Instead of being in the hospital waiting area or crowded around her bed, Luka’s three older siblings were 8 miles away, inside the family's North Austin home with their uncle, a recent Austin transplant; both sides of the family of her and her husband, Antonio, were at their homes in Dallas. It was almost a full day since she gave birth. Other than Antonio, who remained by her side through the delivery, no family members had met the newest Morales in person. No one was allowed.
Morales said other than her children and her brother, no one will meet Luka for another several weeks, possibly months. This is the way things go during a global pandemic.
“Normally when you have a baby, you’re ready for everyone to come visit and meet them, but given the fact of everything that’s going on, we’re pretty much just going to be in our home, quarantined and isolated,” Morales said. “I keep telling Antonio, 'I can’t believe we’re bringing a baby into the world with all of this happening.'”
As the highly contagious coronavirus tightens its grip on Austin, the United States and much of the world, inevitable human events such as pregnancy and childbirth are having to proceed and adapt in the new, cautious and socially distanced reality. Hospitals, birthing centers and OB-GYN offices are issuing unprecedented restrictions and precautions, from limits on visitors to curbside prenatal appointments and check-ins via Zoom.
Expectant mothers, forced to adjust any long-held expectations of the process and comply with rapidly evolving guidelines, said, although necessary, the changes are not easy. Some who spoke with Community Impact Newspaper said they are worried about how much is still unknown about the virus and the lack of scientific evidence regarding its short- and long-term impacts on their and their child’s health.
Pregnancy and the coronavirus
Since the virus is still so new, the lack of solid evidence over how it could impact a pregnancy or a child’s health later in life is a major question and concern for mothers and doctors.
The Centers for Disease Control and Prevention has reported mixed findings related to pregnancy and the coronavirus. No scientific evidence shows pregnant women are more susceptible to this specific virus, but the bodily and immune system changes pregnant women experience might make them more susceptible, generally, to viral respiratory infections, according to the CDC.
The CDC also reports no evidence that contracting the coronavirus while pregnant increases harm to the baby, but “pregnancy loss, including miscarriage and stillbirth, has been observed in cases of infection with other related [viruses].”
Any adverse health effects down the line for children born to mothers with the coronavirus are unknown.
“There’s certainly fear, but what I’ve seen more is resilience in the face of the fear, and they’ve been positive and brave in moving forward in their own lives and pregnancies,” said Lauren Hagen, a nurse at Austin’s OBGYN North.
Adapting in real time
As she approached the 20-week mark of her pregnancy in mid-March, Taylor Torres’ next appointment was one she and her husband had long awaited. With an anatomy ultrasound scheduled March 13, they would, together, find out the gender of their first child. But then her doctor canceled the appointment and shut down communication for two weeks. In the meantime, news about the coronavirus intensified. So, too, did Torres’ uncertainty.
“I wasn’t concerned about myself or our baby at first, but it’s interesting how fast those emotions can change once something in the media about the virus changes,” Torres said. “It really hit me when our anatomy ultrasound was canceled. I thought, ‘Oh wow, this is really serious.’”
When the office opened again and Torres rescheduled her appointment April 2, the office said her husband was no longer allowed to accompany her at any future visits. When she arrived for her anatomy ultrasound, she was stopped outside the office for a temperature check and two rounds of questions: Have you been quarantined? Have you been around anyone who has traveled?—before receiving a mask, washing her hands and entering the office. Alone, she found out she was having a baby girl. The moment was not how Torres envisioned it.
At 18 weeks pregnant, Jessica Finch and her husband, Anthony Olabarrieta, have also had to adjust their expectations for that same 20-week visit, scheduled for April 17.
“It’s not something I’d want to do on my own. For us, it’s our first pregnancy,” Finch said. “I need [my husband] there emotionally. When I heard about the changes, it made me realize that this is serious, and it’s going to be hard.”
Melissa Hudgens, due July 22, has had several prenatal appointments, but her latest was the first one she did in her car. As Hudgens pulled up, alone, a nurse came out to check her in, ask a few questions and have her step on a scale. When the doctor came out, Hudgens reclined back in her car seat for the fetal heart rate check. Minutes later, Hudgens was driving home.
The social restrictions can take away from some of the excitement, Torres said. They can also complicate the situation, especially for pregnant women who already have children. Though generally visitors are prohibited in the area’s hospitals due to the virus, women in labor are allowed one partner. Morales said if her brother had not recently moved to Austin, her husband would have had to stay home with their three children and she would have been alone in the delivery room.
