Transcription:
COVID-19: Pregnancy, Childbirth and Postpartum Care

Melanie Cole (Host):  This is the Northwestern Medicine Podcast on COVID-19 dated March 23, 2020.

Welcome. This is Better Edge, a Northwestern Medicine Podcast for physicians. Joining me today is Dr. Melissa Simon. She’s the Vice Chair for Clinical Research in the Department of Obstetrics and Gynecology at Northwestern Medicine. Today, we’re talking about how OBGYNs are changing their practice to treat pregnant women during the Coronavirus Disease 2019 Pandemic also known as COVID-19. Dr. Simon, it’s a pleasure to have you join us today. These are unprecedented times for medical care across the board. But for pregnant women, this can be an especially difficult time to navigate. Can you tell us how your practice has evolved to provide care for your patients while keeping them safe? Tell us how you are handling routine office visits, Telemedicine, personal protective equipment, screening. Tell us a little bit about what you are doing to navigate the situation.

Melissa Simon, MD (Guest):  We have changed tremendously in the last few weeks especially this last week and we continue to evolve as the Coronavirus details are coming through more and more. So, what we say today, and what we’ve done today may not be what we do tomorrow. So, in general, we have switched to Telemedicine for all nonurgent clinic visits either by phone or by video. In general, only people coming to the clinics right now are people who are urgently needed to be seen, those who are pregnant, who need to be seen; otherwise, we try to keep people at home best as possible. Shelter in place and physical distancing is really important at this point.

In terms of PPE or things to protect ourselves, universal hygiene is just A number 1 right now. Washing hands for 20 seconds or more, all sides of the hands including the thumbs. After everything we touch, or do, we always have to wash our hands. And that’s for the patient and for us and all the clinical care team. Finally, face masks are important for healthcare providers. In general, we are using them when there is exposure to patients that might have flu like symptoms.

Host:  So, what about the necessary in-person appointments such as labor and delivery? How is the Northwestern Medicine team ensuring that it’s safe for women to deliver in the hospital?

Dr. Simon:  That’s a very important question. Thank you for asking it. We are taking all the precautions necessary to ensure that everyone who is delivering a baby in our hospital is in a safe space. So, those are who – those who are pregnant and who have any signs of influenza or Coronavirus like symptoms are being placed in a safe separate area that is not in contact with mothers who are on the labor floor without any symptoms. So, they are totally separate floors, different units so that there is safety for everyone. And the healthcare provider team is specific to each of those different units. So, they are not crossing over from one unit to another. And we’re using all of the PPE required to protect both ourselves and the patients during this time.

In addition, we have a visitor restriction policy. Right now, again, it could change tomorrow, it could change later today, at the moment it is one visitor only and that is really important and again, precautions are taken at all times. That visitor cannot have any flu like symptoms at all.

Host:  So then let’s talk about the risk for COVID-19. Does it differ between pregnant and nonpregnant women? How is this virus affecting pregnant women? What do we know thus far? And also when you are speaking about that, if a woman does develop severe symptoms, what about their unborn child or a newborn at home? Can this increase the risk of miscarriage? These are questions that I’m sure that every pregnant woman and even their healthcare providers may have for you.

Dr. Simon:  Those are all great questions. We don’t have much data at all to go on right now. We do know that at this point, Coronavirus or COVID-19 does not seem to cross the placenta, but we really don’t have data to prove that. So, an unborn fetus is still protected in the womb so to speak. It really is about transmission contact. So, when the baby is born, it is really important to yield to the important hygiene precautions I spoke about earlier, good handwashing, if anyone has a flu-like symptoms should not go near the baby. If the mom has flu-like symptoms, wear a mask, call your healthcare provider. You can continue to breastfeed. All of the breast pump materials need to be washed thoroughly just like you would in any other normal circumstance. Again, washing hands at all times is really important too with all different points of contact with either equipment or baby or yourself or others.

Very important to maintain good hand hygiene. In terms of risk for miscarriage, or any of those other things that you mentioned, we don’t have data. We are starting across the nation, there are some scientists that are starting to collect more information about pregnant women who may have COVID or who are diagnosed with COVID to try to track and see and learn more about what happens during pregnancy with COVID-19. But we are still yet in a very nascent or early stages of that type of discovery.

