Giving birth is like crossing into unknown territory at the best of times. Right now, as an infectious disease threatens to overrun hospitals and put incalculable strain on our medical professionals? It can feel like a minefield. Portland parents-to-be are having to navigate a whole new world, full of questions, and often without all the answers.
Is it safe to go to a hospital? Will my partner be able to attend the birth? Can I transfer to a birthing center? What are the risks to me and my baby? The answers are still evolving as Oregon grapples with this new virus, and the data is limited—but the babies are on their own timelines.
“Babies don’t care that the world is in a pandemic,” says Dr. Kristine Roesen, a board-certified ob-gyn who operates out of Legacy Health System. She is at pains to reassure people, however, that hospitals are still safe. “Everyone is afraid for this disease right now, but hospitals are still a great place to birth. We’re still going to take great care of people.”
Still—as is often the case with births—things might go a little bit differently than planned. Even in the run-up to the big day, prenatal visits are being structured in a new way to reduce any potential exposure to patients and their partners or family members.
“Visits may be spread out, there may be some visits happening via telephone, but the physicians are always on call,” says Roesen. “At no point can you not get the care you need, but your prenatal visit may be structured in a way that, if you compare to a previous pregnancy, may not be the same.”
The usual family birth center tours have been moved to the virtual arena, with four-minute videos taking expectant parents through facilities and protocol.
And when the time comes to head to the hospital for delivery, there are other new protocols to be aware of. Hospitals now have designated doors for entry, and could potentially be at capacity, so Roesen advises parents to call their doctor before heading to the hospital while in labor. (Individual hospital pages will also tell you which entrances are in use.) It’s also worth attempting to build in an extra few minutes when it comes to arrival, as all entrants are screened as they come in their door. Patients can expect to be asked some health questions, have their temperature taken, and potentially be given a mask to wear.
“There’s not a real line for patients, but it will take a few more minutes and you might not be going in the door that you expected to go in,” says Roesen.
Once inside, new rules mean only one person can accompany an expectant mother to labor and delivery. And once the baby arrives, those strictures will apply to visitors, too, including the new arrival’s siblings. “I would encourage people to utilize other resources—FaceTime or Zoom—to show off their babies. Leave your neighbors and grandma at home for everybody’s sake at this point,” says Roesen.
Expectant parents may also have questions about the risk to those pregnant and to the baby. The data on this, says Roesen, is limited.
“From what we know, and this is very limited data—some out of China, some out of New York—you’re not necessarily more susceptible to catching it [while pregnant],” she says. “We do know from the H1N1 and pregnancy, it put people at a much higher risk of complications. With the numbers we’re seeing so far we haven’t seen that with COVID.” That said, she suggests expectant parents keep tabs on the CDC’s pregnancy and breastfeeding page, and the American College of Obstetricians and Gynecologists.
Fear of contagion, however, has led many people to consider whether a hospital is the right choice in the first place, and Roesen says some patients may be good candidates to consider an out-of-hospital birth. “If someone is interested in that, they should talk to their obstetric provider or midwife to see if that would be an appropriate or safe decision for them,” she says, stressing that it’s not advisable for every pregnancy.
Still, Portland birthing centers are reporting an uptick in interested parties, with soon-to-be parents looking to change plans as hospitals prepare for a surge in COVID-19 patients.
“We’ve been very busy in recent weeks receiving calls from expecting families who wish to give birth outside the hospitals,” says Jennifer Gallardo, owner of Andaluz Waterbirth Center and president of the Oregon Association of Birthing Centers. “A lot of them are recognizing that birth centers have more individualized care, which minimizes the risk of exposure for mom and family. We don’t treat sick people, so that feels safer.”
Though many are considering a switch, they’re not always finding it easy. “One thing that’s happening is that there’s still the barrier for expectant families that some insurance companies refuse to compensate out-of-hospital midwives, and birth centers and refuse to cover them at equitable rates,” she says. “There are a lot of families facing extreme financial stress, so when insurance won’t cover their costs, they have to choose between going to the hospital where they’re worried about exposure to a serious infectious disease or being out of pocket.”
Insurance companies, she says, need to open a way for patients to make the safest choice for their families at this time. And there are already signs that things are changing in regulations around birth centers. On March 23, the Oregon Health Authority amended existing rules, allowing parents on the Oregon Health Plan to request out-of-hospital birth services up to 34 weeks gestation, when previously the cutoff had been 28 weeks, citing the need to support “appropriate response during an outbreak or epidemic of infectious disease.”
Gallardo says many of those who work in her field are uniquely positioned at a time like this. “Midwives know how to deal with crises and bring order,” she says. Expectant parents can rest assured: “We are ready for this and eager to help them. We’ve got our gloves and our masks on, and our hearts open.”