In light of the current pandemic, pregnant women are facing one of the most emotionally and physically intense times of their lives in hospitals possibly filled with COVID-19 patients.
In this ever-changing environment impacted by COVID-19, women who have higher-risk pregnancies face a different set of challenges in requiring more visits and potential fetal therapies in order to chance a successful delivery. The Fetal Health Foundation recently compiled the most accurate information out right now about what being diagnosed with a fetal syndrome looks like, how treatment options and travel are being handled differently, and what to expect leading up to and during delivery. Beyond that are the obvious questions around a possible shortage of beds, care team staff and even supplies for a safe labor and delivery, depending on the area in which you receive treatment or live and deliver. Also know and understand that this is a general picture of things, as all centers are handling things a bit differently.
How are patients being diagnosed with a fetal syndrome and how does it look differently right now?
Telemedicine is the new wave of the future for many types of medicine but has proven especially helpful when it comes to receiving a fetal syndrome diagnosis. Even under normal circumstances, an obstetric doctor may notice something unusual in an ultrasound, but mom would be referred to a maternal fetal medicine specialist. Under the current circumstances of a pandemic and travel being so restricted, this isn’t as easy. Being able to have a high-risk mom visit her normal OB and consult with a fetal maternal medicine specialist hours and miles away to receive news on her fetal diagnosis, treatment options available and how to proceed with her pregnancy, saves time, worry and money.
WGBH News’ In It Together recently interviewed Dr. Bill Barth, Maternal-Fetal Medicine Specialist from Massachusetts General Hospital. He said pregnant women are being asked to make far fewer personal visits. Only the essential parts of prenatal care are conducted at in-person visits to minimize the risks of getting out and coming into the city and the clinics. Telemedicine for prenatal care is rapidly evolving and has come highly recommended by the American College of Obstetricians and Gynecologists.
Is treatment for fetal syndromes, including fetal surgery, considered an essential service?
“Dr. Ken Moise and I just submitted an editorial to the Green Journal making that point, that these are life threatening and life altering conditions and should not be lumped together with “elective” conditions. Some accommodations must be made for risks to the mother, risks to the healthcare staff and division of resources, especially in parts of the country currently being overwhelmed with COVID-19,” said Dr. Timothy Crombleholme, Fetal Care Center, Dallas.
What obstacles to travel for treatment exist right now?
“So far, our patients have not experienced difficulty traveling. Most are not flying, but preferring to drive to avoid the risks inherent in moving through airports and being in a confined space with potentially a lot of unscreened people,” said Crombleholme.
Are all fetal centers still functioning normally?
There are a number of fetal centers that have closed during the COVID-19 pandemic due to centers diverting resources to help with infected patients.
Dr. Ken Moise of The Fetal Center at Memorial Hermann Texas Medical Center said, “this is likely to be fluid, based on “hot spots” as they continue to develop.”
The Fetal Health Foundation will update with a list of closed centers as they are available.
For a full list of centers offering fetal therapies, click here.
How might it look for an in-person visit during a pandemic?
If you require an in-person visit, waiting rooms are constantly being sanitized and spacing is essential for social distancing. Prepare to wait further apart from other patients, and possibly be asked to come to your appointment alone to limit the risk of possible infection or community spread.
“[At our center], we have restricted office visits and fetal evaluations to the mother and will conference in the father by phone to decrease risks. We do not have patients in the waiting room they go directly to an exam room. This requires a change in the scheduling of patients,” said Crombleholme.
The good news is that most doctors are consolidating necessary bloodwork, tests and ultrasounds to limit the number of times a pregnant mom needs to visit.
*What can be expected at delivery? How are hospitals increasing safety once a baby is delivered, especially one that might require more resources and support?
Regarding labor, Dr. Barth stated that the plan is to keep things as normal as possible when the mom and baby is healthy. There are certainly restrictions on visitors, (limited to one or none at all in some centers), and your care team will likely all be in masks and gloves. Many doctors and midwives are making calls to prepare pregnant moms of what to expect when they come in, etc. to allay fears of all the changes. Despite the current situation, delivery in the hospital is still the safest for moms and babies and most doctors and hospitals are taking extraordinary precautions to keep them especially safe. It is important for pregnant women to understand that there are no reports from around the world of credible information that pregnant women can transmit the virus in utero or during delivery.
For a routine delivery, care teams are still using the routine equipment; if a pregnant mom is suspected of having coronavirus, the care team wears PPE and trains on putting it on and taking it off protectively and accurately — things look a little differently than for a normal delivery. The delivery room itself is going to be different if coronavirus is suspected — all care team will be in PPE, no skin-to-skin contact after delivery to be cautious.
Crombleholme said, “we are screening all patients for symptoms, but as of yet, we have not been doing COVID-19 testing on all fetal surgery candidates. We are not offering fetal surgery to symptomatic COVID-19 patients, but rather have them wait until symptoms resolve. In asymptomatic patients that are COVID-19 positive, we limit fetal interventions to those that can be performed under local or regional anesthetic.”
“Many institutions are screening all OB patients for COVID-19 with a nasal swab. A rapid test is now available in most hospitals. In addition, some will allow only one (or in some cases no) family member to attend the patient’s surgery or delivery,” said Moise. “All patients and visitors are being given a surgical mask to wear when in the hospital. Newborns are being isolated from their mothers if they are COVID-19 positive. There is currently no good data on whether COVID-19 virus is passed through breast milk. At a minimum, the mother is asked to wear a mask while breastfeeding.”
As the situation continues to change, understand that hospital and fetal center protocols around therapies and keeping everyone safe (especially including mother and baby) may change, too. Be patient, ask the questions you need to have peace of mind about your unique situation and how things may occur, and play it safe by staying home whenever possible.