Under normal circumstances, the emotional toll of a pregnancy after a loss is a great one. Being pregnant after loss during a global pandemic is undoubtedly worse. Medical care has changed across the board for everyone. Once again, we aren’t getting what we expected. Care plans have changed overnight. Or within hours. What we thought was going to happen isn’t, or may not. With so much changing, and so quickly, there are so many questions popping up in our private support groups.
This month, I had a chance to sit down with Dr. Kristen Sharp – in a socially distant and responsible manner via Google Hangouts – to discuss a pregnant after loss mom’s concerns and questions as the pandemic looms over us. I asked her many of the questions I’ve seen moms posting in our support groups. What follows below is a transcript of our conversation.
As you may recall, Dr. Kristen Sharp is an obstetrician in Madison, Wisconsin, a loss mom herself, and also a board member of Pregnancy After Loss Support. She currently runs the Hope After Loss Clinic in Madison, a cutting edge clinic designed specifically for the mom expecting again after loss.
Do you have any recommendations or precautions to give on how pregnant women can stay safe during this time?
I think as much as they can cocoon or socially isolate themselves the better. That will be the biggest protective thing so if someone needs to go out and get groceries, have it not be that pregnant person. If your business is still open and has the potential to work from home, work from home.
How have OB appointments changed since COVID-19 surfaced?
There are two points that contribute to that. One: it’s such an evolving situation that as we speak, where we’re at this week might be different than something we’re recommending next week. And then two: it’s been really different both with varying health systems and regionally with what is recommended. This is based on what their status is and how many COVID cases they’re seeing.
In general, most practices are deeming OB visits as “essential” visits. For example, in our clinic, OB visits are one of the few appointments that we’re seeing in-person. Some of the changes women may see are spacing out OB visits as appropriate in low-risk pregnancies or some of their visits may be done via telephone. One thing that our practice is doing is obtaining vital signs on a patient when they are at their OB ultrasounds. If they have an additional in-clinic appointment that week, we are trying to do that appointment via phone so that they are only coming into the medical center once that week.
Certainly, if someone has a high-risk pregnancy or issue that needs closer follow-up, we’ll continue to closely monitor that and see them as frequently as we need to in order to keep mother and baby safe.
Do you have any recommendations for women who are having a “normal” pregnancy this time around? Technically, they can have spaced out appointments, because there’s not necessarily anything medical professionals have dubbed “high risk” about them. But there’s still a high level of anxiety and fear because of their previous loss experience. We are now in a situation where pregnant after loss (PAL) moms cannot just go in for heart tone checks if they’re nervous.
We’ve also heard in our support group that a lot of the women are rushing out to buy at-home dopplers. Do you think that’s a good decision? Or what would you recommend?
I think the first thing is to have a really open communication with your provider about your concerns. So, for example, if they say you don’t need your 14-week appointment, that you can say you really don’t feel comfortable with that or discuss what other alternatives might be available such as a telephone visit. So I would really be open and honest with the nurses and your obstetric provider about what your needs are. Because even though you may not have a clinical need, there is still that emotional need, and that anxiety component that really needs to be still addressed.
In terms of the doppler… I have a love-hate relationship with the doppler. On the one hand, I think it can be helpful, especially if someone needs that reassurance before you get to the point where you can feel fetal movement. This can be helpful during this time when you may not be able to go to your OB’s office as regularly. But, it can also be a source of stress too if you can’t hear the baby. Depending on baby’s position or the quality of the doppler you may not hear heart tones, but that doesn’t necessarily mean that things aren’t okay.
Where I get nervous about dopplers are when people use it later on in pregnancy, to check on baby if movement has decreased. In this situation, a doppler does not give a great assessment on how the baby is doing. It’s just assessing whether the heartbeat is there or not and won’t always pick up on those changes that could indicate that the baby is in distress. In these situations, you need to call your provider and go in for an assessment.
One of the biggest fears for PAL patients is that their partner won’t be able to be there for OB visits or routine ultrasounds. There is a level of anxiety that this will be the appointment where they potentially get bad news and the anxiety is heightened if they have to go alone. Is that the case for your clinic? And if it’s a situation in which they’re not recommending that partners or support people come, what can the PAL mom do in order to receive the extra support that she may need at the appointment?
This is a really challenging aspect of the care we are providing today. Our health system, as well as many nationally, are not allowing any additional visitors or support people into clinic appointments or ultrasounds. What I would encourage people to do, is to call your OB office or ultrasound unit in advance of the appointment and see if they would allow someone to be on speaker phone or on FaceTime during the ultrasound or appointment. That way they can be there in real-time virtually.
Along those same lines, a question we’re seeing a lot in support groups is: what if my partner can’t be there for labor and delivery? What is your advice to PAL moms facing that possibility?
In terms of labor and delivery, there have been some isolated institutions that have enacted those policies, but again a lot of it depends on how prevalent or how severe things are. I’m really hoping and optimistic that is not going to become a regular occurrence.
I know that most hospitals are limiting people to one support person. Our institution has done that too. One thing I’ve been encouraging people is to have a backup person in case their partner has a fever or is sick with COVID and wouldn’t be able to come.
For those cases where they may be limiting visitors, I would recommend to do as much as you can do electronically or via phone, FaceTime, etc. so that you can get that on-going presence and support virtually. This is something that we have done for patients in the past whose partners are in the military.
I’ve been reading about the length of stay after delivery. Are people getting turned around quickly where they’re going to be discharged within 24 hours? Is something that may have been optional before now required? Are you trying to get people out of the hospital as quickly as possible vs keeping them in?
If people are doing well after their delivery and they and their baby are meeting all of the post delivery, we are encouraging women after a vaginal delivery to leave the hospital after one night or after a c-section leaving after two nights. Certainly, if people are having issues or don’t feel like they’re ready to go home, hospitals won’t force people out the door. There are a lot of institutions where this has been their standard postpartum stay already.
The takeaway is that yes we’re trying to get people out of the hospital a little bit quicker if they are ready to minimize that chance of getting exposed. But we’re not going to be pushing people out the door who have ongoing issues, medical issues, or aren’t otherwise ready to leave. I would say the majority of the people I’ve seen have expressed that they want to skedaddle out of here as fast as they can.
Do you know of any risks for breastfeeding?
From what we can tell, again it’s all preliminary, but we’re not seeing that there is passage of the COVID virus through breastmilk. The concern, though, is that if someone is infected there’s the risk of the virus spreading with the act breastfeeding as you breathe, cough, sneeze over the baby.
Do you have any concerns that have been brought up to you that we haven’t already addressed?
I have seen some increased conversation about home births as a way to minimize COVID exposure. If a woman is looking to do a home birth for the sole reason of reducing that risk, I would not recommend it. In the U.S. the risk of having a neonatal death with a homebirth is 4 times higher than in other countries.
Thank you, Dr. Sharp, for your time during this crisis to speak with the PALS community and share your thoughts about concerns and experiences for the mom who is pregnant after loss.
Thank you too. I am happy to talk again as this situation is evolving.
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Please note that the recommendations in this article are not a substitute for medical advice from your own obstetrician or midwife. Your care provider is most familiar with your personal situation, your region’s response to COVID-19, and is best equipped to answer your specific questions and address your concerns. These questions and answers are intended for informational purposes only. Please do not use this article as a substitute for medical advice, diagnosis, or treatment.