When I first glanced at the pregnancy test, the two purple lines scared me. Technically, my husband and I were “trying,” but I’d only been taking my prenatal vitamin for one day and I’d had wine the past two weekends. I didn’t know if my body was ready to grow a child, and I didn’t know if I’d ever be ready for a pandemic pregnancy. I had no idea how COVID-19 would affect my prenatal or postpartum care, not to mention labor and delivery. Yet there I was, expecting my first kid.
From talking to doctors, doulas and other women, I’ve learned that although many aspects of maternity care have stayed the same during COVID, some things have changed — a few, perhaps, for the better. Here are the four biggest shifts that anyone who’s pregnant now, or hopes to become pregnant soon, should know about.
1. More visits done remotely
Since my first appointment at eight weeks to confirm my pregnancy, I’ve seen my obstetrician every four weeks in person. Once I reach week 28, I’ll start going every two weeks. The clinic also wants me to try to see every doctor in the practice at least once during my prenatal care, so that it’s likely I will have already met whichever doctor’s on call when I go into labor. Based on my own experiences with telehealth, I don’t believe I’d feel as strong of a connection with my doctors over video.
Many obstetrics practices have switched to a hybrid model of in-person and telehealth care for both prenatal and postpartum check-ups, and they plan to continue offering this option to patients after the pandemic. Patients come into the office only as needed for things like blood work, ultrasounds and vaccinations. Whenever possible, these services will be coordinated with an in-person prenatal visit, so that patients get the chance for a face-to-face meeting without an extra trip.
“I do think [using telehealth] feels different to people,” says Dr. Rosalyn Maben-Feaster, an ob-gyn at Michigan Medicine Von Voigtlander Women’s Hospital in Ann Arbor. Some people are fine doing some care virtually, because it’s more convenient and saves them time. “Others say it doesn’t feel like a visit, even though we ask the same things we would if they were in a clinic,” she says. “That is one downside. I would never want someone to feel they’re not getting the care they desire during pregnancy, because it can be a very vulnerable period.”
Other clinics have scaled back on prenatal visits. “We’ve compressed 12 to 14 visits to about eight to nine,” Maben-Feaster says. This may become the new norm. Research suggests having fewer visits doesn’t negatively affect the mother’s or baby’s health. The standard number of prenatal visits is lower in many other countries, and the American College of Obstetricians and Gynecologists may reduce the number of recommended prenatal visits when it next updates its guidelines.
Even though I’m sticking with in-person care for now, I’m going to ask my provider about using telehealth for postpartum visits. Seeing a doctor virtually would be a lot more convenient, since most offices currently don’t allow you to bring anyone — including your baby — with you. Sometimes an office visit is necessary, such as if a postpartum patient needs a Pap smear, wants an IUD or has vaginal tears that need to be checked. But otherwise, most postpartum care can be virtual.
I also plan to do an online birthing class, such as Lamaze or hypnobirthing. While some women report that the virtual version isn’t as helpful as the in-person one, it’s still better than nothing and can help mothers-to-be approach birth with more confidence, says Liesel Teen, a labor and delivery nurse from Raleigh, North Carolina. The providers leading the classes are trying their best. “Classes aren’t the same since we’re not able to give hands-on instructions, but we are able to demonstrate comfort measures,” says Keisha Graham, a birth doula and childbirth educator in Richmond, Virginia. As a bonus, many of these classes, whether they are private or offered by a hospital, create communities where mothers can connect and support each other, as well as the opportunity to meet one-on-one with experts like psychiatrists and social workers.
Finally, there’s the hospital tour, which for me will have to be done virtually or not at all. “I like for my clients to do a dry run if they are birthing at larger facilities, and that is no longer an option,” Graham says. However, some places offer a virtual tour of at least parts of the labor and delivery suite and rooms, plus tips for what to pack. Teen also suggests clients drive by the hospital to figure out where to park and enter before labor, rather than figuring out logistics while they’re having contractions.
