LYNN — A few months ago, Lynn resident Ashley Zukowski planned to have a baby shower, shop for children’s clothes and toys, and have her husband, Scott, by her side when she gives birth in July.
Zukowski, a 28-year-old dental assistant, is expecting her first child, a son. But what was a “normal pregnancy” at first has now become a stressful situation with many unknown variables due to the COVID-19 virus, which has infected more than 16,000 in the state, according to the Massachusetts Department of Public Health.
“The whole thing is confusing,” Zukowski said. “Some articles I read say pregnant women are at higher risk (of illness), and some say we’re not.”
Along with much of the population, Zukowski has been limiting her contact with others, going outside only for walks or exercise, and sending her husband to the store with a list whenever she needs supplies. However, “the safety of the child is most important,” and Zukowski has been particularly careful about avoiding infection. This means Zukowski can’t have the same support network by her side — no parents coming to check in, no husband allowed in the doctor’s office during a checkup.
“I don’t really do anything,” Zukowski said. “Even just being able to go to the store, go shopping, just a little bit of normalcy, I can’t even have that, on top of all the hormones and being emotional.”
Last week, Zukowski arrived at her doctor’s office for a scheduled appointment regarding her pregnancy. She’s had several before, and both Zukowski and her husband have looked forward to hearing their child’s heartbeat during the visits. But, for the first time, Zukowski’s husband was not allowed to attend the visit. She recorded a video with her cell phone of a nurse using a fetal doppler, and showed her husband the video later. “Even just getting to hear the baby’s heartbeat every four weeks, that’s being taken away, that little bit of normalcy,” Zukowski said.
Although she currently plans to have her husband by her side when she gives birth, Zukowski recognizes that that might not be possible as the COVID-19 outbreak grows and hospitals change their policies.
According to a statement from North Shore Community Health Center, no visitors are allowed in its Salem Hospital, West Valley Hospital, and Salem Health Medical Clinics “until further notice.” This applies to maternity visitors.
However, there are some exceptions that allow “one healthy support person,” including for the actual birth, and for neonatal intensive care — as well as for end-of-life care and pediatric patients.
A “healthy support person” is required to be screened by hospital staff upon entering the hospital, and must not have a fever, runny nose, cough or shortness of breath. If they start to have symptoms, they must leave the facility. The designated support person also can’t “switch out” with another, and must stay in the patient’s room unless they are getting food, going to the bathroom, or if there is an emergency.
“The safety of our patients, staff and community is our shared priority. This decision is tough, but essential,” said Cheryl Wolfe, president and CEO.
The hospitals run by Beth Israel Lahey Health, including Lahey Medical Center in Peabody and Beverly Hospital, have adopted a similar policy. Visitors are generally restricted, but, if there are “extenuating circumstances,” one healthy visitor may be screened for possible COVID-19 infection and approved if they show no symptoms and have not been in contact with a COVID-19 patient. According to a statement from Beverly Hospital, such extenuating circumstances include visiting maternal newborn services, pediatric services, ambulatory areas, and patients receiving end-of-life care.
Dr. Kristen Cotter, an OB/GYN at Lynn Community Health Center, provides outpatient care, as well as inpatient, labor and delivery, care to pregnant women at the health center in Lynn and at Salem Hospital. She said doctors are taking steps to minimize the amount of in-person doctor visits a pregnant woman would normally have. The first “visit” with a newly pregnant woman is now done over the phone, and the patient is able to relay her medical history and background. Subsequent visits, although in-person, have been condensed. For example, while a pregnant woman’s second visit is normally an ultrasound, and the third visit is normally a physical checkup with a doctor, those appointments have been combined.
But, Cotter, said, what’s surprising is “how much of what we’re doing feels normal.” Doctors and nurses may be wearing masks, and getting screened for COVID-19 symptoms at the beginning of each work day, but their pregnant patients still have the same questions and needs as before the pandemic.
