Updates and Delivering Alone

First, I hope you are all staying safe and healthy, mentally and physically. Home school started yesterday here. It’s a work in progress. I have been getting a lot of questions of the form: “I have a prenatal visit in 3 weeks, should I cancel it?” I think at this point, my best advice is to think 4 days out if possible. For a hyper-planner like me, this is hard. I’m already spiraling down what I’m going to do with the kids without summer camp. This is unproductive. Even 3 weeks out - it is hard to know. You do not need to decide about that visit now. Breathe. Viral Updates Are there any general viral updates related to pregnancy or children? A small amount of new data on pregnant women with coronavirus in China reinforces existing impressions that the disease doesn’t seem to be worse in pregnancy. In total we have about 38 cases to analyze (which is not a lot) and the outcomes for women seem to be okay; and we do not see evidence of intrauterine transfer. There’s a small amount of new data from China about COVID-19 in children, based on 171 cases. Notable is that most kids have mild disease, about 16% are totally asymptomatic, and the most common single symptom was cough (about half of kids). There was one death in this sample, of a 10 month old with other complications. The first CDC numbers on the virus also confirm the low rates of hospitalization in kids. Generally, we seem to be converging on the view that (non-immune-compromised) children usually have mild disease. Delivering Alone I do not know a good way to talk about this, but many of you have written to me about it to ask. Many hospitals in New York City have begun completely restricting labor and delivery wards, meaning no one other than the laboring woman can be there. This includes partners. If you are delivering in New York right now, you will deliver without your partner. They also will not be allowed to visit after the birth. This policy is controversial. It is not a WHO-advocated policy; NY state hasn’t supported it. There are concerns that it puts laboring women at risk without an advocate. It strikes many people at inhumane. It will almost certainly push some women into home birth, and this raises real risks of tragic outcomes. On the other hand, there are safety reasons for this. Asymptomatic or mildly symptomatic people can spread the virus. There are enough tests to test women in labor, but not their partners. If the virus spreads around the NICU, this could be tragic. Whether this is the right policy or not, there is no getting around that this is devastating. If it affects you, I am so, so sorry. I wish I could give you a hug. Instead, I can offer the much less warm approach of answering some of your specific questions. Is there any evidence on long term effects of delivering without a partner? No. In the short term, surveys show that having support people in labor improves the perceived experience. And I wrote in Expecting Better about the value of having a doula in terms of lower C-section rates and labor satisfaction. But we don’t have long term data on outcomes like this, and it would be hard to imagine how you’d put it together. Not having a partner with you in labor is not randomly assigned (except in this particular case, oddly). Stepping back, though: having spouses around the delivery room is still not practiced everywhere, and for a long time wasn’t common in the US. There isn’t any reason to think the husbands out in the waiting room (at this stage, they were mostly husbands) were worse parents. Adoptive parents may well not be there at delivery or immediately after. Parenting is a long haul. I do not want to understate how upsetting this situation is, but you can be a great parent from afar for delivery and days 1 through 3, and then in person from days 4 through infinity. Should I leave NY? This depends a lot on your personal situation and probably on where you are in your pregnancy. If you are due next week, it is likely to be very hard to leave. If you have eight weeks left, there is probably time to find a provider elsewhere. Having said this, given the current situation it is hard to know whether these restrictions will follow you (I think it is unlikely but everything about this epidemic has surprised me). If you do want to move, it is very likely you’ll need to think about moving now. Most providers out of NY are likely to ask you to self-quarantine for a couple of weeks before they even see you. You wouldn’t be alone in leaving if you do; at least one of my pregnant NYC friends has already decamped and I suspect others will follow. Should I try a home birth? I still think this is a mistake. This is especially true if you are close to delivery. Yes, this has drastically raised the stakes and I can see why more women would be drawn to birth at home. But the situation has also raised the risks to home birth - exposure from a midwife, finding a midwife at this late stage, the risks of hospital transfer, etc, etc. If you are closer to mid-pregnancy, with more time to plan, this may be more feasible to do safely although please, please be careful. Also, it is possible restrictions will be lighter in a few months. It’s really hard to predict. Any Actual Advice? Four further thoughts. First, it may be worth asking your doctor what the hospital policy is on early release if all is going well after birth. When I had my son I left the hospital (in Rhode Island) after about 12 hours. If your goal is to get home to your partner as soon as possible, this could be a good option. Hospitals may be eager to discharge patients, as well. Just make sure you have a follow-up plan. Second, for this and many other virus-related reasons you may want to labor at home as long as possible. This would give you more time with your partner as support and limit your hospital exposure. This won’t be possible for all women, and obviously there is no epidural at home, but in the world of second best perhaps this is it. Third, when it comes to it, think about how you will stay connected. Will your partner be on the phone? Zoom? Can you labor with your ear buds in so he or she can hear the first cry? The most concrete advice about this I could find comes from guidelines for deployed military partners; they recommend Skyping into the birth. Finally, if you are laboring alone in the hospital it is going to be lonely. Yes, having your partner on the phone could help. But this is a time to call in reinforcements. Can you group Zoom your best friends during labor? Or your mom? Have people on call to be there “with” you. Please take care of yourselves.

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