Pregnancy & Childbirth: What to Expect During a Pandemic

Podcast Transcript

Nada Youssef:  Hi. Welcome to the Health Essentials podcast brought to you by Cleveland Clinic. I'm your host Nada Youssef. When it comes to expecting moms and their partners, many have a specific birthing plan in mind and have imagined what it will be like to bring their newborn home. The COVID-19 pandemic changed the way our hospitals and communities function. These changes are all to help keep our patients, staff, and community, safe and healthy and to reduce the possible spread of COVID 19. And during this unprecedented time, many expecting parents are left wondering how this may affect their birthing experience and their newborn baby, and here to help us navigate this moment of uncertainty, is Dr. Goje. Thank you so much for being here with us.

Dr. Goje:  Thank you for having me.

Nada Youssef:  Sure. Dr. Goje is an obstetrician, gynecologist and also a reproductive infectious disease specialist. She's also an assistant professor of OB/GYN and reproductive biology.

And so our listeners, please remember this is for informational purposes only, and it's not intended to replace your own physician's advice. So let's start with pregnancy. Are pregnant women considered high risk due to this pandemic?

Dr. Goje:  So excellent question, but it's a two-fold question. Pregnant women have the same risk of acquiring COVID-19 just like a non-pregnant person, but when a pregnant patient acquires COVID-19, evidence suggests that she may be at a higher risk of having a severe infection of COVID-19. There was a study from the CDC, which is the Center for Disease Control and Prevention, that shows that pregnant patients with COVID-19 had an increased risk of hospitalization and ICU admission compared to their non-pregnant counterpart with COVID-19.

Nada Youssef:  I see. So if mom catches the virus, will she give it to her unborn baby?

Dr. Goje:  No. First of all, we have to remember that COVID-19 is an evolving pandemic and we're learning more about it. I want our listeners to be reassured that we keep acquiring data, we keep analyzing data, but as of today, there is no science backed evidence that mothers transmit COVID-19 to their babies.

Nada Youssef:  Okay. That's good to know. So many pregnant women are wondering if they should keep their regular scheduled appointments and screenings during this period of restrictions. What's your advice?

Dr. Goje:  Yes, please. Please keep your appointments. It is very important that pregnant patients keep all prenatal appointments, whether it's an on-site appointment or a virtual appointment or ultrasound, please keep your appointments. Also referring back to that CDC article from June, the women who had a higher risk of hospitalization and ICU, some of them had other underlying medical conditions like cardiovascular disease, lung disease, diabetes. So you want to optimize your health to make sure that you and the baby are getting the best care. So please keep your appointments.

Nada Youssef:  Sure. And then when you come to your appointments, there is scanning, correct? We're scanning patients coming in to see if they have any fever or anything like that, any symptoms. But what happens if you don't pass a scan when you're coming in for your appointment? Let's say you have a fever or any other symptoms. Can you still get the tests? Can you do your appointments? Should you go to express care online?

Dr. Goje:  It's okay. If you don't pass the scan. Pregnant patients have always been protected. If you don't pass the scan, we'll will ask you questions. Have you been in contact with people that have flu-like symptoms? Who have colds? Have you traveled to areas that have a high incidence or rates of COVID? And pregnant patients will always be at the top of the line for testing. You'll be tested. Your primary care or your OB doctor will make sure that you get all the best care. So don't be concerned if you don't pass the scanning. In fact, it's just to make sure that you get the best care. We'll take care of you.

Nada Youssef:  Great.

Dr. Goje:  ... You from coming into the hospital to get your care. And I want to also tell our pregnant patients that the hospitals are making sure that you're protected. So there are less chairs in the waiting room. By keeping everybody six feet apart, your providers, all the way to the patient service representative, are wearing face masks to make sure they protect you. So please come in. We have all the provisions made to make sure that we prevent you from getting COVID-19.

Nada Youssef:  That's very reassuring. That's great. But now if a pregnant woman does have a cough, fever or other symptoms, what should her next steps be?

Dr. Goje:  Excellent. If she has a cough, let's run through all the symptoms because it's not just cough or fever, shortness of breath. From studies, sometimes women have atypical symptoms. They could have body aches, they could have diarrhea. They could have headaches. They could have joint pains. If you have symptoms that just are out of the ordinary, things that are not usual for you, the first thing to do is call your primary care provider or call your obstetrician gynecologist or your well-woman provider or your midwife, and tell them what is going on. They will screen you based on the symptoms and your questions, and then triage you for the COVID testing. And from there, decide if you need higher level of care, or if you can just stay home, be quarantined and then they will call you regularly to see how you're doing.

Nada Youssef:  Now. When I had my children pre-pandemic, there was a lot of childbirth classes, breastfeeding classes, can these classes or training classes you can call them, be taken online?

Dr. Goje:  Yes, all of your classes are still available. And please avail yourself of those classes. New mom classes, breastfeeding classes, Lamaze, weight management, there are a lot of virtual classes that are available. Just call the baby helpline and ask for whatever class you will be interested in attending, and they will help you navigate to the right class.

