COVID-19 and Maternity Care in Columbia

Coronavirus. COVID-19. SARS-CoV-2.

These words are relatively new for most of us, but they’ve had a huge impact on local businesses and medical care. As the wave of Coronavirus cases grows, the look of maternity and labor care is starting to rapidly change. If you are due within the next few months, you may want to stay up to date as local hospital policies change to prevent further spread of the virus.

What’s Changed?

Some providers have begun rescheduling prenatal visits and may be limiting visitors and children present during visits. As of this post (3/20/20), all local hospitals have imposed limits to the number of visitors a patient may have, and this includes limits during labor. Currently patients at any Prisma Health area hospital (including Prisma Health Richland, Prisma Health Baptist, and Prisma Health Parkridge) are limited to one support person for the duration of their stay. That one designated visitor cannot swap out with anyone else, and the visitor will be screened for illness prior to admission. Lexington Medical Center has now implemented a no visitors policy, other than the primary support person, who must have a bracelet. They are also asking the support person to stay on the floor to minimize the risk of transmission, but that is not absolutely required. All visitors here will also be screened prior to admission. I will attempt to keep this post updated as any policies continue to change.

These limits can clearly change your plans for labor. Extra family and friends are no longer allowed. This limit also eliminates the possibility of of bringing a doula or birth photographer unless there is not a birth partner present. This was no an individual physician decision, and at this time the hospitals report that your physician cannot overrule this limit. If you are due in the next few months and were planning to have a doula and/or birth photographer, now is the time to work with your support to create a backup plan.

COVID-19 Risks in Pregnancy

Thus far, there have been no changes in birth outcomes if the mother has COVID-19, and it is not recommended to change protocols regarding care during birth due to this virus. Research has shown that the virus is not present in the placenta or amniotic fluid, and if baby is found to test positive soon after the birth, then the infection was caused by another person present or contact with a positive mother- the baby was not ill in utero and was not made sick in the birth process.

There is limited research that suggests pregnancy can be in some ways protective against this virus. This does not mean that pregnant people are not getting sick, but they often are showing only fewer symptoms or develop a weaker infection.

The World Health Organization (WHO) recommends that families still do skin to skin care after birth, breastfeed (if desired) , and keep baby in the parents’ room even if there is a suspected or confirmed case of COVID-19.

Babies who contract COVID-19 have thus far had no severe illness. A few have mild cold/flu symptoms, but the majority have been asymptomatic. This applies for all children under 10 years old.

COVID-19 and Breastfeeding

The CDC and World Health Organization (WHO) recommend continuing breastfeeding even if the mother and/or baby has COVID-19. Tests have not found the virus present in any tested milk samples from patients who are known to be positive. Continuing breastfeeding can help support baby’s immune system and help baby fight off the virus if it is present.

Changes in Our Services

Here at Little Orchids, we are trying to adapt to still support our clients under these new hospital policies. As part of social distancing, we are encouraging families to schedule a virtual or phone consultation with us instead of coming to meet in our office. This allows us to still chat and answer any questions while reducing any possible virus spread.

We have also begun offering Virtual Doula Support. If your hospital is not allowing doulas during your birth, we’re offering completely remote pregnancy and labor support via phone and video calls. You can find more information about all virtual and remote support options on on our website.

Evidence Based Birth® released a completely online option for their Childbirth Class series. We are happy to help provide this option to families in our service area. We are also waiving the additional fee for booking a private class vs a group class. This online class option covers all the same information as the normal group class; learn more about the Evidence Based Birth® Childbirth Class here, and please contact us if you would like to book a class.

Several families have recently reached out to discuss how to possibly deliver at home instead of going to the hospital. We are doulas, and as such we have to maintain support roles only; we are not medical providers. We can attend births at home with you, as long as you also have a licensed provider present. If you need recommendations for local midwives, please send us a message! Some midwives are even accepting late transfers at this time due to the Coronavirus pandemic.

Hoping you all stay well!

ACOG Recommends to Limit Intervention

The American College of Obstetricians and Gynecologists (ACOG) recently updated their recommendations about monitoring and care for women in labor. With the new recommendations, the common picture of a laboring mother stuck on her back with continuous monitors will hopefully change. 

So what are the new recommendations?

 - The management of labor can be individualized for low-risk women who naturally began labor with a baby who is head down. This can include offering intermittent monitoring and offering forms of non-medical pain relief. 

- A woman in the latent (early) phase of labor does not have to be admitted right away if the baby is doing ok. The care provider can offer frequent check-ins instead, which can keep the mother more independent and comfortable. The care provider can also suggest methods of non-medical pain relief. 

- If a woman is admitted in early labor due to fatigue or pain, she should be offered education, non-medical pain relief methods, changing positions for comfort, and further support. Specifically, this includes allowing the woman to drink liquids during labor and utilizing non-medical pain relief methods such as massage and allowing the mother to relax in a tub or birth pool. 

- If a woman's water breaks, but labor does not start in the next hour, then the mother may choose to wait and see what happens instead of needing to be quickly induced. In order for the woman to make this choice, she should understand that there is limited data to show how safe this expectant management is, and she should understand any associated risks. If the woman does understand and still makes this choice, then her decision should be supported. 

- Evidence has shown that one-on-one continuous support (not including nursing support) improves labor outcomes. Sound familiar? This is exactly what a doula provides- continuous support!

- As long as labor is progressing normally and the baby is tolerating labor well, then there is no reason to artificially break the amniotic sac (in other words, don't make the water break)

- In order to help facilitate offering an intermittent monitoring option, staff should be trained in how to use a hand-held Doppler device.

- Pain relief can be tailored to the individual woman by using both non-medical and medical methods of pain relief. 

- Women should be permitted to move around during labor since frequent position changes can help the mother's comfort while allowing baby to find the best position. However, movements may be limited if treatments or further monitoring is necessary. 

- Coached pushing should not be expected of every woman. It is now recognized that many women push better by following instincts than they do by following coaching orders. The pushing technique used should be whichever works more effectively for the woman. 

- Unless the baby needs to be born quickly, the mother should be offered a chance to rest if she wishes before she begins the pushing stage. Women who do not have an urge to push and women who have an Epidural can greatly benefit by resting. If a woman has the urge to push, then she may go ahead and do so. 

The new recommendations may seem a bit overwhelming, but they are a great step towards offering women evidence-based individualized care. Although there will always be room for improvement, and new research will always bring some changes, these new recommendations should go a long way towards improving care for laboring women.