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Explainer: Health Care Guidance on Pregnancy During the Pandemic

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

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Jayne and daughters

New Moms: Top Ten Things I Wish I’d Known

In honor of Mother’s Day, I asked local moms what they wish they could have told themselves as new moms with the luxury of experience, confidence and wisdom behind them. As a postpartum doula, I bear witness every day to the transformation motherhood brings to women. Sometimes the first few months feel like a painful bootcamp peppered with sleep deprivation, spit-up stains and body parts you barely recognize. Then slowly you emerge from the fog and begin to fit into the over-sized role of “Mom” that originally seemed too roomy and alien. Like a stretchy dress, gradually the identity forms to your updated definition of self: It might not be the exact color you asked for, but it’s a style that suddenly suits you.

Here are some meaningful observations local moms told me they wished they had known:

1) Formula feeding guilt will pass

“For weeks after deciding to be a formula-only family, tears would spring to my eyes whenever I saw breastfeeding ads in my Instagram feed or breastfeeding supplies at the store — when I had to check ‘formula’ on all of the doctors’ forms and was asked by acquaintances whether or not I was breastfeeding.”

So many moms feel this weight of guilt for not doing what they were told “is supposed to come naturally”. It’s very difficult to have clarity when you’re in the midst of this struggle. You may question your mothering abilities and judge your perseverance. Breastfeeding is difficult and can impact your mental health when the challenges start to overshadow the benefits. The same mom quoted above went on to say this:

“Six months later, I don’t even think about it. And some of my mom friends with babies at a similar age say their child isn’t even interested in nursing anymore as solids are taking over their attention span!” What seems catastrophic when your baby is four weeks old will seem less critical with time and perspective.

2) You will hate your husband no matter how hard he tries

I appreciate this mom’s candor. Don’t worry dads, it’s not really your fault — and it’s not forever. It’s just that new moms usually learn the ropes faster than new dads. This often makes them impatient with their partners: They don’t soothe the right way, they don’t burp the right way, they take too long warming a bottle. They don’t seem to even flinch when the baby is screaming on the changing table. Later on, new moms may resent the men in their lives for being able to go back to work. Yes, women yearn for the freedom to walk out of the house showered and fresh to a place where no baby cries and they’re able to eat lunch when they’re hungry, not six hours later. Many moms feel that their day-long, night-long baby tending is a burden their partners can’t fully understand or share. Dads, this exasperation will fix itself over time. But make no mistake: Both partners need to communicate their needs otherwise you’ll be left with a festering wound of resentment.

3) Sex after vaginal delivery might intimidate you

Doctors will often give you the green light to have sex again after your six-week postpartum checkup — sometimes with a prescription for birth control (which can feel like a parking ticket). What they really should tell you is you’re only ready when you feel ready, not because the doctor gave you the green light. It might have been more helpful to explain that lack of sleep, hormonal changes, flattened libido and the constant feeling that someone needs you all the time is the biggest sexual buzzkill ever. Sex, both physically and emotionally, will be a tentative and sometimes disappointing road. But other forms of intimacy will substitute very nicely. In Meaghan O’Connell’s book “And Now We Have Everything,”her husband has an enormous revelation when he discovers that his wife is not rejecting him in the boudoir as he suspected, she’s just suffering from a flaccid sex drive. She gets furious with him for not understanding how losing her libido was like losing an old friend. Yet, that is one of many misunderstandings between new parents that can readily be addressed with simple honesty.

4) Parenting is a lifetime of worry

 “No one prepared me for the fact that I am already worrying about whether my son will be bullied at school or whether he will have friends, whether he will have a partner in life who loves and supports him. No one prepared me for the fact that I have a five-month-old daughter, and I’m already worried about setting good body image expectations for her and making sure she is supported in her dreams. It was a shock to me that you are thinking so far ahead.”

Parenting becomes a lifelong obstacle course of worry: how much you can and cannot control and when you’re going to have to let go and recognize you may not be steering this ship. With each phase the types of concerns change. They become less about the physical (“Is she still breathing?!”) and more about the psychological. This is usually the time when you ask yourself, “Omigod, what did I put my parents through?” because you are starting to understand what it feels like to parent.

5) Mood disorders and identity crises are real

 “While I knew about postpartum depression and anxiety, I never knew how much of an impact was going to come my way. I have the best husband in the world, and it was hard for both of us.”

It’s one thing to hear about it, quite another to experience a postpartum mood disorder. For many moms, it’s a perfect storm of fatigue, rapid changes, parenting challenges and hormonal disruptions. Fortunately, there is plenty of help available. Support can come in many forms and variations. There is help for all levels of mood disorders, from free support groups to psychotherapy to hiring more help at home so you get a break. Both parents should be aware of how common mood disorders are and how to seek out the support they need (see link below for more information).