Nada Youssef:  Great. All right, well, let's go ahead and start talking about childbirth. Now how will a new mom's experience at the hospital be impacted by this pandemic? How is it different?

Dr. Goje:  I will surprise you to say for the woman, it's not different. She's still going to get the excellent care that she wants. For the provider, we have a lot of things in place to prevent transmission. Childbirth is one of the most beautiful experience that anybody will ever want to have. And I know our pregnant mothers have an idea of what they want. They call it a birth plan. I call it a birth preference because it's what you prefer really, because things sometimes are dynamic and can change. So you should always talk to your providers about what changes you should expect in this pandemic. All our laboring mothers will still have their significant other for emotional support, and they can have some virtual support as long as it's HIPAA compliant, meaning it's not breaking the rules of privacy of the patient. So they just need to discuss with their provider what kind of support they can have both onsite and virtually.

Nada Youssef:  How about the length of stay at the hospital? Is it kind of the same as it was before the pandemic?

Dr. Goje:  The length of stay is still the same. You will stay based on what we call the standard of care, until we know that mother and baby are healthy and ready to go home.

Nada Youssef:  Now mom's maybe thinking home birthing is better or safer alternative to staying away from the hospital, but tell us why is the hospital is still the safest option even during a pandemic?

Dr. Goje:  The hospital will always be the safest option because childbirth, although it's the most beautiful experience, is also a very dynamic experience. No childbirth is the same, even for a mother that had 10 children. Every child is unique and you cannot decide what will happen during a childbirth, even with the most experienced home birth attendant. Every mother needs access to excellent care. And with all the rigors of being screened to get into the hospital, we need our mothers to get access to care immediately. And that's why I think that looking at all what is going on, home birth is not the best thing at this point. Also, if a newborn needs a higher level of care, we need that newborn to get access to the best pediatricians and neonatologist, and that cannot be gotten from home at this point. So this is not time to have home birth. I think this is a season where we should all advocate for our newborns to be born in the hospital. We'll make sure that patients and their newborns are protected.

Nada Youssef:  Sure. Having access to experts is very, very important.

Dr. Goje:  Very.

Nada Youssef:  Sure. Now, if tested prior to birthing and let's say a mom was found positive, what happens next? Can she still give birth at the hospital? Can her partner still be there?

Dr. Goje:  Absolutely. She will give birth in the hospital. She will receive the same excellent care. Her partner will be there and she will have her baby. What changes is that the healthcare provider wears PPE. They wear the correct protective equipment to make sure that everybody is well protected. Her birthing plan or preference to a large extent is still the same. She still gets her epidural if she wants. She still gets her natural childbirth if that is what she elects for. She still gets her a trial of a vaginal delivery. And if she needs a C-section, she still gets one.

Nada Youssef:  Now, if mom does have COVID-19 while giving birth, what does that mean for the baby? Does the baby have to be quarantined away for 14 days from everyone?

Dr. Goje:  No. When a mother who is COVID 19 positive has a baby, we have what we call a shared medical decision. Her baby's not quarantined away. Her baby has the option to co-locate with her, which is share a room with her. What we encourage the mother to do, is to protect the baby from contracting COVID-19 by always maintaining strict hand hygiene, washing her hands for at least 20 seconds using a hand sanitizer that has at least 60% alcohol, always wearing a face covering, making sure that anyone who comes around the baby is healthy, has no symptoms of any infection and is wearing all the necessary face coverings, and maintain all universal precautions.

Nada Youssef:  Sure. Now, if the newborn does need to be taken to the NICU, how are visits being handled and how are patients being safe?

Dr. Goje:  So that is a bit different, because the NICU, the Neonatology Intensive Care Unit, is a place for sick babies, premature babies, babies, whose immune system is not fully developed. So these are very vulnerable children that have to be protected. So only healthy parents or caregivers are encouraged to come to the NICU, but we will prefer a healthy caregiver to be directly in charge of the baby. And if there's no healthy caregiver, there will be what we call a shared medical decision, whereby we sit down with the parents to discuss how best to take care of their baby, protecting every other premature baby and sick baby in the NICU.

Nada Youssef:  Now, speaking of newborns, how might having a newborn at home be different during the pandemic?

Dr. Goje:  It should be different because our goal is to protect the newborn. And we talked about doulas and we talked about the mother who might need some support. With newborns and new mothers, there has to be a balance. Some mothers need support; difficult delivery, she needs emotional support. Cesarean section, she needs some support. So we have to have that balance. Also there's that shared medical decision of: "I need help." Postpartum depression, "I need some support." You have to have that balance of support with the fact that you don't want to expose the newborn to COVID-19. So if you're getting a doula or a birth support person, that person should self-quarantine, maintain universal precaution for your benefit. And for some homes, as we talked about, they have actually advocated for screening and testing of people who will be immediately caring for their newborn.

Nada Youssef:  Great. And then if any visitors want to see the newborn, grandma, grandpa, family members, they can always do virtual. Okay, great.

