Gillian Burkhardt, MD Gillian Burkhardt, MD

What to Expect When You're Expecting

UNM Hospital Offers Five Tips to Prepare for Healthy Labor & Delivery During the COVID-19 Outbreak

Let's just say what many pregnant women are thinking: The novel coronavirus, COVID-19, has thrown a wrench in planning for labor and delivery.

On top of stocking the nursery and reading about epidurals, some women are worried about catching the virus when they come to the hospital to deliver.

New Mexico's early, aggressive stay-at-home orders helped us avoid the surge of COVID-19 infections reported in hard-hit areas like New York and Detroit. Unfortunately for many people, staying home means more time to read and watch alarming news and social media stories.

But for most of New Mexico, the infection rate has plateaued, and it is safe to come to the hospital to deliver.

UNM Hospital is the only Level 4 maternity care center in New Mexico, which means we care for moms and newborns from all over the state, especially those with critical needs. So, we set strict guidelines to reduce exposure risks in the hospital.

As an academic health center, we have ample staff and space, giving our patients more seamless care. We have set up separate teams of doctors and nurses, with separate rooms for patients with and without COVID-19.

All patients who are admitted to our hospital are tested for COVID-19. We plan to pre-test women who are scheduled for cesarean-section (C-section) or induction of labor a few days before their delivery date.

That's great news for pregnant moms. We are reducing exposure risks for women and newborns who do not have COVID-19. At the same time, patients who do have the virus are properly isolated while still getting the mother-baby care all women deserve.

You can have a safe, satisfying birth experience despite the pandemic. Use this list of five tips to prepare for delivery in 2020.

1. Choose one support person to attend the birth.
Many women are worried they'll have to go through childbirth alone. But that's not the case. From the very beginning of the pandemic, we have been firm that we want to support women in having one visitor in the room at the time of the delivery.

So, we created a plan that allows for women to have one support person in the room with you. This might be your partner, a close friend, a family member or your doula.

This is true for patients who do or do not have COVID-19. However, if you know you or your support person have the virus, or are suspected of having it, we will make sure you are both OK with being in the room.

These rules are in place to protect patients, newborns, visitors and staff. We may allow exceptions in certain situations.

We understand you may have concerns about the one-visitor guideline. Your providers are always available to talk to you. Download a free birth preferences planner.

2. Gather your medical history, including potential COVID-19 symptoms or exposure.
Close to your due date, make a mental or physical list of your symptom history and potential exposure to the virus. Ask your support person to do the same. Symptoms and factors to think about include:

•    Aches and pains
•    Breathing trouble
•    Chest pain or discomfort
•    Diarrhea
•    Dry cough
•    Feeling very tired or fatigued
•    Fever
•    Sore throat

This will help make the hospital admission process quicker. While your visitor waits, we will ask you privately about your contractions, whether your water has broken and all the traditional labor questions. We'll also take your temperature and ask whether you have COVID-19 symptoms or may have been exposed to someone with COVID-19.

When we know you're going to be admitted, we'll test you for COVID-19. We will ask your support person about their symptoms and provide both with masks. Then we'll get you ready to deliver the baby.

With or without symptoms, you will receive the same level of care as any other patient. There are just a few extra steps we'll take to protect your newborn and other patients if you have the virus.  

3. Prepare to see PPE!
During the pandemic, our nurses, midwives and doctors are wearing personal protective equipment (PPE) for every patient visit. All providers will wear a face mask, and some may have gloves, a gown, a head covering and eye protection.

We know seeing providers in full gear can be a little scary. And we know not seeing our faces might take away some of the personal connection with your delivery team. I think about that a lot – it's tough to give up those bonding moments, but for now they are needed for your safety.

When you see providers in PPE, know that we are taking precautions to keep the hospital safe for all patients. The American College of Obstetricians and Gynecologists says hospitals or accredited birth centers are the safest place to give birth, even during the pandemic.

If you choose to deliver in the hospital, protecting you and your baby is our first priority.

4. Plan to go home sooner.
Part of our COVID-19 protocol is to reduce the amount of time patients spend in the hospital. Before the pandemic, moms and babies would typically stay in the hospital up to two days after a vaginal delivery and up to four days after a C-section.

