Navigating pregnancy, labor, and the postpartum period can be daunting even during the best of times. COVID-19 has added an entirely new layer to this already worrisome period, leaving many expectant mothers feeling overwhelmed and uncertain -- to say the least. One of our goals at Jenny + Evie is to be a source of current information for expectant and new moms. This is especially important to us during this time of coronavirus, when recommendations are changing weekly and even daily. We were thrilled to tune into a recent webinar by The Motherhood Center in New York City: Pregnancy, Delivery and Postpartum in the Time of Coronavirus, led by the center’s Medical Director and Co-Founder, Catherine Birndorf, M.D. and Carnegie Hill OBGYN Caitlin Fiss, M.D., as well as Paige Bellenbaum, LMSW, also a Co-Founder. We summarized some of the questions posed by listeners, and the answers from Dr. Birndorf and Dr. Fiss.
Q: What are you seeing these past few weeks in practice? What are you noticing has changed since coronavirus?
A: Dr. Fiss noted that as much as possible, her patients are being seen via telemedicine. In some cases, obviously, many women who need blood pressure checks, blood tests, and urine samples are still coming in for appointments. But they are going back to the bare necessities -- many patients are down to two or three appointments per pregnancy, as compared with six or seven under normal circumstances. Dr. Fiss emphasized, however, that mom and baby still need to be checked on, and that will continue to happen, whether via telehealth or in person.
Q: I am 17 weeks pregnant and have asthma. Should I isolate?
A: Yes, Dr. Fiss said. She went on to say that everyone who is pregnant should consider themselves at high risk because currently, we just don’t have enough information about COVID-19 and its effects. Dr. Fiss went on to point out what we DO know about COVID-19 at this point in time. One thing being that because of maternal physiology, and being prone to pneumonia and having reduced lung capacity, the expectation was that pregnant women would do a little worse with coronavirus -- but the silver lining has been that that’s not the case in Covid patients, so far. However, Dr. Fiss noted, doctors are seeing an increase in preterm labor, a slight increase in pre-eclampsia and C-sections (although there isn’t enough data to say this widely).
Q: What are you seeing with women at this time in terms of perinatal mental health and emotional wellness?
A: Dr. Birndorf reported that overall, everyone’s anxiety is up right now. And if you’re anxious to begin with, you might be on even higher alert than usual. She noted that some women with pre-existing mental health issues may be experiencing more distress than normal -- but some, ironically, feel that the world has finally risen up to their anxiety level and don’t feel very different, since their “normal” is this heightened sense of anxiety and alarm -- what the rest of us are currently experiencing as our “new normal.” Dr. Birndorf also said that call volume has been going up, signaling that interest in taking care of mental health has increased. People’s nervous systems are on overdrive, and they’re generally feeling very stressed, overwhelmed, and worried.
Q: Here in New York, there are many hospitals restricting a partner. How do we manage the anxiety around delivering alone? (***Note: since the recording of this webinar, New York has reversed its ruling on restricting partners from being in the delivery room. However, we decided to leave Fiss’s & Birndorf’s replies in case their advice is applicable to any moms who may face this dilemma in a different state, or are facing delivery without a midwife, doula, or other support person***).
A: Dr. Birndorf expressed that while it’s heartbreaking and very difficult for women to give birth without the support they originally intended to have, she believes women possess more strength and resilience than they realize to get through a challenge such as this. She also noted that the best way for support people to act is “as if” they’re Covid-Positive. We can’t risk having OBs taken out of the workforce, because it poses too great of a risk to the general public.
Update: Dr. Fiss recently told GOOP: “After being on the labor floor last Saturday, I’m against the governor’s mandate. Having additional people in the room is adding potential coronavirus exposure to our health care workers as well as our other patients, and it’s using up valuable personal protective equipment and coronavirus tests. Right now, we won’t know for eight to twelve hours whether our patients’ partners are going to have positive or negative test results for COVID-19. And our medical teams don’t have the right equipment to protect themselves against these potential exposures. If and when we have the right personal protective equipment -- and enough of it -- I’ll be happy to reconsider. But until we can protect those on the front lines, I don’t see how we can put them at additional risk on top of what they incur coming to work every day during this pandemic.”