Dr. Goje:  I have always advocated for virtual visits. I think that's why I call it a birth preference. If we start talking about birth preferences early in pregnancy, we realize that we can have the same excellent experience during the COVID season as we had pre COVID, by just thinking outside the box. Thinking about virtual baby showers, virtual parties. They can experience everything. The haircuts, the crying and everything. And so keeping everyone safe, because grandma also needs to be safe if she's within that age range of greater than 65, medical conditions that can actually get sick with COVID.

Nada Youssef:  Sure. And we all have to adapt to these changes to keep our families safe.

Dr. Goje:  Absolutely.

Nada Youssef:  Excellent. Now let's talk about lactation consults and new mom groups. I know those were very, very helpful for me. Are those support groups still available? Are those all also online?

Dr. Goje:  Absolutely. Those support groups are available. Some of them are onsite and all of them are online. So the mom support groups are all online and there are more groups now. There is support for postpartum depression online. There is a lot of comfort groups online. More have sprung up during this COVID-19 pandemic, that new moms or moms to be, or dads to be, can avail themselves of. There's lactation consultation online. And while the mother is in the hospital, there's actually onsite lactation support. So they will still get the lactation consultant support them in the hospital, and then they can follow up virtually with that person post natal delivery.

Nada Youssef:  Excellent. So if someone in the home is diagnosed with COVID-19, do they need to quarantine from the baby?

Dr. Goje:  Yes, please. If anyone at home is diagnosed with COVID-19, please, they should quarantine from the baby. As we discussed earlier, we have not seen vertical transmission, which is mother to child transmission of COVID-19, but we have seen what I call a horizontal transmission, whereby adults have transmitted COVID-19 to newborns. So it is possible to transmit to a newborn.

Nada Youssef:  And even if you're not diagnosed with COVID-19 and if you think you've been exposed to someone with COVID-19, also do the same, correct?

Dr. Goje:  Yes, please.

Nada Youssef:  Okay. Sure. Now, if mom is diagnosed, can she still breastfeed or does that do anything to the baby?

Dr. Goje:  Excellent question. I love that question. When a mom is diagnosed with COVID-19, she can breastfeed if that is what she wants to do. There are two ways that she can breast feed her baby. She can nurse directly from the breast, making sure she maintains strict hand hygiene, wearing a face, covering, maintaining all precautions. If she's very sick and she's short of breath, she's coughing, and she's unable to do that, she can actually express the breast milk either manually or using the breast pump. And then another caregiver can give the milk to the baby. If you're going to express breast milk, please make sure that the breast pump is cleaned every time it's used appropriately using the manufacturer's directions, and make sure that that all bottles and all the other things that used to express the milk are all wiped down correctly.

Nada Youssef:  Those are very good precautions that you're stating, but is the breast milk itself, that wouldn't have anything in, I mean that is safe if mom has COVID and the baby does not. And just giving the baby milk even if you're expressing it, giving it to her in a bottle, or maybe dad's doing it, that the milk itself is safe.

Dr. Goje:  The milk is safe.

Nada Youssef:  Great. Excellent. Well, Dr. Goje, those are all the questions that I have for you today. Did you have anything else you wanted to add?

Dr. Goje:  I have two things to add. One of the things I talked about with you was about attending prenatal care, and I want to express it, that it is really important that our mothers to be, attend prenatal care. There was a study from the United Kingdom by a doctor called Khalil, Asma Khalil et al, that looked at the incidence of stillbirths in COVID-19 pandemic period, and found that there was an increase in stillbirth. But the surprise is that the increase in stillbirth was not associated with COVID-19. So they started looking for what could be the reason. And some of the hypothesis that was put out was the fear of coming out to seek care, could have actually led to the increase in stillbirth. For example, when patients have a decrease in fetal movements, they call their providers who ask them to come in for a fetal surveillance or something like that. Patients maybe were not calling or they felt, "Oh the hospital is already overburdened by COVID. Why add my own burden to that?"

Or patients who are diabetic or hypertensive who will have gone for weekly testing were not showing up. So it just lends credence to the fact that patients need to seek their medical care as scheduled, regardless of what COVID-19 pandemic prevalence is in their community. The other thing is, I know a lot of our mothers are very anxious. There's a lot of data out there about anxiety and depression during the COVID 19 pandemic period. I just want to reassure the pregnant patient and her family that we're doing everything to still give her that experience. You've heard me say that birthing experience, I'm an obstetrician gynecologist, and I know that women want an experience. There's something they have looked forward to about having a baby. And we're still out here, hoping to give them that excellent experience while making sure it's done in a safe environment. So I hope that helps them with anxiety, that we're all out here, making sure that we can give them that best experience with safety for everybody.

Nada Youssef:  Dr. Goje, your information is most helpful. Thank you so much for being here today.

Dr. Goje:  Thank you so much for having me.

Nada Youssef:  And for our listeners or viewers, if you'd like to schedule an appointment with Cleveland Clinics, OB/GYN and Women's Health Institute, you can visit Cleveland clinic.org/obgyn or you can call (216) 444-6601. And for more podcasts with our Cleveland Clinic experts, you can visit clevelandclinic.org/hepodcast. And for more health tips, news and information from Cleveland Clinic, make sure you're following us at Clevelandclinic, one word, on Facebook, Twitter, and Instagram. Thank you again for joining us.