Host:  Well then Dr. Simon, what do you say to healthcare providers, other gynecologists, if their pregnant women are asking them or worried that their doctors or even their obstetricians might be diverted in an emergency setting and may not be available when they are delivering. Would that be the case? How are you dealing with that?

Dr. Simon:  I can totally understand that fear. That is what we are all gearing up for is trying to limit our practices as much as we can for any elective procedures so, all elective especially gynecology procedures are being cancelled right now or postponed. Only the most necessary ones are being done. All the clinic appointments that are nonessential are being cancelled or postponed or done via Telemedicine. And we are really trying to focus our efforts clinically as obstetricians and gynecologists across the nation on the cases and care of patients that we need to care for most readily and those are the women who are about to deliver in general. And so, therefore, we have really focused our efforts and are able to shift our time so that we don’t run out of practitioners and care team members to be able to accommodate those births.

Now, I could foresee in some hospitals where there are fewer obstetricians; it may be necessary to collectively share patients across practices and be able to be open to delivering with any OB trained care provider that may not be somebody in your practice. These are the times we are living in right now. We hope that’s not going to happen in any part of this country. But at the moment, that is what we are going to have to do is mobilize as much of our efforts as possible and share care across practices and teams to be able to accommodate this unprecedented time with COVID-19.

Host:  Aside from physical health Dr. Simon, there’s a concern across the board of our mental health during isolation, during pregnancy especially. How are you advising your patients to stay mentally well? This can help so many providers to advise their patients as well. How can their providers help them with this incredible stress that we are all under?

Dr. Simon:  It is totally normal to feel anxious during pregnancy and after giving birth at any time but especially now given the Coronavirus outbreak. This is just totally normal to feel really stressed out and not functioning at full capacity. I want to reassure providers that they reassure their patients and if patients are listening as well, I want to reassure the patients that you are definitely not alone. It’s completely normal to feel this way. You just have to do the best you can and at this demanding time. And so what we really are focusing on trying to get the message out to take some time for yourself if you can. If you can go outside and take a quick walk around the block, if that’s possible.

If not, there’s lots of different YouTube videos in many different languages on meditations, on affirmations, on mindfulness and yoga. Just slowly breathing and exhaling, standing up tall and really taking deep breaths. It can help a lot. If those aren’t working and you don’t have a family member or a loved one or a friend that you can reach out to; absolutely call your healthcare provider and reach out because again, we are doing Telemedicine consultations. We have hotlines to refer people to if they are starting to feel very anxious or depressed. There are Telehealth options also for counseling sessions from other healthcare practitioners which are being done across the nation. And I think all of those things are really important options.

Other things would be apps. There’s plenty of apps out there like Headspace and Mind the Bump and Expectful and Calm that can help you meditate and help you breathe and help you focus. But again, please call your healthcare provider in these times if you need help. Because again, this is not out of the norm. You are definitely not alone in these feelings of feeling stressed out and anxious.

Host:  And Dr. Simon, as we wrap up, what would you like to tell other providers, healthcare providers, obstetricians, gynecologists, working with pregnant women during these uncertain times and what you’re doing at Northwestern Medicine to make them feel secure?

Dr. Simon:  I think reassurance is really important and understanding that there is just no certainty of what we’re going to be doing from a day to day basis because the COVID-19 epidemiology changes on a day to day basis. And with respect to pregnant persons we just don’t have good enough data to know what COVID-19 can do to a pregnancy at this moment. So, it’s really important to just continue to provide reassurance and that here at Northwestern Medicine, at Prentice women’s Hospital specifically, we have created separate units for patients who are undergoing care for rule out of Coronavirus or COVID-19 or have any flu-like symptoms. There is a totally separate unit for pregnant women in the hospital. And so women who do not have any flu-like symptoms and are not under investigation for possible Coronavirus are in a separated area with separate healthcare staff as well.

So, there is the safest environment we possibly can provide to all patients right now regardless of symptoms or no symptoms, Coronavirus or no Coronavirus. We are doing our best at Northwestern Medicine to provide care for everyone who needs it.

Host:  You certainly are and thank you so much Dr. Simon for coming on today and sharing your expertise and reassuring and encouraging women that are going through this right now and for their providers. Thank you again. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at www.nm.org to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine Podcasts. I’m Melanie Cole.