Medical Providers Navigate Pandemic Pregnancy Care

Certified professional midwife Ray Rachlin examines baby Dylan.
Certified professional midwife Ray Rachlin examines baby Dylan. (Courtesy of Meg Brock Photography)

COVID-19 has changed nearly every aspect of our lives, including the process of bringing new ones into the world.

Cheryl Yondorf, a physician in the Department of Obstetrics and Gynecology at Einstein Medical Center Philadelphia, said hospitals are working with two goals in mind as they provide maternity care during the pandemic.

“We’re trying to balance being able to provide good prenatal care with keeping patients away from hospitals and COVID-19 exposure,” she said.

Blood tests, sugar tests for diabetes and certain postpartum contraception procedures are still performed in person, but Einstein has created a telehealth program so providers can check in with patients from the safety of their homes.

Patients can take their blood pressure and answer questions about their bodies virtually. They are encouraged to visit in person if they have serious health concerns.

The hospital is also sending women home earlier if they are in stable condition after giving birth.

“Whereas women would stay for two days after a vaginal delivery, now we’re trying to get them out after one day. If a woman had a C-section, we would normally send her home after three days, and now we’re trying to send her home after postpartum day two. Obviously, we would never compromise care. It’s just for those women who are stable,” Yondorf said.

The hospital has adopted social distancing measures, limiting the number of people allowed to attend births.

“Whoever that woman wants to bring as her support person throughout her entire labor, delivery and postpartum state, she can bring that person with her. They just can’t swap out, because we want to limit the number of people coming in and out,” Yondorf said.

Now that hospitals are limiting the number of people who can be in the delivery room, many women are choosing to be with their partners and must find other ways to connect with members of their support network during delivery.

“One couple in particular, when it came time for the birth, I could not be with them. So my support was primarily on the phone,” said Selma Brothman, a certified doula and coordinator at Philly Doula Co-op.

Doulas do not perform medical procedures, but they provide emotional support and use non-medical techniques like massage and movement to help women manage pain during labor. Brothman also provides educational resources during pregnancy and breastfeeding.

“Virtually, I can suggest try massaging this way, try doing something this way. Helping with the fear factor is a big thing,” she said.

Ray Rachlin, a certified professional midwife who owns Refuge Midwifery in West Philadelphia and performs home births, has been inundated with calls and texts from people who want to avoid hospitals altogether.

“I usually have two or three births a month and now I’m doing four to five a month. People are really scared of exposure, primarily because they don’t want to be separated from their babies,” Rachlin said. “Up until this point, the CDC recommended babies be separated from (COVID-19 positive) parents for two weeks until the infection has been resolved, which is horrible.”

Expectant parents are now considering home birth as a safer option.

“So there are some things about home birth and community birth that are already really well-suited for this crisis,” she said. “There’s no sitting in waiting rooms, there’s no sending people to labs.”

However, many people have misconceptions about the preparations involved.

Baby Marshall came into the world with the help of midwife Ronni Rothman.
Baby Marshall came into the world with the help of midwife Ronni Rothman. (Courtesy of Ronni Rothman)

“Home births are planned for months. Oftentimes, you build relationships with the midwife for months. It requires more spiritual and emotional and financial preparation,” she explained.

Rachlin added that hospitals are still the safest places for people with risk factors and pre-existing conditions like high blood pressure or diabetes to give birth.

Ronni Rothman, a certified nurse-midwife who owns WomanWise Midwifery in Norristown, has heard from several women who do not want to give birth in New York, the nation’s COVID-19 epicenter.

“We’ve had a lot of people calling us from New York wanting to come to Philly to stay with relatives and wanting to transfer to my practice,” she said. “We took one woman who was early on in her pregnancy, but we also had a bunch of people calling in the last month of pregnancy and we just can’t handle those numbers.”

Providers are also advising expectant parents on the best ways to manage increased anxiety and follow social distancing precautions.

“It’s affecting everyone’s anxiety levels tremendously,” said Julie Cristol, a certified nurse-midwife and clinical director for the Lifecycle Woman Care birth center in Bryn Mawr. “There’s a general fear among pregnant women that if they go to the hospital they’ll catch COVID-19.”

Cristol said recent data released from Columbia Medical Center in New York does not indicate pregnant women and fetuses are more susceptible to the coronavirus.

“My advice for people who are pregnant and expecting in the next couple of months is to stop working and self-isolate starting between 37 and 38 weeks so the likelihood of being COVID-19 positive during birth is greatly reduced. Ideally, the whole support unit should self-isolate from 37 weeks on if they have that option economically,” she said.

She stressed that the risk of contracting the virus in the Philadelphia area was still low and that home births, birth center births and hospital births are safe options because all providers are taking necessary precautions.

“I tell my patients to get outside and go for a walk and stop going down the (news) rabbit hole. You need to keep mentally healthy, but you don’t need to know how many people died in Italy yesterday,” Rothman said.

Yondorf has observed that people may feel like they cannot contact their doctors for help during the crisis.

“One of the biggest misconceptions is people think, ‘I can’t call my doctor because they’re obviously closed.’ We’re not closed, we’re open and they should never hesitate to reach out,” she said.

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