AN OB-GYN EXPLAINS WHAT TO EXPECT DURING YOUR PREGNANCY AND DELIVERY

How to Navigate Pregnancy During COVID-19

If you are pregnant right now, you’re probably see-sawing between being exhilarated, worried, anxious and excited. All normal! You also probably have a lot of questions about what to expect throughout your pregnancy and giving birth in terms — even if this isn’t your first pregnancy, it’s a different scenario than pre-COVID-19. Dr. Kameelah Phillips, a NYC-based OBGYN, is actively seeing patients and delivering healthy babies on the frontlines at Lenox Hill Hospital (you can follow along on her Instagram). She has tips and advice on what to expect from your doctor’s appointments, hospital stays and labor that will help you plan for yourself and your support team.

 

Q&A:

Q: What precautions should a pregnant patient take for in-office appointments?

A: 

  • Many offices are spacing out patients to prevent the waiting room from filling up. Inquire about the least busy times and schedule accordingly.   
  • Wear a mask if available.  
  • Wash your hands before and after the visit.
  • Have your questions ready so that the visit is as efficient as possible.
  • Don’t use a doctor’s visit as a reason to catch up on all your shopping. Proceed home when you finish.
  • Try to avoid public transportation if you can. Otherwise wear a mask during travel.
  • Schedule your in-person visits so that multiple things can be done at once, i.e. a scheduled ultrasound appointment or vaccination along with check-up.

Q: If someone thinks they are pregnant, should they be going in to be tested by their OB/GYN?

A: I would recommend a home pregnancy test, which is pretty accurate (as long as they are in date, they are fine). I rely on those. If a person tells me, "I took three tests and they're positive," then she's pregnant and she doesn't need to come in to confirm. What I have been trying to do is if they have a reliable period, I can calculate when I should expect to see something on the ultrasound and then potentially offer them a visit around that date so we know how we're moving forward. If it's a woman who has had a history of an ectopic or another type of abnormal pregnancy, then we have to come up with another schedule, because clearly we want to diagnose an ectopic pregnancy and treat it early.

 

Q: Are you changing how often patients come in and do appointments virtually? What can be skipped?

A: Here’s what we do in my practice as of right now.

  • Less than 11 weeks: Virtual. The initial intake visit can be done virtually, especially if less than 11 weeks.
  • 11-13 weeks: In Person: . The dating (first trimester) ultrasound and nuchal translucency are done between 11-13 weeks and the initial OB labs can be done at this time.
  • 20 Weeks: In Person. The anatomy appointment should be done around 20 weeks.
  • 28 weeks: In Person. At 28 weeks we will do vaccinations, RhoGam and repeat labs. Previously we would have an appointment between 24-28 weeks for this.
  • 32 weeks: Virtual. The 32 week visit is generally in person, but can be virtual.
  • 35-36 weeks: In Person. The 35 -36 week visit is in person so that the GBS and other labs can be collected.
  • 37 weeks Onwards: Depends on Situation. From 37 to delivery visits should be weekly, but depending on your situation, you may consider alternating with virtual visits.
  • Postpartum: Virtual. The postpartum visit can be virtual unless there are complaints that need to be physically addressed.  

 

Q: By how much should patients be spacing out appointments? 

A: Consult with your doctor. Spacing out may be dependent on the patient. Do not look for or expect consistency during this time. This is all very new territory for patients and doctors. In general, we have dropped some of the every two week visits which typically take place after 28 weeks.

 

Q: Can other appointments, like sonograms, be delayed? 

A: The nuchal and anatomy should not be delayed. Other surveillance sonograms may be delayed depending on the issue.


Q: How are you handling gestational diabetes testing? 

A: Typically, you'd have anywhere from 28-34 weeks to get your diabetic screen done, but now we're going to push it to the RhoGam visit (which, if you’re RH negative, is at 28 weeks) and just do everything at once.  We don't want to compromise care and miss important diagnoses but we’re trying to combine that visit with another important landmark to minimize visits. 


Q: What is the biggest change you are expecting for hospital deliveries?  

A: The biggest changes primarily have to do with the degree of protection I have to wear for deliveries. It used to be a more intimate experience, but now with PPE, it is more uncomfortable.  Patients also have to wear face masks which is a bit challenging for some. Imagine working out with a mask on…it doesn’t seem that fun. I have seen patients rise to the occasion and not complain. They are very understanding of the sacrifice that everyone has to make during this time and have been very accommodating. A few weeks ago, partners were restricted from deliveries because of an increase in COVID-19 infections. This was very stressful for most families. Hopefully, patients and their partners will be more mindful of their symptoms and the hospital communities so that restricting partners does not have to be a consideration again.


Q: What policies are in place at the hospital and office that are different now for COVID-19? 

A: Many hospitals are checking temperatures of patients and their partner prior to entering the labor floor. Patients are also answering a screening questionnaire prior to coming to the floor. Only one support person is allowed during the extent of the hospital stay. In triage, we only allow the woman being evaluated and her partner waits outside until a decision is made about admission. Everyone is expected to wear masks until they are discharged to home. We are not allowing partners to come in and out of the hospital while the woman is in labor. Partners are also rescreened for fever every 12 hours. Vaginal deliveries and C-sections are being discharged early unless they have medical issues that require a longer stay.

 

Q: Should women wait longer to go to the hospital when they are in labor to reduce potential exposure time? 

A: We're all really encouraging women to call ahead of time. Call, call, call. For example, women might have come before if they lost their mucus plug but that doesn’t mean anything for length of labor. The true emergencies are heavy vaginal bleeding and decreased fetal movement. If you are having heavy vaginal bleeding, you should just get to the hospital. If you notice decreased fetal movement, call your doctor immediately and drink something sweet, cold or caffeinated, and typically you should feel the baby move, which is reassuring. Another reason to call before you come is that entrances have changed, elevators might be different. You don’t want to get there and be like, “well, this is where I was last time,” and it’s not the same anymore. 

Another reason to call is so we can let Labor and Delivery know that you're coming because we have different rooms for COVID-19-negative, COVID-19-positive, and suspected people. Your doctor will call and say, "I have a COVID-19 positive patient coming" so the hospital can prepare the COVID-19-specific room for you. It helps to give us a heads up as opposed to a patient showing up, being in triage with everyone and saying, "Oh, by the way, I'm COVID-19 positive." 


Q: Are new mothers being discharged earlier from the hospital as a precaution? 

A: Yes, at my hospital, we are trying to discharge women on day one if they are vaginal and on day two for a c-section. If you had a vaginal delivery and you're not moving around as well, it's hard. Technically in the hospital, you'd probably still be laying in the bed and you certainly can do that at home on your couch or in your own bed. If there's a need for you to stay, you're staying. We're not kicking you out. We're making sure that we're still delivering the best care under the circumstances. For example, I had a C-section patient the other day, and she just was not meeting her milestones, so she stayed, no stress. We're still really taking the best care possible of women. 

 

All opinions and views expressed by our experts are their personal opinions and are not medical advice. Always consult your care provider if you have questions or concerns.

Read more from Dr. Phillips as she answers our questions about postpartum care, breastfeeding and recovery in the age of COVID-19, and explore all our content around pregnancy, postpartum and breastfeeding in this current crisis.

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