Pregnancy, Delivery, and Postpartum Care During the COVID-19 Pandemic

Almost any pregnancy is full of excitement but can be stressful at times. Add in having diabetes and living through a global pandemic, and it can be quite anxiety-provoking. This article summarizes how recent policy changes due to COVID-19 may be affecting women with diabetes who are currently pregnant or have recently given birth.

A High-Risk Pregnancy

For women with diabetes, pregnancy is automatically classed as a high-risk affair. Although a healthy pregnancy is very possible with any type of diabetes, a lot of emphasis is placed on optimizing glycemic management, and women are closely followed with extra appointments and ultrasound scans throughout the pregnancy, and in particular, during the third trimester.

Telemedicine and In-Person Appointments

For those who are going through pregnancy during the COVID-19 pandemic, certain appointments may be possible to achieve via telemedicine. For example, if you’re working with an endocrinologist to manage your blood sugar levels, odds are, that can be achieved largely through telemedicine (or email). However, certain other checks (like ultrasounds), or if a woman is experiencing concerns or complications, there is no substitute for an in-person healthcare provider or even a hospital visit.

Ask your provider(s) which in-person appointments they expect you to keep and why. Also, keep in mind that there will likely be additional precautions, like waiting in your vehicle, instead of the waiting room, for example.

To curtail the spread of the novel coronavirus, most doctors’ offices and hospitals have now implemented strict policies concerning the number of visitors who are allowed at appointments. Most will find that for all (or almost all) appointments, women will be asked to come to their appointment without any additional visitors.

Of course, these new policies, while important, also can bring up considerable emotional issues. Pregnancy is supposed to be an exciting time, most often shared with loved ones, like your partner and family. Milestone appointments, attended alone, may feel bittersweet.

To help increase support during these times, ask your healthcare providers what their specific policies are and inquire whether it is possible to have your support person or people attend with you virtually. For instance, you may find that your practice will allow your partner to phone in via videochat to virtually experience a milestone ultrasound, and will give them an opportunity to ask any questions that they might have. While not the same as under normal circumstances, this can offer women more emotional support during these exciting (and challenging) times.

Labor and Delivery

One fear that many women are expressing these days (and rightfully so!) is one of having to labor and deliver their babies without a support person. While formal “birth plans” are notorious for falling apart (at least somewhat, as no birth is predictable), this is perhaps the first time in our recent history that women have to worry about not being able to have their emotional support system in place for the big event.

It appears that most hospitals are balancing the need for limiting viral spread with the importance of emotional support for patients during this critical time. Most likely, your hospital will allow one support person to attend your labor and delivery (although this may not be the case everywhere, especially in COVID-19 disease epicenters). However, be prepared that they may not be able to accompany you during the postpartum hospital stay. Ask your hospital ahead of time what the policy is (also for vaginal delivery vs. c-section) so you can be prepared. Also, you may find that (if deemed appropriate) your discharge from the hospital may happen sooner than what is typical.

Diabetes online community member, Shannon M. (who has type 1 diabetes) described to us her challenging experience with delivering her baby boy amid the COVID-19 outbreak:

“I planned on being induced at 39 weeks but was induced the day I hit 38 weeks due to the doctors personal concern about the virus. The hospital was also thinking of starting to allow no help in the delivery room and they wanted to make sure I had someone there with me, as well as to get in and out of the hospital before the virus spread got even worse. My biggest concern the entire time ended up being for the virus rather than health of the baby in general.

While I was in labor, they decided I needed an emergency c-section and took me into another room. I was concerned about going into so many different rooms because that increased my chances of getting the virus rather than being afraid of the c-section itself.

After everything, my baby was taken to NICU for low blood sugars. As I had expected this, I wasn’t too worried, but again, worried about his extended stay in the hospital because of the virus. This also meant I had to visit him daily in the hospital, which concerned me, trying to not get the virus myself and transfer it to him or the rest of my family.

They only let me recover one day in the hospital from the c-section, when it’s usually three days. The social worker admitted to me the cases were getting bad in our hospital and just wanted everyone who didn’t absolutely have to be there, out. Everyone had to wear masks and gloves throughout the hospital. One of my nurses continued to not wear her mask around me and it made me very paranoid.

My baby is still in the NICU. It has now been 13 days and I still have anxiety visiting him. I don’t leave his room to eat or use the restroom unless I absolutely have to. It’s been a horrible experience and cannot wait to get him home. I also live in Essex county NJ, which is the second-worst infected county in the second-most infected state, as we are 20 minutes from NYC.”

Postpartum Care

In addition to possibly leaving the hospital earlier than expected, women are likely going to experience more isolation than they normally would. Importantly, this can affect the rates of postpartum depression, which is of great concern.

Taking time every day for essential self-care and human connection is important for all new moms and is perhaps even more critical during these tough times. Having a support system in place, even if you’re only able to communicate remotely, can help women feel more supported.

Photo credit: smpratt90 (Pixabay)

While many women will probably attend their 6-week postpartum check-up (especially for birth control, like an IUD), this may not be the case for those who don’t have any upcoming procedures, questions or concerns (I actually cancelled my own 6-week postpartum check-up that was supposed to take place mid-March). Be sure to bring up any physical or mental health concerns to your doctor right away. Don’t forget that many issues can be addressed via telemedicine (e.g., mental health appointments), so you can safely stay at home with your baby.

Also, don’t forget to check in with your pediatrician’s office about what their policies are. Most likely, only one parent will be able to attend the child’s well-visit appointments. Some appointments may even be postponed, depending on the specific circumstances.

Jennifer A., who delivered her son at the end of March, describes:

“My son has only had one appointment over a phone chat. It was OK. I prefer to keep him safe but I also want to make sure my son is healthy and growing right and that is hard to tell over a phone.”

Conclusions

Going through pregnancy, labor and delivery, and the postpartum period, while also managing diabetes, is difficult enough but can feel overwhelming during a global virus pandemic. Understanding that the inconvenient policies are there to help protect you and your baby, and getting the mental health and emotional support you need during and after pregnancy is key to keeping the big picture in mind and being able to enjoy this very special time.

Are you currently pregnant or have recently had a baby during this crisis? We’d love to hear about your thoughts and experiences.

Source: diabetesdaily.com

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