Delivery and Infancy during COVID-19: Expert Tips

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The current coronavirus crisis is a constantly moving target, with information and official guidance seeming to shift by the hour. Now more than ever, expectant New Yorkers are in need of reliable advice on how best to promote safety and health during the delivery process and the immediate days after. We hope these questions and answers from Jaqueline Worth, MD, and Julie G. Capiola, MD, IBCLC—sourced from a recent webinar hosted by boober founder Jada Shapiro—will be a source of reassurance during these uncertain times.

 

 

Please note: Information is changing daily regarding hospitals and policies. Please check with your birthing hospital and pediatrician for the most up to date information.

 

 

PRE-DELIVERY

 

Q: How should I handle prenatal physician visits? Are they still happening in person?

A: Dr. Worth recommends limiting nonessential visits, and is offering telemedicine for any patients who don’t feel safe coming to the office. She is providing urine dipsticks for patients and recommending that they have a blood pressure cuff and other instruments on hand to check their vitals. One thing that’s not possible remotely is checking the fetal heart rate, so Dr. Worth is advising patients to track fetal movement and using the results as a surrogate for healthy fetal status.

 

Q: Looking toward a potential shortage of hospital beds, should I consider being induced or scheduling a c-section?

A: It’s a reasonable question—should I just get it over with before things get worse? In making this decision, consider that induction does almost always expose a patient to a longer time in labor in the hospital (20+ hours), while a c-section is the fastest way to give birth but does expose a patient to a longer recovery time in the hospital.

 

Q: Am I more susceptible to coronavirus because I’m pregnant?

A: There’s no evidence that expectant parents are more susceptible to the virus or that it can be passed to the baby while pregnant.

 

Q: If I’m currently trying to get pregnant, should I stop?

A: It’s a good idea to delay a few weeks—just a brief pause—and then reassess.

 

DURING DELIVERY

 

Q: Are non-birthing partners being allowed into the delivery room?

A: This isn’t currently true at Dr. Worth’s hospital, but some hospitals are restricting who is allowed into the delivery room to guard against the spread of COVID-19. We have to accept this fact in the context of a public health emergency, and trust that the experts are doing what is necessary to protect us. Protocol is updated day to day, so check with your hospital.

 

Q: What are the options for virtual support during childbirth?

A: People may not realize that there’s such a thing as virtual doula care, but there certainly is, and boober is currently advising all clients to adopt it. Remember that, at this point, the guidance is to avoid other people completely. Having your doula in the delivery room via FaceTime, or even just being able to call them on the phone, can be a huge help.

 

Q: Regarding staffing and specifically the presence of nonessential staff in the delivery room, how are hospitals implementing safety protocols?

A: Dr. Worth reports that hospitals are trying to minimize the number of people in the room, both to keep parents safe and to reduce the risk for staff. If a birthing parent is COVID-positive, there would be an extra deep-cleaning protocol for the room.

 

POST-DELIVERY

 

Q: During and after delivery, will I have to be moved into a different hospital or otherwise adapt to a diminished number of rooms?

A: Dr. Worth has not heard anything about this possibility. There seems to be an effort to find additional spaces for coronavirus patients (e.g., Governor Cuomo has called for the Javits Center to be used as a field hospital) so that those in the hospital for reasons other than COVID-19 do not have to be displaced.

 

Q: We’ve heard it’s best to limit the time spent in the hospital. Are you discharging birthing parents earlier than usual?

A: Dr. Worth is trying to send people home a day early: one day post-birth for vaginal births, and two days post-birth for c-sections.

 

Q: What testing needs to be done on the baby, and how does early discharge affect testing plans?

A: If the baby is medically clear and needs to be discharged prior to 24 hours of life, then they still need to receive the New York State Newborn Screen and a congenital heart disease test in a timely fashion. Check with your doctor to see if they can receive these tests in your pediatrician’s office rather than in the hospital post-birth.

 

Q: Are hospitals reducing the number of shared recovery rooms to mitigate COVID-19 spread?

A: Dr. Worth has not heard anything about this possibility, but her hospital is having all babies rooming in.

 

Q: Will I have to be separated from my baby if I test positive for COVID-19?

