Even under perfect conditions, childbirth can be challenging. But as hospitals across the country deal with the COVID-19 pandemic, Women’s and Children’s healthcare teams are having to come together to solve problems and establish best practices — sometimes in real-time — for women and their newborn babies.
Two Envision physicians, one OB-GYN hospitalist and a neonatologist, recently presented a case of a woman admitted to their hospital with pregnancy complications at 31 weeks’ gestation. Normal pregnancies extend to 40 weeks, so at 31 weeks, the baby would be considered quite premature if delivered in the near future.
For the patient, this baby was a miracle. The patient had attempted to become pregnant for years and had suffered some tragic losses during that time. She was even undergoing adoption proceedings when she learned of this pregnancy.
Soon after admission to the hospital, the patient developed a fever as well as respiratory symptoms. She even required oxygen, which is unusual during pregnancy. The patient underwent COVID-19 testing and was placed in a negative pressure room.
The truth is, we don’t know a lot about how COVID-19 affects pregnancy. We don’t know a lot about how it might affect a newborn baby. But we do know that pregnancy in and of itself is considered a high-risk condition. During pregnancy, our immune system and lung function is not normal, perhaps predisposing us to infections such as pneumonia, making COVID-19 disease a particularly risky proposition to a pregnant woman.
Her care team explained to her what this meant and what it meant to be pregnant and infected with coronavirus (SARS-CoV-2). The mother was very scared, but she trusted her team. Her health continued to deteriorate, prompting her doctors to induce delivery. The team, including the labor floor, obstetrician, neonatologist, nurses and the respiratory therapist, reviewed the latest recommendations from specialty societies, as well as the CDC and the World Health Organization. They simulated the delivery, resuscitation and, because the baby was being born at 31 weeks, what the transfer to the NICU would look like.
The baby was resuscitated, as most preterm infants require some degree of resuscitation at birth, by our team and was transported to the NICU. Under most circumstances, it is our policy to allow the father to observe initial newborn stabilization and accompany us to the NICU. However, due to enhanced isolation precautions in the context of COVID-19, the father was not allowed to observe the resuscitation, nor was he allowed to accompany the baby into the NICU while the team was stabilizing and getting the baby ready. The mother's initial test results for COVID-19 is still pending, so she remains in isolation. She was only able to see the baby from a far distance. However, I am happy to report the baby’s condition is improving.
As the COVID-19 pandemic continues to impact so many lives, medical teams are being tested and being presented with new challenges. It is in success stories like these that teamwork, preparedness and sacrifice will get us through. But it’s not just our clinicians; whether you work in housekeeping, recruiting, licensing, credentialing, revenue cycle management, security, supply chain, government affairs, IT or HR – you play an instrumental role in helping us as caregivers to protect and take the best care of our patients.