Women, health care providers say changes in pregnancy, delivery care during pandemic have pros and cons

Meghan Armstrong and her husband had their first child more than three years ago, back when things were “normal.”

In May, when they learned she was pregnant again, they weren’t that nervous; rather, they started taking every COVID-19 precaution to make sure they and their son, Tristan, stayed healthy.

“We do curbside pickup, shop online at the co-op and food delivery service,” she said. “I was on sabbatical from UMass and have been teaching online since I returned.”

Before she got pregnant, Armstrong, who lives with her family in Northampton, said she heard “amazing” things about Pioneer Women’s Health in Greenfield. The first meeting she had was virtual. Since then, she has had to attend in-person monthly appointments without her husband — not like the first pregnancy, when he could be with her every step of the way.

Armstrong sees midwives at Pioneer Women’s Health and will deliver at Baystate Franklin Medical Center. She noted COVID-19 case numbers are lower in Franklin County, which factored into her decision to seek services in Greenfield.

She remembers her last labor and delivery well, and wonders what it will be like this time. Armstrong, 42, is considered to be having an “advanced maternal-age pregnancy,” so she has to be a little more cautious than younger mothers-to-be, especially amid the pandemic.

“We’ll just follow what they tell us to do,” she said.

The pros of having a pregnancy during a pandemic, she said, is that she is paying even closer attention to what she eats to keep her body and immune system strong.

“I’ve had the chance to stream lots of online yoga and been able to teach remotely, which cut out a lot of anxiety,” she said. “I’ve also done lots of hiking and gotten lots of fresh air with my son and husband.”

Armstrong said the cons include not being able to share things with her husband in real time and worrying that if numbers start to rise, the hospital will enforce strict rules that could include limiting her husband from going back and forth from the hospital.

“I actually don’t feel as restricted with my pregnancy as I have in other aspects of my life during the pandemic,” she noted.

Baystate Franklin and Pioneer Women’s Health

Katie Temes, a nurse midwife with Baystate Health’s Pioneer Women’s Health on Sanderson Street, said some policies and procedures have been somewhat different during the pandemic, while others have not. She is one of the midwives caring for Armstrong.

“Franklin County is so lucky not to have the numbers like the rest of the state and parts of the country,” Temes said. “But, the hospital is responding accordingly and keeping a close eye on them. It’s taking a risk-based approach.”

For instance, visitor policies are changing frequently at all Baystate Health hospitals, including Baystate Franklin, depending on case numbers.

“As of now, patients in the labor area are able to have their partner with them, as well as an additional support person,” Temes said. “After delivery, a patient’s partners are welcome to stay and one additional visitor per day is allowed during set visiting hours.”

Temes said one of the unfortunate results of a pandemic is that pregnant women must come to their outpatient prenatal care appointments unaccompanied.

“We understand how challenging this is for families, and are frequently looking for ways to include partners and siblings,” she said. “Our new monthly virtual sessions can be attended by the entire family.”

Temes said studies have shown that pregnant women have an increased risk of developing severe complications of COVID-19, compared to the general population.

“We encourage pregnant people to take all recommended precautions, including mask-wearing, frequent hand washing and minimizing contact with anyone outside of their household,” she said. “We recognize the variety of circumstances that expecting families find themselves in, and as care providers we aim to engage in open and judgment-free discussion with our patients around weighing and mitigating COVID-19 risks.”

Temes said mental health is also very important during pregnancy, and especially during a pandemic.

“One of the greatest challenges we’ve seen our patients struggle with is the isolation that they endure as new parents,” she said. “Having a newborn in the best of times can feel isolating, and the pandemic has only exacerbated this. We’ve been working on more frequent phone or video check-ins with patients in the postpartum period, and we are frequently sharing recommendations for postpartum online support groups.”

Temes said Pioneer Women’s Health and Baystate Franklin have seen a small number of families move to the area from COVID-19 hotspots like New York City and Boston. Those patients have told health care providers that moving to this part of the state is a fundamental component of their COVID-19 safety plan for pregnancy and life with a newborn.

“Things changed suddenly in March, but we’ve adjusted and adapted to the ‘new normal’ and some things really work,” she said.

What seems to be most difficult for people, she said, is not being able to share the experience like they used to, like having their partner there for the first ultrasound, or having their parents, grandparents and the baby’s siblings able to visit together as a family to welcome the new arrival.

Another big change, Temes said, is participating in telehealth visits. Some people really enjoy the virtual appointments, while others miss the in-person experience.

Cooley Dickinson Health Care

Dr. Edward Patton, chief of obstetrics and gynecology at Cooley Dickinson Health Care in Northampton, echoed much of what Temes said.

“The hospital is keeping things safe and healthy for pregnant women and their families,” Patton said.

Unlike in the past, a patient’s first visit is done by phone or virtually, where a nurse takes her medical history, including previous pregnancies.

“It’s basically the intake we did in-person before the pandemic,” he said.

The second visit is in person, and for low-risk patients, the rest of the visits are a combination of virtual and in-person visits. The pregnant woman meets once a month until about the 28th week of pregnancy, when she starts meeting bi-weekly. At 36 weeks of a presumed 40-week pregnancy, patients have weekly visits.

High-risk patients, however, typically have more in-person appointments. And of course, labs, exams and tests are done in person.

“Some people really like virtual appointments,” Patton said. “That might continue after COVID-19, just because people prefer it and it was something we had talked about before. COVID-19 accelerated a few things we were thinking anyway.”

Doctors, nurses and midwives keep a close eye on their patients because, Patton said, data shows that pregnant women tend to get more seriously ill than the average person does when they contract COVID-19, though mortality rates are no higher than other populations.

“Our offices are safe, clean and are kept that way constantly,” he said. “We want to minimize the threat for our staff, patients, everyone.”

Delivery hasn’t changed much, except that patients wear a mask and the medical staff dons personal protective equipment.

“We take what we normally do to the next level,” he said. “The biggest change, actually, is that we test women for COVID-19 when they come in to have their babies.”

Because COVID-19 case numbers have been so much lower locally than in other areas of the state and nation, Patton said Cooley Dickinson has returned to allowing two people in the labor room with the patient.

When women return home and if postpartum is uncomplicated, they receive a call from a nurse two weeks after the birth. Then, they come in for a visit four to six weeks later. Some who aren’t having any issues choose to have a virtual visit at that point.

“People refer to what we’ve lived over the past eight months or so as ‘unprecedented,’ but I like to say it has been ‘remarkable,’” Patton said. “We’ve restructured how we care for our patients. It’s pretty impressive. Patients have adapted well and so have we. I think this will transform medicine in general.”