Q: Will losing support people (doulas, midwives, partners) make people seek births in the home?
A: Dr. Fiss said that home births are not recommended, and that they are incredibly dangerous -- especially in the last few minutes. In many cases, should something go wrong, there is not enough time to get to the ER.
Q: Some women are creating music libraries or having loved ones record messages for them to listen to in the delivery room. What are some ways women who know they won’t be with their partner/midwife/doula/support person to prepare for birth?
A: Dr. Birndorf suggested staying connected to loved ones or support people through Zoom or Skype. She also emphasized the importance of “feeling your feelings” (fear, fury, anxiety) and knowing that whatever you’re feeling is legitimate. Don’t deny your feelings, and know they will pass, and that it will be okay.
Q: How has the postpartum experience changed for a brand new mom?
A: Dr. Fiss noted that new moms are experiencing more anxiety than usual, and feeling unsure about how they can care for a newborn when they’re finding it difficult to regulate their own emotions. She has observed that if moms are Covid-Positive, they’re worried about giving it to their baby, and if they’re Covid-Negative, they’re worried about getting it and giving it to their baby. New moms are having to be extra-careful about hand-washing and wiping everything down, and adjusting to not being able to have anyone helping in the home as they might have planned to (baby nurse, postpartum doula, or close family members).
Q: What is the “baby blues” and how does a mom know if she has something more acute, in the range of a PMAD (Perinatal Mood and Anxiety Disorder)?
A: Dr. Birndorf explained that some degree of anxiety is normal after birth -- after all, it serves us as a species to be somewhat worried and feel protective. Most women, with the exception of a few, experience the “baby blues,” which kick in around Day 3 of postpartum and last for about two to three weeks. They’re attributed to the rapid plummeting of high levels of estrogen and progesterone that occurs after birth. The blues are characterized by an “emotional hypersensitivity” -- swinging from overwhelming joy to irritability to laughing to crying. And, this all may be more intense in the context of Covid. Even during these more anxious times, Birndorf says, moms should start to feel more stabilized by the third week after birth.
You may be crossing the threshold into a PMAD if things start to feel worse, not better, around the three-week mark. Dr. Birndorf suggested asking yourself the questions: Are you able to get your usual stuff done? How dysfunctional/distressed are you? Are you unable to sleep when you know the baby is safe? Are you having intrusive thoughts you can’t get out of your head? If the frequency of these feelings is greater than normal, and your level of distress is high, that’s when you know you may have tipped over into what could be a “mild to moderate to severe” perinatal mental health issue, and it’s time to reach out to get the help you need.
Q: What do moms need to know about breastfeeding during COVID-19?
A: Dr. Fiss stated that breastfeeding is still being recommended. It’s considered safe and COVID-19 is not being passed through breastmilk. The challenge is if a mom is infected, a baby at the breast is in close proximity to mom’s coughing, talking, and sneezing, and can inhale droplets easily. One suggestion she has is to pump and have someone else give the baby breastmilk. Breastmilk itself is safe, we just need to think about the safest manner possible to give it to baby.
Q: Is there anything else we haven’t covered you want listeners to know from a physical/emotional health perspective?
A: Dr. Birndorf said she’s been seeing a phrase a lot lately that resonates with her: “boosting your emotional immune system.” She emphasized that the best thing a new mom can do psychologically/mentally is to take care of herself (as cliche as she knows that sounds). She noted that we all have to define what our own self care is -- “whatever makes you feel calm and comforted and safe and able to live your life.” Whatever those things are for you, maximize them, and minimize the stuff that stresses you out. It’s all about “self-care and some more self-care,” Dr. Birndorf reminded listeners. Moms have to be well psychologically, so she encourages moms to go to therapy online or attend a support group online. She ended with reminding listeners to please tell The Motherhood Center if they have a specific support group need, and they will try to meet it.