Identity crisis is something else that rears its head unexpectedly. One mom I spoke to couldn’t understand why having a baby made her feel like she had just broken up with a boyfriend. We discovered that she was actually feeling a loss; she was grieving her former self — the carefree, independent, well-rested self who seemed to have vanished the moment she became a mother.

“I think something else to know is that you aren’t the same person after you have a baby, and that’s also okay. You are a version of yourself, but your world has totally changed, so any notion that you are just going to bounce right back into your former life whether it be with work, friendships, family relationships is kind of absurd. I used to care a lot about offending people and hurting peoples’ feelings or looking needy or like a hypochondriac. Now I am more assertive in my needs.”

6) Doctors aren’t gods

 This has been a huge wakeup call during my pregnancy and with my baby. I used to think that doctors knew everything and were just to be trusted completely, but now I understand that they are just educated people giving their opinions, and it is okay to do your own research and go with the doctor that you feel most comfortable with. You need to be able to advocate for yourself and your child. It’s like a superpower that comes with being a parent that I don’t think I had before. If something seems wrong, don’t be afraid to go to a specialist; that’s why there are specialists.”

Lesson number one in parenting is trust your instincts. No one knows your baby like you. It may take a little time to gain that confidence, but once you feel it, you’ll have a new understanding of the phrase “mama bear” and be ferociously protective when you need to be.

 7) Breastfeeding is hard work

 I assumed that someone would come and tell me when to put the baby to my breast and what to do. I knew that it had to be done right after birth, but I was so tired and confused that it slipped from my mind.” Hospitals do their best to help with breastfeeding, but you won’t always get the guidance you need when you need it. For some new moms, this first obstacle can lead to more breastfeeding complications and struggles. “My baby developed jaundice and had to be readmitted to the hospital. We were a mess.”

This mom’s experience is another reminder of how important support can be — whether from a lactation consultant, a doula or even virtually. Generations ago women had the support of their tribe — the elders, the midwives, other lactating mothers. If breast milk didn’t appear, a woman’s baby might be nursed by another mother in her village. Now we have to seek support in the form of hired help, volunteers in our community such as La Leche League, or support groups like the one at CarePoint Health in Hoboken. Most new mothers need assistance with breastfeeding, and culturally we are sorely lacking in that area. Explore all areas of support from doulas to volunteers before you throw in the towel on breastfeeding.

8) Learn to live with less control

 For some women this can be the hardest lesson of all. Personal expectations may be high. You might have sailed your way through an Ivy League school, landed an amazing job, been promoted to a coveted position … but the baby game is on a whole different level. Your perfectionism will give way the minute you realize that babies are unpredictable, individual creatures with their own agendas. There are many books, videos and podcasts devoted to shaping your baby’s world conveniently to yours, by scheduled feeding, iron-clad nap schedules, sleep training and more. This initially appeals to moms who thrive on routines and predictability. Unfortunately, your baby will usually have other plans.

Almost a year in, and I still struggle with it. For example, my child refuses her oatmeal in the morning, and I am like, ‘Oh, God, now she will never eat oatmeal again, what am I to do?’ Next morning, I have this anxiety about her not eating her oatmeal, and she eats all of it. I still have to keep reminding myself that everything is temporary.”

9) Cherish the newborn moments

 “While I was in it, I just kept wishing for an older baby, one that would be easier to manage and provide me with more sleep. What I learned is that those other stages aren’t necessarily easier, just different, especially now that I have a full-blown toddler. Enjoy this little bundle that will just sleep on you for hours and is satisfied with only being fed until they drift into slumber again.”

There will always be those people who say “enjoy it while it lasts” as they gaze longingly at your two-month-old. You know for a fact they have clearly forgotten what sleep deprivation feels like or stepping barefoot into cat puke because you’re so bleary eyed. Someday you’ll look back fondly on the newborn period, but while you’re in it, it does feel like the longest time ever. Exhaustion will make new parenting feel like a twenty-four-hour commitment — because it is.

10) Babies can be so much fun

“I didn’t realize that truly bonding with a baby can take some time — for both parents. You may feel protectiveness, but the actual tethering bond that makes you fall in love with your baby and be unable to imagine your world without her took a while when I expected it was instantaneous.”

This makes perfect sense. After all, how often do people fall in love at first sight? Not often! So, it stands to reason that parental love can sometimes be a slow boil.

“Nowadays, we laugh so much more than we used to before we our baby was a crying newborn. I still wish we had more sleep, but that’s a story for another day.”