Victoria Meinhardt, co-owner of the Austin Area Birthing Center, said expectant mothers and professionals are “mourning” the loss of connection that is integral to the process.
“Birth is really a social event, and if we’re social distancing and birth is a social event, then, yeah, it’s going to be sad, and we’re going to have some grief about that,” Meinhardt said. “This is going to be for a while. I don’t think we’re going to be doing this for just a few weeks. I think it’s going to be a while.”
Difficult but necessary changes
Tight restrictions on partners only apply to in-person prenatal appointments, and doctors are now trying to move as many appointments as possible to telehealth. Some doctors said, six weeks ago, the thought that any prenatal appointment would be done over the phone or video call was unthinkable.
“Before this, I would have never imagined it, ever,” Meinhardt said. “I want to see my women. I want to look into their faces. I want to see their bellies, I want to touch their bellies. I want to look into their eyes and know they’re OK. But if I can’t do it that way, how else can I do it?”
Hagen said, previously, every prenatal visit came with a regular fetal heart rate check. A doctor cannot perform a fetal heart rate check over telehealth. Mothers now either have to go longer without hearing their baby’s heartbeat—something expectant mothers and doctors said can create agonizing uncertainty—or purchase and learn how to use self-assessment tools.
Hagen said, although unprecedented, the changes prioritize the health and safety of mothers and babies.
“We would never encourage a woman before to skip an in-person visit because the sooner we can catch problems the better,” Hagen said. “But the risk of the virus is a more present and absolute risk than an occasional skip of the heart rate check. The chances of something going wrong in that window are much smaller than carrying or contracting the virus.”
Several doctors said they are encouraging mothers to conduct their own measurements in lieu of regular in-person visits, but they require equipment and some knowledge. Fetal heart monitors, also known as fetal dopplers, retail online between $50 and $120.
“Self-assessment is empowering, but on the other hand, you’re wondering if you did it right,” Torres said. “It’s hard to know if you’re finding the right points to measure. Not being able to hear the heartbeat [at an appointment] is hard, and I don’t have to tools to be able to do that.”
Finch said in-person appointments are the only way she feels reassured about what is going on inside her. She is tempted to order the fetal doppler to help quell her anxious moments. Between office visits, she said, she will have to trust the merits of telehealth appointments.
Hagen said some pregnant women, such as those with high-risk conditions, have different monitoring needs, and telehealth is not always a viable option. She said the levels of precaution can vary among doctor’s offices, and mothers should communicate with their personal providers to understand why they are implementing, or not implementing, specific changes.
Fear, uncertainty and resilience
Expectant mothers say the rapidly evolving recommendations for avoiding the virus and the subsequent changes to much of the process around pregnancy and childbirth have enhanced a sense of anxiety and uncertainty.
Birthing centers have seen a surge in interest, according to midwives across Austin. They said they are seeing more women who do not want to give birth in hospitals as coronavirus cases continue to rise. Emma Morrison, owner of the Beautiful Beginning Birth Center, said there has been a significant increase in interest from women who are already well into their third trimester.
“There is a huge mental shift that has to happen from going to a hospital birth to a natural birth,” Morrison said. “But there is now more fear about birthing in a hospital. They are viewing hospitals as the place where people with COVID-19 are going and dying, and they don’t want to be in the same place.”
Hudgens and Finch both plan to deliver in hospitals. They said their doctors made clear to them that if they go into labor, they should avoid the emergency room at all costs, since it is where coronavirus patients will likely be. The maternity wards have been locked down, according to a spokesperson speaking on behalf of all area hospitals, and only those who have been checked and cleared can enter.
Torres plans to deliver at a birthing center but said uncertainty of what is to come and having to constantly adjust expectations has added significant stress to the pregnancy. Her baby will be the first grandchild on either side of the family. She said she always hoped for her mom to come stay at her house for the first week to help and spend time with the newborn. Although everyone is eager, no one knows when they will be able to safely meet.
Although it’s been difficult at times, Torres said she is trying to take it day by day.
“Growing up, my mom used to tell me it’s a miracle that any babies are healthy and able to live to begin with. I’m trying to go back to those roots,” Torres said. “I do also wonder if we’ll get to have a baby shower.”