As the world has muddled through these past seven months, scientists have found answers to some of those questions. But pregnant people are still navigating a changed and difficult terrain. Studies reveal that COVID-19’s impact on pregnancy, birth, and the postpartum experience includes increased mental health issues, disruptions in access to healthcare, and less in-person support at every stage. American Black, Indigenous, and Latinx families were already more likely than white families to experience difficult pregnancy outcomes like premature birth. Researchers are investigating whether the pandemic has worsened those health disparities, which are driven by racism and social inequality, among other potential factors. As for the direct risk posed by the virus, so far the U.S. Centers for Disease Control and Prevention (CDC) says that pregnant people infected with the coronavirus are more likely than nonpregnant people to get severely ill, though not more likely to die. And a preliminary new report from the CDC suggests that COVID-19 increases the risk of preterm birth significantly, with pregnant people who are symptomatic delivering early 23 percent of the time. (The average rate of preterm birth in the United States is 10 percent; according to the report, pregnant people with COVID-19 who are asymptomatic deliver early 8 percent of the time.) Fortunately, other research, such as a study published in JAMA Pediatrics in October, suggests that it is unlikely for mothers to pass COVID-19 to their fetuses or newborns, and that breastfeeding is likely safe, even for people who test positive for the novel coronavirus. Crucially, the American Academy of Pediatrics no longer recommends that mothers with COVID-19 be separated from their newborns for infection control. Experts note that our knowledge about the impact of the coronavirus on pregnant people and their babies is still evolving, and that the data doesn’t include pregnancy status for most of those who test positive for COVID-19. As the months of life with COVID-19 tick by, pregnant people and obstetric providers are adapting to this new reality. For Lindsay Schoenfeld, this was distressing news. Schoenfeld, 36, had stopped working at her job in corporate finance in order to care for her 3-year-old as she approached the very end of her pregnancy; her babysitter could no longer come to work because of the city’s shelter-in-place order. When her obstetrician suggested she be induced on her due date, March 23 — the first day of no-partner births — Schoenfeld felt a sense of grim resignation. In the labor and delivery room, she was aware that the hospital staff were under tremendous stress, even as they went out of their way to make her feel supported. She had been tested for COVID-19 on admission, but the result (negative) wouldn’t be known until late the following day, so she suspected the staff was worried she was infected. She tried to breathe deep through a mask and face shield while her contractions came fast and hard. She FaceTimed her husband. “I could hear in his voice that he was so demoralized,” she remembers. “He didn’t know how to help me.” As her son was born, her husband watched on his cell phone, snapping a screenshot as Schoenfeld cut the umbilical cord. She knows she was lucky, but it’s hard for her to look at that picture now. Since that day early in the lockdown, the impact of COVID-19 on pregnancy and birth has not so much improved as stabilized. Most hospitals now allow at least one support person for someone in labor who has tested negative for COVID-19, and some allow a partner during ultrasounds. But in many hospitals, pregnant people who have tested positive cannot bring a partner for prenatal care or for the birth. Other precautions now in widespread use to prevent the spread of the coronavirus during pregnancy and childbirth include increased reliance on telehealth for prenatal care as well as new hospital protocols that include rapid COVID-19 testing upon admission, universal masking, and physical distancing of patients from each other. Changes to standard care and visitation policies vary from region to region and hospital to hospital. That’s in line with the official guidance from the American College of Obstetricians and Gynecologists, which suggests certain pandemic-aware modifications for prenatal and birthing care, but notes that specific decisions should be made by individual facilities on the basis of the local infection rate and the resources and space the facility has available.
Birth With a COVID-19 Diagnosis
Some parents have found creative ways to work within these new COVID-19 restrictions. Anna Beth Browning, 26, a real estate agent and bartender from Grapevine, Texas, was shocked to discover that both she and her boyfriend tested positive for COVID-19 shortly before she was induced, on June 19. Both felt like they had minor allergies, nothing more. Browning’s boyfriend manages a restaurant; they believe he was exposed at work, but going without a paycheck wasn’t an option. The diagnosis meant that Browning’s boyfriend couldn’t be present for the birth of his child — at least, not inside the hospital. He and her 7-year-old daughter from a previous relationship put on masks and set up lawn chairs outside the window of her first-floor labor and delivery room. They opened the window a crack to pass snacks back and forth while Browning was in labor and the whole family was together, in a way, when their baby boy was born. Throughout her stay, Browning was cared for in a single room with the door closed — common hospital protocol for mothers with COVID-19. Healthcare workers clad in PPE (personal protective equipment) entered only when necessary. Browning’s biggest worry was that her baby might be taken away from her until she tested negative. But her obstetrician reassured her that this practice is no longer considered necessary or beneficial; mothers can choose to have their babies cared for in the nursery for the duration of the hospital stay, but that is of limited use if the mother and baby will be going home together in a day or so. Instead, Browning’s obstetrician advised her to wear a mask when breastfeeding or cuddling, and to wash her hands a lot. Even before the pandemic, Black and Indigenous people in the United States were already at much higher risk of death during pregnancy than white people for reasons that include the effects of systemic racism. Now a growing body of data suggests that COVID-19 is disproportionately impacting Black, Indigenous, and Latinx communities. That means that pregnant people in these groups are more likely to have been exposed to the coronavirus and are also more likely to experience health problems related to the virus, pregnancy, or both. “This is a very difficult time, particularly for Black women, as it relates to both the COVID pandemic and the turmoil surrounding racism in our country. These things are both heavily affecting moms,” Dr. Collier says. “COVID has unmasked the ugly effects of racism on every level of health and healthcare. The same is true for maternal health.” Stephanie W. Telles, 36, the director of the government accountability office at the New Mexico state auditor’s office in Albuquerque, was acutely aware of these problems during her pregnancy this past spring and summer. “Hispanic women have higher risk — especially advanced maternal age Hispanic women,” she says, speaking of maternal mortality and problems like premature birth. “That was a concern for me.” Telles wanted to be proactive in advocating for herself and her baby, but she didn’t feel that she was getting the information she needed. She thought her midwives were excellent, but the pandemic was changing everything about healthcare dizzyingly fast. “I told my midwife, ‘I think I’ve fallen through the COVID crack,’” she says. She started going to a virtual pregnancy support group through the March of Dimes, which she found comforting, and which helped her figure out what to ask her midwives. In the end, she decided to be induced on her due date, July 28, partly because she felt it was medically the safest option and partly because it meant her husband could enter the hospital with her — if she were to walk into the hospital in labor, COVID-19 protocols meant he would have to wait outside until she was admitted. Her baby girl was born on July 31. Telles reflects on the deep contradictions inherent in childbearing right now. “On top of the pandemic, there’s civil unrest everywhere,” she says. “I was feeling really dreadful. I was feeling the isolation. I was having thoughts about how irresponsible it is for me to bring a child into the world right now. “But then we also need the hope. We need the goodness. Our daughter is bringing so much joy to our lives and to our friends and family.”