Postpartum mood disorders see:

Breastfeeding support:

Local support groups & classes:


Header:  Photo by Katie Welles


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Pregnancy and Parenting in the Time of COVID

“In motherhood, love can manifest most powerfully as fear.”  This quote is from the new book by Sarah Menkedick, with the timely title “Ordinary Insanity.” One might argue that our current situation is one of madness framing our mundane daily activities. Pregnant women and new families are living through an extraordinary historic moment doing the most ordinary things: carrying, birthing and parenting children. Yet there is nothing normal about our lives right now. This is a time of chronic concern for all humans on the planet, but for parents, especially new families who haven’t yet acquired their self-confidence as parents, it can be a recipe for anxiety.

In the past two weeks, New York area hospitals banned pregnant women’s spouses (and other romantic partners) and their midwives from assisting with births. Understandably those near their due dates panicked and scrambled to switch hospitals or flee the area; some even considered birthing at home. Then, just as abruptly, the hospitals reversed course and announced that one support person could be present at delivery. But the damage had already been done. Pregnant women now fret: “Will my hospital rules change again? Is the hospital even safe? Will I be discharged before I’m ready? What if my labor nurse is infected?”

In addition, all the fun things pregnant women expect to enjoy—a “babymoon,” yoga and childbirth classes, baby showers—have been put on hold or rearranged to comply with our solitary confinement.

This is not to say that COVID-19 has been all bad for new parents. Spending time indoors with no distractions and partners home for a potentially much longer paternity leave constitutes the perfect postpartum bubble.

But those bubbles burst with age.

“I feel like right now I’m a terrible mother and a terrible employee,” one mom confessed in a virtual support group. She’s not alone. All parents working from home are feeling divided by their pressing work and childcare obligations. Maybe in the past you spent a few days working from home when your sick child couldn’t go to daycare, but this is different. With daycares closed and babysitting help too risky, there is no reprieve; the weeks are grimly stretching out before us.

In a recent session of a support group for moms with toddlers, parents shared tips on how to create a makeshift playpen while on a conference call. “The one benefit is all of us are in the same boat—my boss, my colleagues, our CEO. It’s a great leveler.” One popular approach is for one to parent to work while the other watches the baby or children—but if you’re a single parent, this is obviously impossible. So, some single parents are leaving their homes and hunkering down with their own parents.

“I don’t know what I would have done without my mom,” says Alison, a single mother of twins. “It’s just too much for one person to juggle. We’re not supposed to work and take care of babies at the same time, but I have no choice!”  This combination of work and childcare is fueling unprecedented stress levels.

I spoke with Mollie Busino, director and psychotherapist at Mindful Power, a counseling practice in Hoboken. Many therapists have begun treating their patients in a virtual format like Zoom or Skype, and that has made counseling much more accessible. “This is a time of worry, and families need to protect themselves, especially in situations where anxiety is likely to escalate. I’m recommending that parents limit their time on social media, watching the news, and listening to a friend or relative who is consumed with panic about the Coronavirus,” Busino said.

Likewise, birth-workers, yoga instructors and other educators are creating virtual support groups to help new moms navigate this situation.

Still, parents are losing their ability to cope.  “If one more person says ‘this is the new normal’ I’m going to lose it!” says Lauren, a mother of two under age four. “I’m trying to work, my husband is trying to work, my four-year-old has no preschool to go to, and my baby is oblivious to the lack of adult attention right now.”

In Jersey City, parents are accustomed to utilizing our beautiful parks, playgrounds, interactive music and yoga classes; we have it all here, but much of that is on hold for the moment. In a recent new moms support group, I spoke to a mother of a newly toddling one-year-old, and she sounded heartbroken. “This is the time I should be watching my daughter run around, play on the swings, see her cherished friends—and we’re stuck inside with too much screen time and no fresh air.” When I suggested she go to a less-populated park (like Liberty State Park), she shrugged off the suggestion. “I think that’s worse,” she said. “Then I worry that the air we breathe, the things we touch, the person who walked—they’re all threats.”

So what to do?

Don’t let your anxiety spiral into depression. If the strain of this quarantine is starting to overwhelm you, take measures to protect yourself in the same way you would against the Coronavirus: Look for virtual new moms’ groups, seek online counseling, consider taking medication (which you may need only temporarily). Every day during this period of isolation feels long and repetitive, prompting lots of “Groundhog Day” memes. But perhaps you can connect virtually face-to-face with relatives and friends, something you might have done via only text or phoning before. Maybe you’d feel better expressing thanks—even for small, seemingly inconsequential things. I thing I can assure of you of is that this will end—and when it does, we are really going to appreciate the little things in life; we are really going to smile at that slice of pizza on the pedestrian plaza.

For help with perinatal mood disorders:

Peggy Kraft, Clinical Social Work/Therapist:

Mollie Busino, Psychotherapist, Mindful Power:

The Seleni Institute: Perinatal Mental Health:

The Motherhood Center:

Partnership for Maternal & Child Health: 973-268-2280 x 154:


Header: Distancing in Liberty State Park, photo by Jayne Freeman

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