Being pregnant during a pandemic

By now, the collective anxiety, uncertainty and even fear about what we know — and don’t know — about COVID-19 is a universal one. But what if you’re pregnant?

Being pregnant, and expecting to deliver a baby amidst the backdrop of the coronavirus, may ramp up those feelings. Thankfully, local hospitals are putting plans in place to address those concerns.

Idaho Press contacted health officials at St. Luke’s and Saint Alphonsus health systems to find out how they are planning for the impending labors and births over the next coming months — and, hopefully, to quell some of the fears of those moms-to-be.

Will there be enough beds for me to have my baby at the hospital?

Both hospital systems are taking action now to ensure that hospital beds currently being used for day-to-day necessary hospital procedures — emergencies (Johnny sticks a fork in his eye), non-elective surgeries (think burst appendix, cancer surgery, etc.) will remain open for them. And that includes the maternity ward/labor and delivery.

“There is a certain component of our jobs which is unchanged and cannot be turned off,” said Dr. Kenny Bramwell, system medical director for St. Luke’s Children’s Hospital and service line in Boise. Bramwell said that medical staff members are taking extra precautions and separating suspected COVID-19 patients from others and so far have been able to sequester them in negative pressure rooms. That means, the air in those rooms does not circulate with any other hospital rooms.

But, Dr. Bramwell said, there are a limited number of negative pressure rooms — about a dozen at the Boise hospital. “Ultimately, it is likely there will be more (COVID-19) patients than we have negative pressure rooms for.”

If and when that happens, the hospital may need to dedicate a hallway, wing or floor for COVID-19 patients, Dr. Bramwell said.

Dr. Eve Preus, a doctor of obstetrics and gynecology at Saint Alphonsus Medical Group in Boise, said COVID-19 precautions and plans are underway there as well.

Dr. Preus said Saint Al’s is strictly following guidelines from the Centers for Disease Control and Prevention and the American Society of Obstetrics and Gynecology. At the Boise hospital, she said there is currently one negative pressure room to care for a COVID-19 positive patient in the labor and delivery area.

“And while this may sound like not a lot — and isn’t — to put in perspective even the ICU only has a few special rooms like this, and this is standard around the country,” she said.

Because of this, said Dr. Preus, “the CDC says if needed, the next best thing which would be safe to prevent transmission is a private room with a closed door, and all of our rooms meet this criteria.”

However, she said this closed door private room arrangement will work when there are only a few cases; if there is a surge, they will go to Plan B.

“We are planning for a ‘surge’ in cases in our hospital where patients with COVID could be cared for away from patients without the disease,” Dr. Preus said, “and while we are still in the planning stages there are several ideas about which spaces could be used for this that are aimed to protect mothers.”

Dr. Preus said she wants to “reassure mothers that we are taking all the necessary precautions to keep them and their infants safe.”

What if I get the coronavirus while I’m pregnant? Where will I go? Will it pass to my baby?

Dr. Bramwell said at St. Luke’s if a pregnant woman is suspected of having COVID-19, she is immediately assessed.

“What we are doing is our best to isolate them,” he said, “but when they first arrive, we do not know, but they may show up (later) with symptoms.” Currently, there is not a dedicated labor and delivery area for those who may have the virus, but all of the labor and delivery rooms are separate.

Dr. Bramwell said while it isn’t conclusive, the limited research so far has indicated that the coronavirus does not pass from the mother to the fetus through the placenta. However, once the baby is born, that’s a different story.

Transmission “is more likely to happen after birth than before birth,” Dr. Bramwell said. “We certainly know it is contagious through the air.”

But, he said, “the likelihood of vertical transmission is low. And if you look at the mortality rate of patients less than age 10, that’s close to zero. I’m not aware of any mortalities in ages less than 14; they seem to be able to compensate for this illness.”

Dr. Preus said similar plans are in place at Saint Al’s. If a mother is suspected of having, or has been tested positive for the coronavirus, “the mom and baby are to be separated right away after birth,” she said. “It sounds terrible … but it’s for the protection of the infant. The baby is to be separated immediately.”

The mother can still breast feed, she said, through pumped breast milk.

Will I be able to have a birth partner with me during labor and delivery?

Dr. Bramwell said that at St. Luke’s, husbands are currently allowed to be with wives during labor and delivery, and there can even be one other birth-support person. But, as many things in this evolving environment, what is true today many not be tomorrow.

“It’s worth knowing that we have changed our policies about visitors a few times in the last two weeks,” Dr. Bramwell said. “It is likely that this will change again and it is possible that my answer will be different, as I think it may become necessary to limit visitors even further.”

Dr. Preus said there are restrictions about birth attendance at Saint Al’s, too.

“Right now, we’re allowing one birth attendant and not allowing them to switch out. But that may change,” she said. “Currently in New York, they’re saying no visitors.”

As time goes on, both health professionals urged pregnant women to be in close contact with their health providers. Dr. Preus said even clinic practices have changed to include a reduction in the number of office visits and the use of phone and telehealth as well as increasing the time between prenatal visits, “to reduce our patients’ exposure,” she said.

“I don’t blame pregnant women for being unsettled,” Dr. Bramwell said. “It’s a tough time.”