Waaayyy back in March 2020 — omg was that seriously a year ago? — new policies and procedures for prenatal care and labor & delivery were literally being devised and implemented on the fly. Months later, things have “normalized” (HAH) a little bit, although some particulars still remain in flux — and so do variations in practice depending on where you live.
As information about COVID-19 continues to evolve and we ride the COVID wave up and down as a nation, hospitals and practices across the country are revising and updating their protocols on an ongoing basis.
The reality is that labor and delivery today is different from what anyone would have expected pre-pandemic, and it probably will be so for quite a while.
Every state and hospital is continuing to tackle things differently — there is no blanket protocol.
- Depending on community transmission, prenatal check-ups may be conducted in person as scheduled or virtually, via telehealth appointments (but generally speaking, you should anticipate having more virtual visits):
- Some locations are holding clinic visits only for necessary in-person tests and screenings, such as ultrasounds and lab work (and are enforcing careful physical distancing measures for any such appointments as well as trying to consolidate those visits for as few encounters as possible — many places are also conducting temperature checks first thing).
- For virtual appointments, some offices are having women take their own vitals and measurements at home.
Some places are actually asking women about their individual preferences WTR in-person virtual appointments (!), so you may want to think ahead about how you feel about it.
- The Society for Maternal-Fetal Medicine recommends that no support persons or visitors be allowed to accompany women for in-person prenatal appointments;
- Some practices have cut a couple/few certain nonessential prenatal appointments entirely;
- Many practices are bumping the anatomy scan back as far as possible, closer to 19/20 weeks, so that there is a lower likelihood of having to come back for any follow-up scans;
- Prenatal education and childbirth classes have moved to the cybersphere.
The goal of all these protocols^^ is to protect pregnant women and babies and to reduce community spread of COVID-19.
→ See also: Coronavirus: Children and Pregnant Women
Pregnancy and Vaccination
The CDC, The American College of Gynecologists, and the Society for Maternal-Fetal Medicine all recommend offering the vaccine to pregnant patients, and many individual OBs/practices are coming out in favor of their patients getting vaccinated (U. Michigan, for example). Still, every outlet also stresses that vaccination is a choice, not a requirement, for prenatal care.
If you are having a hard time deciding whether to receive a vaccine, this short article from Harvard Medical School explains some of the considerations, and this ACOG patient conversation list notes the salient points about risks (vaccine v COVID), safety, efficacy, fertility, data, etc.
Experts note that the vaccines do not impact fertility, and that the safety data thus far, though limited, indicates that there are no adverse outcomes associated with vaccination (miscarriage, stillbirth, etc.).
*If you are pregnant and you do choose to get vaccinated, consider registering for the v-safe vaccination registry through the CDC to help collect more data on this topic.
Labor & Delivery:
- Many hospitals are barring visitors from L&D wards (maternity wards) to protect women and babies from exposure to COVID-19;
- The overwhelming trend (since last March, when NYC hospitals barred any visitors during L&D for a few days) is still to allow one (COVID-negative/vaccinated) individual to accompany a mother (*this is likely what most women will encounter);
- Most hospitals are working to test all women admitted for labor and delivery (and any unvaccinated partners who accompany them) automatically; and in many places, COVID-positive mothers are delivering in separate sections of the maternity ward;
**If your birth partner is not yet vaccinated, please be sure to check the policy about testing in advance. If your birth partner^^ is required to test negative (in many areas), you should line up a backup support person in case they in fact test positive. This has caught many women off guard, so we just want you to know that it’s a possibility.
- During active L&D, you will be spared PPE, but before and after, you will likely be expected to wear it. (Your delivery team will be wearing PPE, of course.);
- Some OB teams are dividing their health care personnel between inpatient and outpatient to help minimize exposure;
- Postpartum visitors are also being restricted, in both number and movement (they can’t come and go);
- *If you test positive for COVID-19, your baby can still room-in with you, according to the latest guidelines from the AAP. (You’ll still want/need to wear a mask during close interactions, though.);
- If you are not COVID-19 positive, your doctor/hospital may be more open to your going home sooner, which has been reported by most moms who recently delivered.
BTW, most health authorities — including practicing midwives and nurse-midwives — are not recommending changing your plans to have a home birth (especially at the last minute).
We wish you the best of luck as you embark upon your new journey during this challenging and unprecedented time. Once you’ve welcomed your new baby, read on for more resources to get you through the postpartum phase. Deep breath, mama.
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