Changes to Labor & Delivery during COVID-19
As providers scramble to keep patients safe amid the COVID-19 pandemic, hospitals are finding innovative ways to deliver quality obstetrical care - and a memorable birthing experience - during an otherwise uncertain time.
Amber Price, DNP, CNM, chief operating officer at the Women's and Children's Hospital at Centennial Medical Center, said safety measures were implemented from day one of the virus's onset. "As things developed and we understood the seriousness and potential impact on pregnant women, we started working on visitation policies and building guidelines around that," she said.
Price continued, "From the very early days, we decided it was important patients had support." The hospital, which welcomes 3,400 babies a year, has continued to preserve partner support for women in labor, also allowing for the presence of a professional birth doula (both masked).
Access to Care
Nicole Heidemann, MD, medical director of obstetrics/gynecology at Centennial and an obstetrician with Centennial Women's Group, said access to care has remained a priority. "Down to essential OB visits, we're still providing well above what standards should be," she said. "We're still a patient-centered institution and want to help alleviate fears of being in a hospital and of the virus itself."
Heidemann and her peers are continually educating patients regarding safety protocols so they can feel confident and safe. The practice also is utilizing phone and telemedicine visits when possible and now offers drive-up appointments - an especially popular alternative among patients with younger children in tow.
"We've really tried to keep in touch and still provide safe, excellent care," she said, noting the critical nature of person-to-person contact in obstetrics. "The idea was born to have drive-up visits so patients stay in their cars, and providers can assess them in person. We can do so much with telemedicine, but the bottom line is that OB is a hands-on specialty and not just about medication adjustment. We're listening and feeling and hearing, and it's been a really great innovation to keep patients safe in a low-risk environment."
Dr. Nicole Schlechter
Nicole Schlechter, MD, PhD, chief medical officer of Saint Thomas Midtown Hospital, said gradual changes in safety measures have elicited a myriad of responses from patients. "We've gone from having five guests in Labor and Delivery ... to two ... to one, and from unlimited visitors in the NICU to two to one," she said. "It's been a progressive evolution, but it seems like we've done it our whole lives, and we still have daily conversations about the next step."
But Schlechter said the sliding scale of reactions from patients is no different than typical opinions in birthing choices. "You have deniers, who want their entire families in the room with no masks, and some so afraid they don't want anyone in the room," she said. "We see the entire spectrum of reactions, just as we do with staff and physicians and friends."
Heidemann said fear of contracting the virus has led some patients to request home birth transfers, but she stresses that often is the result of misinformation or a misunderstanding of how women's hospitals are functioning. Birthing hospitals, some of which include ERs specifically for moms-to-be, provide a safer respite. "I would really reiterate to patients that we have a wonderful institution and that they're safe here. I wouldn't want a patient to choose a less safe environment because of fear," she said.
A New Normal
Schlechter expects the 'new normal' to create lasting changes in Labor and Delivery, including more telehealth - particularly for childbirth classes and virtual tours, which have proven a hit among patients and providers, alike. She also expects long-term use of heavier personal protective equipment.
"Many obstetricians don't wear a mask or goggles during delivery because it's such a personal, intimate experience," she said. "I think many will continue to wear a mask and eye cover because those are issues we didn't think much about before. People will also continue to wash hands a lot more for years to come. The new normal will be a different new normal, and hospitals won't be rushing into going back to the way it was before as far as visitation and PPE. The last thing we want to do is be the cause of a second surge."
She said it's a balancing act to give patients an incredible birth experience while keeping everyone safe. "We're doing it slowly and thoughtfully, not just for OB but for surgery, ER and general medicine," Schlechter added.
Heidemann said drive-up care will continue to allow providers to gradually open up, while drive-up testing will help keep patients on track for planned admissions without an in-office visit. "Testing before admission will allow us to gradually open up to the entire community, and as more people become immune and fall back into old patterns, the same basic behavior in the community will linger for a while," she said. "People will social distance for comfort, and that will determine how we set up waiting rooms or stagger appointments until we all start feeling we can go back to a normal routine."
Preparing for the Future
The pandemic also has helped hospital leaders better prepare for future epidemics. "We're so much more prepared if it happens again," said Schlechter, who helped create a hospital-wide, four-phase Surge Plan as the virus emerged. "We would go straight to social distancing and know the importance of early testing, not just at a local but a national level. We also know how many more beds we might need and how to staff them ... and know how much we need of equipment, from IV poles to ventilators and trash cans. Our plan has been meticulously drawn out."
Schlechter also is grateful for the many positive moments since the pandemic's onset, including unprecedented thoughtfulness toward healthcare workers. "I keep coming back to how kind and generous I'm finding people are," she said. "The best in people is brought out in the worst of times, and I hope people will stay supportive and loving and maintain that balance."