Courtney Levin and her husband, Andy, are the proud parents of an 11-year-old son, whom they assumed would be their only child. Doctors had told them, in fact, that they could not have more children. Imagine their surprise when they learned they would have a baby this year.
Now imagine what it has been like for them to be expecting as COVID-19 continues to spread through our community as well as around the world.
“I have several high-risk factors, so I have appointments twice weekly at Sinai Hospital for fetal monitoring. It’s been pretty stressful. I’m so worried about delivery and exposing us to the virus, but home birth is not an option for us,” Levin writes to us. “It’s my second child, I’m 41 and a Baltimore County Public Schools teacher, so I’m also worried about going back to school potentially.”
It’s been rough, she admits, although some days are better than others. She teaches high school science through BCPS’s e-learning program and is currently working from home with her son, and Andy, who is also a teacher.
“I have been trying to focus on setting up the nursery and prepping for baby to keep my mind on happier times,” she says. “Having a high-risk pregnancy was stressful before, but this added stress has been hard.”
By mid-March, or three-quarters of the way through her pregnancy, Sinai Hospital changed its visitor policy; Levin’s son was no longer able to attend appointments with her. Then the policy changed again, and no one, not even her husband, could go to appointments.
“I was very concerned about not having my husband there for the actual delivery,” she says. “Luckily, they are still allowing one visitor or support person for labor and delivery. But I was told that could change at any time.”
For now, most Maryland hospitals are allowing mothers to have one support person with them during the delivery, says Dr. Ngozi Uzogara Wexler, an obstetrician with MedStar Montgomery Medical Center. But, like Levin, she knows that at any time partners could be prohibited for safety reasons.
“We’re not there yet, and we hope not to get there,” Wexler says.
At MedStar Montgomery Medical, the support person now must pack his or her own to-go bag, just like the patient herself, because once admitted, that person cannot leave.
“We treat every patient with compassion, but the underlying assumption is that they could be a COVID-19 patient,” Wexler says.
In a similar effort to decrease traffic, labor and delivery staff has even stopped using the hospital’s phlebotomist, and nurses on the unit are drawing blood, she adds. The unit also uses its own housekeeper and is not sharing that staff person with the hospital.
Levin is hoping to be induced at 37 weeks but adds that “at the moment, my doctors are recommending we take it week by week depending on the current situation. They want to minimize the amount of time we are in the hospital as much as possible, so it may be necessary to go either earlier or later.”
There is very limited data on how COVID-19 affects pregnant patients, says Dr. Kathryn Boling, a primary-care physician with Mercy Personal Physicians at Lutherville. Physicians in China completed a few studies; while the number of patients in these studies is small, they showed that symptoms for pregnant women are not worse than for the general population
That’s important, because pregnant women are often more susceptible to respiratory infections due to changes in their immune systems, Boling says.
“In those low numbers, it looks somewhat reassuring,” she says, adding that pregnant women still need to be careful. Follow all precautions advised by their doctors, she says, both at home and at the workplace, if they are essential workers.
Another family member, for example, should do the grocery shopping if possible, and everything needs to be wiped down when brought into the home from the store, Boling says.
Mothers can expect the same level of care from their obstetricians, but some of that care may be through virtual visits, Wexler says. Obstetric patients are usually seen weekly from 36 weeks until delivery. Now those visits may alternate between virtual and in-person.
She has prescribed blood-pressure cuffs so patients can check their own pressure at home. They also weigh themselves on a home scale during the video visit. Wexler can even check a Cesarean scar during a virtual visit, she says, adding that her patients are accepting of these new practices.
“A lot of patients don’t want to come in,” she says. “They don’t want to be exposed.”
Another tool? An app called Babyscripts that physicians use to send patients updates, or patients use to document blood pressure and other health indicators.
White Marsh mom Joahnna Fournier understands the unique anxieties. She is a mom, a pediatric nurse practitioner, and she delivered her second child, a little boy named Asa, on March 24.
“I was happy to have my husband with me,” she writes us. “My anxiety since being discharged is trying to still meet the educational needs of my other child, who is in kindergarten, since we are now having to provide distance learning all while tending to a newborn. Kids need social stimulation, too, and acquire basic problem-solving skills just by being at school with their peers on a daily basis.”
She is trying to stay optimistic. “I hope we can all stay healthy through this and pray that our children can still thrive with social distancing,” she says.
Second-time mom Sari Lerner of Burke, Virginia says she too is staying optimistic in this stressful time.
“Mentally, I also feel like I’m doing pretty well. I’ve struggled with anxiety my whole life, but surprisingly, I feel like it has been under control during this time,” Lerner writes us. “I take the things I can control seriously, such as allowing only immediate family within six feet of me, not going to stores, staying home, not reading every single news report, avoiding all of the presidential press conferences, and getting my information from a more reliable source.”
Instead, she has been keeping busy, taking naps when she needs to and “allowing myself to be sad sometimes that this isn’t the experience I anticipated.”
Rolling with it
Lerner is a high school special education teacher for Fairfax County Public Schools. She has a daughter who is 4½ and is scheduled to deliver her son by Cesarean section on May 12.
“I’ve always said my birth plan contains two must-haves: a medical professional and drugs. My doctor has been reassuring that I will have both,” Lerner says. “I am disappointed that I will not have the photo shoot in the hospital that I planned for after the birth. My daughter will not get to come to the hospital to meet her brother. No one will be visiting us.”
“All that is sad,” Lerner says, “But in the end a healthy baby and mom are what matters. I will roll with the punches.”
Wexler, who is the mother of four, has been prioritizing sleep, exercise and meditation when she is not with her patients. She and her family live on a farm, and caring for their animals has been another good outlet for all them, she says. What also helps is the care and concern everyone is showing each other. As a physician, she is always asking patients how they are doing; now they are asking her and her staff the same question.
“I’m amazed at the little compassionate moments,” she says.