A: The Royal College of London is not currently recommending separation. COVID-19 is not present in the breastmilk, so transmission would be through respiratory droplets. If the birthing parent tests positive, options would include breastfeeding with increased hygiene precautions (handwashing, mask) and pumping milk to be fed to the baby by a healthy individual. Regardless, parents should continue breastfeeding even if they test positive. The antibodies in the breastmilk will help protect the baby.

 

INFANCY

 

Q: How concerned should I be about newborns catching COVID-19?

A: In general, babies and children under 20 years have fared well with the virus. That said, a recent study showed a higher incidence of severe and complicated cases in the under one year population. However, some of the cases in that study were only presumed COVID-19; the babies might not even have had it, or they might have had it in addition to other respiratory problems affecting that age group, such as RSV. Bottom line: Play it safe and keep your under-one-year-old extra protected.

 

Q: What do I do if I think my newborn might be sick?

A: If a baby is under four weeks of age and has a fever, they must go to the hospital. That has always been true, regardless of COVID-19. Similarly, issues such as poor feeding, lethargy, and jaundice call for immediate care. To qualify as having a fever, a baby’s temperature must be 100.4°F or 38°C. Please use a rectal temperature for babies under two months of age in order to ensure the most accurate reading.

 

Q: Is it safe to use ibuprofen to treat COVID-19 symptoms?

A: At this time, the WHO has retracted their earlier statement that described increased risks associated with using ibuprofen to treat COVID-19. Dr. Capiola reminds you that the fever itself is not the problem (unless your baby is under eight weeks); rather, the fever is part of our body’s natural response to fighting an infection. If ibuprofen helps to make your feverish child more comfortable, then use it, but don’t feel like it’s crucial to bring that number down.

 

Q: Should I bring my infant in for their regularly scheduled early doctor’s visits?

A: The American Academy of Pediatrics stated this week that children up to four years old need to continue with their regularly scheduled early well visits, and especially their vaccinations. (The last thing we need is a pertussis epidemic on top of a COVID-19 pandemic). Older kids’ check-ups can be more optional or conducted via telemedicine.

 

Q: Can healthy, asymptomatic grandparents and family members visit my newborn?

A: At this point, the official recommendation is that people over 70 should not leave the home, and nonessential social interactions should be limited as much as possible. It’s best for grandparents and family members to visit virtually during this time.

 

For more support, check out boober’s COVID-19 resources and virtual doula services. Here is a link to boober’s upcoming virtual classes. Please email Jada if you need help now: 

 

Jaqueline Worth, MD, Physician and Author @Village Obstetrics and Village Maternity, graduated from The Brearley School, Bryn Mawr College, and Columbia University’s College of Physicians and Surgeons. She has been an obstetrician for nearly twenty years, and has delivered thousands of babies. Her practice, Village Obstetrics, is dedicated to working with women to achieve a safe birth that meets their individual needs. She is also a co-founder of and co-physician at Village Maternity, a collaborative physician-midwife practice in downtown Manhattan and soon, Park Slope. She is the proud mother of two young women, lives in New York City, and spends much of her time delivering babies and witnessing the miracle of life at Mount Sinai Hospital. She is the co-author, along with Adrienne L. Simone, MD, and Danielle Claro, of The New Rules of Pregnancy, available on Amazon. The book is the 2019 National Parenting Product Award Winner.

 

Julie G. Capiola, MD, IBCLC, Pediatrician and Lactation Consultant @Premier Pediatrics and The First Month, completed her residency at Yale-New Haven Hospital, where she was awarded the prestigious Morris Krosnick, M.D. award. This award is given annually to the senior resident who best exemplifies the qualities of caring, compassion, dedication, and the pediatrician whom you would most like to take care of your own children. She has been in practice for 12 years is also an International Board Certified Lactation Consultant.

 

Jada Shapiro is the founder of boober, where parents find expert in-person doulas, lactation consultants, and other maternal care providers. She also founded Birth Day Presence, NYC's top childbirth education and doula training center. A doula, childbirth educator, lactation counselor, mother and step-mother, she has assisted hundreds of births, taught thousands of families about childbirth, consulted about birth and lactation on major motion pictures, and regularly offers her expertise to media outlets like the New York Times and Today.

 

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