Cotter wants pregnant women to know they “still need prenatal care” and should not be skipping appointments due to COVID-19 — something which has become more frequent, she said.
“We are seeing women skipping appointments and saying, ‘I thought I wasn’t supposed to go out,’” Cotter said. “All the complications that happen during pregnancy still happen during the coronavirus.”
One major difference is the one-visitor policy, Cotter said, but she’s also worried about women after they give birth. Even after women leave the hospital, they are still asked to practice social distancing at home, and can’t have many visitors with the newborn baby. Just like people who aren’t pregnant, new mothers are asked to stay home as much as possible, and stay at least 6 feet from others when out.
“It’s hard because they don’t get back that first month of having a newborn baby,” Cotter said. “They don’t have that same support around them.”
There is also a heightened concern for pregnant women because it’s too early to know whether they are more susceptible to becoming seriously ill from COVID-19 than someone who isn’t pregnant, Cotter said.
“On the one hand there is a concern because of the history with the flu. We know that pregnant women, if they get the flu, they can have a more serious course of disease. They are more likely to die, more likely to be sent to the ICU,” Cotter said. “But, the data out of China is showing that they are similar to non-pregnant people (who get COVID-19). So much of the evidence we have is anecdotal.”
There are only limited studies about how COVID-19 affects pregnant women and their babies. According to the U.S. Centers for Disease Control and Prevention, pregnant women seem to have the same risk as adults who are not pregnant in terms of contracting COVID-19 and becoming seriously ill.
However, the CDC also cautions that pregnant women “have changes in their bodies that may increase their risk of certain infections.” Also, pregnant women have had a higher risk from becoming seriously ill from viruses in the same family as the COVID-19 coronavirus, as well as a higher risk of other respiratory infections, like influenza, according to the CDC.
In limited studies, COVID-19 has not been detected in breastmilk, and it is not likely mother-to-child transmission of COVID-19 is possible, according to the CDC. But, as with many questions, the CDC has no definitive answers regarding pregnancy during the COVID-19 outbreak, and “a very small number of babies have tested positive for the virus shortly after birth.”
For Zukowski, still months away from giving birth, she expects her next doctor appointments to be done virtually, over the phone. Zukowski said she expects to weigh herself, check her heart rate, and report over the phone, and she’s ordering her own fetal doppler from Amazon to monitor her child’s heartbeat herself.
“They essentially want me to do the appointment myself,” Zukowski said. “They normally listen to his heartbeat, make sure he’s OK. Doing a virtual appointment, it’s kind of like, ‘How do you know he’s OK?’ You’re missing out on those experiences as well.”
“Just getting to go and hear the doctor’s confirmation that the heartbeat sounds great, your measurements are great — to not have that is scary,” she said.
Zukowski said she does puzzles, works out, and watches Netflix to kill time. She’s worried about the “unknown” — how long the outbreak will last — and has to be extra careful.
Furthermore, it’s a two-way street. Not only are Zukowski’s family members prevented from coming to see her, but she can’t go check in on them either. Her grandfather has been hospitalized with COVID-19, and it’s uncertain if he will recover.
“My grandfather is hospitalized,” Zukowski said. “My nanny called to say goodbye yesterday, and now today he seems a little better.”
Zukowski said she feels “lucky” that her baby is due in July, rather than in the immediate future, like some people she knows. However, the thought of the COVID-19 outbreak still being in full swing in several months is worrisome, and she is nervous her husband won’t be allowed to be there for the birth of his first child.
“There’s so many things to worry about,” Zukowski said. “It’s so unknown. There’s uncertainty about everything. Even having people come to the hospital (for the birth) — just not having that support system is devastating.”
It’s understandable that everybody is uncertain about the current pandemic, and no one has real answers about when it will end, but it’s also nerve-wracking to continually hear “I don’t know” from trusted doctors and nurses, Zukowski said.