Now, we're changing our approach to help moms feel comfortable going home within one to three days. Of course, this all depends on your physical and emotional health after delivery.

It's impossible to predict how you'll feel during and after delivery. And with schools out of session and other adults in the home working remotely, you might not have the downtime you hoped for to rest, heal and bond with your newborn.

So, it's even more important during the pandemic to plan ahead for extra help at home. You can do this without breaking stay-at-home orders.

For example, you might plan to have a relative or friend stay with you for a while after the baby comes. Both you and the loved one should self-quarantine for at least 14 days leading up to your due date to reduce the risk of exposure. Then, the loved one can serve as your support person during labor. Or they can meet you at home after you are released from the hospital.  

Allow your loved one to help you with the baby, caring for older kids and taking care of the house. This support is so important for your physical and mental health, especially with everything going on in the world right now.

During "normal" times, we pay close attention to cues that a new mom might have postpartum depression (PPD). While some mood swings are normal—often called the "baby blues"—PPD is more severe. Patients might have deep depression or scary, intrusive thoughts of hurting themselves or the baby. Sometimes, patients don't realize anything is wrong.

It's possible that the stress and physical isolation associated with the pandemic might increase the risk of PPD. Stay in touch with your provider and allow a loved one to help out at home and keep an eye out for symptoms. Call 505-272-2245 for information about PPD care.

5. Get used to talking on the phone—a lot.
Leading up to delivery, you might visit with your doctor by phone more than you do in person. For all the difficulties the pandemic has caused, it has also offered opportunities to improve the efficiency of how we provide prenatal care.

Our providers have been thinking critically about the essential elements of prenatal care that require an in-person visit. Of course, we want to see you regularly to perform your ultrasounds, check the baby's heartbeat and monitor your blood pressure. But many of our conversations with patients could easily be handled over the phone or via video conference.

In a state as rural and expansive as New Mexico, using the phone more could save our patients hours of drive time each week during pregnancy – not to mention reducing virus exposure risks during their travels.

In the same spirit, we are also providing much of our postpartum care by phone, including breastfeeding support. UNM Hospital is a baby-friendly hospital, which means we offer advanced breastfeeding (lactation) support for all our new moms. Our lactation experts are now helping new moms by bringing their tips and wisdom to you by phone.

We are also on standby over the phone for moms who experience the baby blues or are worried about potential PPD symptoms. Personal, judgment-free mental health support is available 24/7. We can connect you with community resources, in-person care when needed or counseling sessions over the phone.  

When your baby is about six weeks old, we'll ask you to visit the hospital for an in-person checkup. During that appointment, we'll make sure your body has healed from delivery and get you started on birth control, such as an intrauterine device (IUD), if you wish.

Family planning services are essential in New Mexico. To make the exam even quicker, we can talk with you by phone to get all your information before you arrive. That way, you can simply get your birth control and get back to your busy day.  

Please do not ignore concerning symptoms. Before the six-week checkup, even during the pandemic, come to the hospital for symptoms like these, which might indicate a medical emergency:

•    Breathing issues
•    Chest pain or discomfort
•    Abdominal cramping
•    Concerning mood changes
•    Excessive bleeding
•    Exhaustion or lethargy
•    Feeling like something terrible is going to happen
•    Sudden or high fever

These symptoms can be a sign of serious conditions such as PPD, an infection or maternal hemorrhage. It is safe to call 911 and come to the hospital during the pandemic. And getting here quickly gives you the best chance at a healthy recovery.

You and your baby will be safe at the hospital. Each day throughout the pandemic, our team of nurses and providers take time to think through and plan for different scenarios that might arise. For all of us, the pandemic has brought a sea of change, which can be tough for expecting moms who are eager to meet their new babies.

Know that we are here for you during this trying time. Know that you and your baby will be safe at UNM Health. And know that we are constantly on the lookout for opportunities to improve your birth experience, despite the pandemic.

I am proud to be part of an amazing team of doctors, certified nurse midwives, nurses and support team members. We're excited to help bring your little one into the world.

To visit with an OB/GYN or Certified Nurse Midwife, please call (505) 272-2245, or request an appointment online.

 

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