Labor and Delivery in the days of COVID-19

By: Jennifer Lincoln, MD, IBCLC

The novel coronavirus has changed almost every aspect of our lives, and the daily goings-on in our Labor and Delivery unit are no exception. Here’s an example of how COVID-19 affects a typical day for on our unit.

My L&D floor is essentially an Emergency Department for pregnant women. Not only do we care for pregnant and postpartum women, but we see any woman who is pregnant and comes to the hospital for an issue, whether it’s a headache, dehydration, or even a kidney infection. This means we have to be as prepared as the traditional Emergency Department when it comes to screening for and treating women with coronavirus.

Add into the mix the complicating factor of pregnancy, and the susceptible newborns who are also patients on our unit, and we have a recipe for disaster if we were able to not take this pandemic seriously. Thankfully, preparation and the ability to adapt quickly has allowed us to be ready for the fight.

The changes are evident even before a woman walks onto our locked unit. She is screened at admitting by a temperature check and symptoms screening questions. The same goes for her partner.

Once she is cleared, she enters our unit. She used to be greeted by smiling faces but now sees a sea of scrubs, masks, and surgical caps. She can’t tell that we are excited to meet her or see our concerned faces when she is scared and in pain.

If she is admitted to the hospital rather than being sent home, she will have a COVID-19 nasopharyngeal swab done. This is uncomfortable, but we have deemed it necessary to screen everyone on our unit to be able to identify asymptomatic carriers. This is just another reminder that she is here giving birth in abnormal times.

Our unit used to be one where there were no visiting hours—supporting family and friends were welcome anytime, because babies are born any time! We also are used to births where partners, siblings, friends, doulas, and grandparents might be present. Our rooms were joyous places where everyone excitingly awaited the arrival of a new bundle of joy.

COVID-19 has taken that from us. We now limit visitors to one person who must remain with the patient at all times. This means no more excited siblings waiting to become big brothers or sisters and their shouts of joy when they get to announce the gender of their new baby. That dad who is here to see his baby be born? He can’t leave to go care for his other kids after his partner gives birth, so childcare has become very complicated for these new parents.

Instead we now have quieter and emptier rooms, with expectant mothers who miss their older children. Facetime and Skype try to fill the void, but it’s not the same.

Our patients now have a hard time remembering who we are because we all look similar in our personal protective equipment, though we go above and beyond to make that connection beyond the masks and gowns. If she develops a fever in labor, even more gear is used—again, making an event that should be exciting and momentous somewhat frightening.

Throughout all of this, we continue to manage the emergencies that still happen even though a pandemic is in progress: hemorrhages, shoulder dystocia’s, and the need for urgent cesarean sections. We continue to remember the basics, with the added stress of coronavirus always lurking at the periphery.

In the beginning of the pandemic, emails were going out daily about protocols, workflows, and guidelines. Sometimes multiple ones were released in a day, or just when you got one protocol down it changed completely. As frustrating as this is, we are lucky that our hospital has always been responsive and worked extremely hard to keep everyone informed.

Patient education has been at the center of this entire pandemic. Education about how important it is to still prioritize your health and call your doctor when worried, and education on how to modify some prenatal visits to virtual ones. We distribute lots of patient-facing material about COVID-19 symptoms, safety measures, and reassuring patients that we are still here to care for them.

On discharge, we have gone the extra mile in coordinating appointments. Who needs to be seen sooner and who can wait longer? Have we gone over all this material so the new parents feel completely comfortable knowing what the warning signs are, and how to get a hold of us even before coming to the hospital? What can we address here and take care of so they don’t need to come back to the office more than is necessary?

Coronavirus has made it obvious that our healthcare system is fragile. It has also shown us, however, that what we are doing to reach our patients online and via “alternative” methods like telehealth consults are forward-thinking and hopefully here to stay in some ways. We are all excited to go back to the days of normal obstetrics and happy birthdays, but in the meantime we are adapting and moving forward with providing excellent care.