2. Less support during visits and labor
Even under normal circumstances, I’d be going to most prenatal appointments by myself, as opposed to with my husband in tow. It just wouldn’t be feasible with his work schedule. But in a non-COVID world, he would come to my 20-week ultrasound. Now, he’s missing it. Research shows this appointment is a key moment for partners, who don’t get to feel a baby kicking from the inside (or field comments from strangers about their growing stomachs). As uncomfortable and annoying as some of the pregnancy experience can be, being pregnant is an undeniable, constant reminder that you’re about to become a parent. For dads and other partners, seeing the baby move during the ultrasound helps the pregnancy “sink in” and actually helps them transition to parenthood.
Typically, my ob-gyn’s office doesn’t allow patients to use cell phones in ultrasound rooms. But the rules are more relaxed right now; I’ll be allowed to video-chat my husband so he can “be there” for this important moment. It won’t be the same, but it matters to me — not only because this still isn’t “real” to him, but also because I want him to have that tear-jerking “that’s my kid” reaction that I’ve already had, twice.
When it comes to who and how many people can be physically present during childbirth, COVID-era policies vary from one hospital to the next: Some allow patients to bring one support person plus a doula. Others only allow a support person, but permit doulas to “join” by phone or video chat. Others don’t even allow doulas to be involved remotely. These policies can change on a dime, according to Talitha Phillips, a labor and postpartum doula and CEO of Claris Health, a Los Angeles-based nonprofit that supports women through pregnancy. During the pandemic, Phillips has seen hospitals relax heightened safety protocols one day and then revert back to a one-person-only policy the next.
Plenty of pandemic parents-to-be have decided doulas are worthwhile whether or not they’re allowed in the delivery room. Ultimately, I opted against using one under such uncertain circumstances. As long as my husband is there beside me, I’ll have the support I need.
3. Shorter hospital stays
My personal feelings about doing a home birth haven’t changed because of COVID: It’s just not for me. But with COVID, it appeals to me even less. If I had decided to give birth at home and then needed to go to the hospital anyway, I’d worry that a longer intake process, thanks to preadmission COVID testing, could make any complications more problematic. My stay in the hospital will likely be shorter than normal either way. “Birthing people are being sent home faster than before COVID, in 24 hours rather than 48 hours after a vaginal birth in many cases,” says doula Jada Shapiro, founder of boober, a site where new parents can find postpartum care professionals.
Returning to the comforts of home sooner seems like a perk. But to ensure I get the care and support I need with breastfeeding, I’ll have to speak up. Luckily hospitals still offer lactation consultants who work one-on-one with new moms and their babies. Postpartum nurses are often trained in lactation support as well, and once mother and baby are home, virtual visits provide additional support, which appears to have benefits. “The lactation consultant can easily pop in three times for 15 to 30 minutes to support you through three different feeds and count it as one visit,” Shapiro says. “In person, this isn’t possible.”
4. Increased mental health screenings and resources
I have a history of anxiety and depression. Being pregnant during a pandemic has been super lonely, especially before my husband and I told our extended family and friends. I felt like I had nobody to talk to, and new questions or concerns popped up every few hours. It took a month or two, but I found an obstetrician-led Facebook group that’s been a wonderful source of support and community.
Obstetricians know their patients feel more anxious and fearful than usual right now. “We found there was so much more [anxiety] that we extended our typical appointment times from 10 minutes to 30 minutes,” Maben-Feaster says.
“The [pre-COVID] standard was to screen before discharge, and now we screen and review the warning signs each time we see a patient. That way, if they start to feel there may be an issue, they can call us and we’ll help them navigate it,” says Dr. Pavan Ananth, an assistant professor of obstetrics and gynecology at Columbia University Irving Medical Center in New York City. In his healthcare system, if any patient appears to need or want support, the doctor gets consent to send their information to the mental healthcare coordinator. A team member calls the patient, assesses what resources or support might be helpful, and helps them access those services. If the patient’s insurance doesn’t cover something, they’ll set them up with an in-network provider.
A silver lining to prenatal, childbirth and postpartum care during COVID-19 is the realization among providers that the same model of care doesn’t work for every patient. “We’ve treated pregnancy as one-size-fits-all for a long time, and that’s not the case. Each patient has unique medical and psychosocial needs in pregnancy and thus needs to be accounted for,” Maben-Feaster says. “Prenatal care is a partnership, and the best way to get what you need is to make sure you are in close communication with your physician or midwife.”