Recommendations from a team of experts to help women and their health care providers stay safe

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By Kimberlee Bongard

More than 100,000 women give birth each year in New Jersey. Pregnancy typically brings both joy and some trepidation, but the coronavirus pandemic has shifted that balance toward anxiety for many parents-to-be, who may be worrying how to keep both mother and baby virus-free through birth and the postpartum period.

With this in mind, the New Jersey Health Care Quality Institute created a work group — made up of neonatologists, obstetricians, doulas, midwives, labor and delivery nurses, social workers and other experts — which has issued recommendations to help pregnant women and their health care providers stay safe and healthy during the pandemic. Its accompanying report takes into account the effects on pregnant women of state measures to stem the spread of the disease and the impact the virus could have on such vulnerable populations as African Americans, those of low income and those with underlying medical conditions.

The recommendations include guidance for providers to ensure that all pregnant individuals obtain safe and equitable care, despite the social-distancing and infection controls necessary to reduce the spread of the virus. They cover all stages of a pregnancy — from prenatal visits through birth and postpartum care — and what to do if a pregnant woman gets the virus. The report also touches on alternative birthing sites, acknowledging that some expectant parents have turned to home births or another alternative out of fear of going to a hospital where COVID-19 patients are being treated. The work group said the recommendations will be updated as new data and guidance on this still relatively mysterious virus becomes available.

The work group’s recommendations specifically cover prenatal care, triage and testing guidance for facilities, labor and delivery, postpartum care and alternative birthing. Among the main recommendations are:

Prenatal care: In-person prenatal checkups should be minimized as much as possible, while maintaining patient safety, and substituted by telehealth checkups with the mother taking her own blood pressure except in the case of moderate and high-risk pregnancies. In addition:

• Prenatal group classes should be conducted via telehealth.
• Significant others are discouraged from attending any in-person medical visits and the woman should minimize the amount of time spent in a doctor’s waiting room.

Triage and testing guidance: On arriving at the hospital to give birth, a pregnant patient should be tested for the virus. In addition:

• According to guidance issued by the Department of Health, the number of support persons permitted to be with a patient is limited to one and that person should be asymptomatic for COVID-19.
• A spouse or other person allowed to stay with the patient for support should stay with the mother at all times and all should follow the hospital’s guidelines for the use of personal protective equipment.
• All staff should use PPE properly and practice proper infection control procedures.

Labor and delivery: Medical staff should give patients information in advance detailing what to expect when they arrive at the hospital to deliver, such as new triage procedures around labor support and discharge.

• Staff interaction with the woman in labor should be minimized.
• New mothers suspected of having the virus should be counseled about the tradeoffs between having close skin-to-skin contact with the newborn and the potential of transmitting COVID-19 to the child.
• Mothers should be instructed in how to wear a mask properly.

Postpartum care: Staff should educate mothers about the benefits of breastfeeding; so far, there is no evidence that the virus can be spread through breastmilk. In addition:

• Mothers who choose to breastfeed should be educated on the sanitation precautions they should take to prevent the spread of COVID-19, both personally and when using a breast pump.
• New parents should not put a mask on their infant; it’s not recommended that children under two wear a mask because they may have difficulty breathing.
• Almost 30 years ago, a battle was won to require insurers to pay for two nights in the hospital for new mothers and babies, but the report recommends early release from the hospital when possible while still maintaining infant safety to reduce their risk of contracting COVID-19 in the hospital.
• Postpartum visits may be conducted via telehealth unless an in-person visit is necessary.

Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, said the guidance is meant to reduce the added stress of the pandemic.

“Pregnancy and childbirth can bring joy, of course, but also some apprehension, even in normal times,” she said. “The pandemic adds a new level of uncertainty. This document is intended to let people understand what their care will look like and to understand what will happen during each step of pregnancy and childbirth. We hope that having that understanding will keep people safe, ease anxiety, and improve the birth experience.”

Header: Photo by Jonathan Borba on Unsplash