hired a doula, a professional childbirth coach, she will have to choose between that person and her partner or spouse coming into the hospital with her at most local facilities. The person accompanying the mother must also have their temperature checked before they are allowed into local hospitals, and then they can’t leave the building. If they do, they won’t be allowed back into most local hospitals for the birth.
Yet not all women giving birth will be tested for coronavirus. At SSM Health, only women who exhibit signs of the illness will be given the test while they are in labor, said Dr. Allan Fisher, who specializes in maternal and fetal medicine at St. Louis University.
If a pregnant woman is known to have the coronavirus, the parent and baby will be immediately separated once the child is born, which Fisher described as “heartbreaking.”
For now, SSM Health is allowing women who tested positive to pump breast milk for newborns, even when they are separated, since it doesn’t appear to carry the virus.
Despite all the precautions being put in place, medical experts don’t yet have much of an idea of how coronavirus affects pregnant women or the babies they deliver. The Centers for Disease Control and Prevention said a very small number of babies have tested positive for the virus after birth, but it’s not clear whether they contracted the illness before or after their deliveries.
Doctors are placing extra restrictions on pregnant women, in part because pregnancy puts women at higher risk for complications for other respiratory illnesses that are similar to coronavirus.
Fisher said there’s also concern that having the coronavirus puts women at risk for going into labor early, though there isn’t a lot of data collected about the virus and childbirth yet. In the coming weeks, doctors expect to have a lot more information about the potential risks to mothers and their children.
“We’re still not getting a full picture yet” of what childbirth looks like if the mother has coronavirus, Fisher said. “The rules are rapidly changing for how to handle delivery.”
Other options
Hospital restrictions are driving more women to look at alternative sites for childbirth. The First Breath Birth and Wellness birthing center in O’Fallon, Missouri, is receiving at least 30% more calls than normal about their services. In addition to delivering babies at the center, the organization’s midwives also oversee home births in the St. Louis region.
“Almost all of the clients that are calling in larger volumes right now, it’s people that are wanting to transfer later in their pregnancy. So, these are people who are 28 weeks and above,” said Lisa Pontious, a certified nurse midwife and the center’s clinical director.
The organization changed some of the ways it handles patients in the coronavirus outbreak. The birthing center does more virtual visits with clients instead of in-person checkups. It’s even conducting women’s appointments in cars in the parking lot to limit exposure.
But unlike hospitals, the center isn’t limiting the number of people who can be present at the birth, which is a selling point for some expectant mothers. Some women want to be able to have their doulas, parents, other children and photographers all present at the birth, Pontious said.
Others are afraid that if they give birth in a hospital, they might be increasing their risk of contracting the coronavirus.
Pontious warns that birthing centers and home births are not appropriate for all pregnant women. The center cannot handle a high-risk pregnancy. It also can’t administer an epidural and has limits on the other types of narcotics that it can use during childbirth.
Childbirth outside of a hospital can also be more expensive, Pontious said. Many insurance companies won’t cover the cost of a home birth, for example, she said.
For Brown, having her baby outside of the hospital isn’t something she’s considering. Some of her friends and family members have suggested she look into a home birth, but she doesn’t feel comfortable having a midwife and other staff in her home at the moment, she said.
“I’m not allowing my parents to come into my house right now; it doesn’t make sense to bring other people here,” she said. “That just seems pretty overwhelming, and I’m already pretty overwhelmed.”
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