13 Apr Expecting the Unexpected: Pregnancy and a Pandemic
MedicalResearch.com Interview with:
Dr. Alicia Warlick, MD
Anesthesiologist at UNC/Rex, American Anesthesiology
Raleigh, North Carolina
MedicalResearch.com: As a physician working on the frontlines of the COVID-19 battle, how are you addressing expecting mothers’ concerns about the disease and how it might impact their pregnancy?
Response: While COVID-19 has disrupted nearly every aspect of healthcare, whether its virtual appointments or delayed surgeries; there are certain things that are inevitable – like childbirth. As this virus continues to take over the country and we learn more about it each day, pregnant women are facing new challenges and fears. For women approaching their due dates, questions about staying healthy, keeping their baby safe and limiting their risk of exposure while in the hospital are all leading to anxiety and stress. And while policies and guidelines are constantly changing, as physicians we need to remind our patients that we are there to alleviate their concerns, address their questions and remind them to not lose sight of the joy the comes with bringing a child into the world. It’s a scary time for everyone, but by working together and supporting one another, we will get through this.
MedicalResearch.com: Several hospitals around the country are limiting visitors and birth partners in the delivery room. What advice would you share with patients who have no choice but to face labor alone?
Response: Not having a loved one for support in the delivery room can cause a lot of anxiety and stress for women. I would recommend telling patients to look into different forms of technology to stay connected with family and friends while in the hospital. If they have a smartphone, tablet or a laptop, think in advance about how those tools can help before, during and after birth. Some facilities are allowing partners to be in the delivery room via FaceTime or similar platform, to ensure they can still be a part of the moment. I would also recommend telling them to download meditation apps, music or games that can help distract from the stressful environment in the hospital. Being prepared with a technology plan can help patients stay connected and provide a loving support system while respecting the social distancing guidelines. It can also help relieve stress, worries and anxiety associated with a changing birth plan and limits on visitors while in the hospital.
MedicalResearch.com: How can doctors get new moms and their babies out of the hospital quicker?
Response: Given the circumstances, patients want to minimize time in the hospital and get home as quickly as possible. Medical societies like the American College of Obstetricians and Gynecologists (ACOG) have encouraged hospitals to explore ways to quickly discharge healthy moms and babies to help limit the risk of inadvertent exposure to COVID-19. For example, discharge may be considered after one day for women with uncomplicated vaginal births and after two days for women with cesarean births.
With that in mind, physicians can implement approaches that help new moms and their babies get home sooner without compromising their recovery – especially after C-sections. As an obstetric anesthesiologist during this health crisis, I have been using a non-opioid option called EXPAREL which is injected during surgery and releases a numbing medication over time to provide pain relief for the first few days after surgery when patients need it most. EXPAREL has allowed me to discharge my healthy C-section patients sooner, with limited need for opioids and more well-managed pain.
I encourage doctors to talk to their patients about non-opioid options, like EXPAREL, that can help them recover and go home quicker following a C-section to limit their risk of exposure to COVID-19.
MedicalResearch.com: What if an expecting or new mother is being treated for COVID-19?
Response: We are learning more and more each day about COVID-19 and its effect on pregnant women and infants. During this pandemic, anesthesiologists like myself are continuing to provide our pregnant patients, including those who have tested positive for COVID-19, with epidurals and spinal anesthesia to help manage pain during labor. In fact, the American Society of Regional Anesthesia (ASRA) guidelines recommend regional anesthesia over general anesthesia for patients with COVID-19.
The CDC reports “a small number of infants born to mothers with COVID-19 have reportedly tested positive for the virus that causes COVID-19 shortly after birth. However, it is not clear if these infants were exposed before or after birth.” With that being said, if the mother is being treated for COVID-19 at the time of birth, it is possible she will have to practice social distancing for the recommended 14-day period to ensure she doesn’t pass the virus to her baby.
If a new mom is being treated for COVID-19, there are some factors to be aware of once they bring the baby home as well. The American Academy of Pediatrics (AAP) released new guidelines for the care of infants whose mothers have COVID-19, and while studies have not found evidence of the virus in breast milk, it’s important to take extra precautions when breastfeeding. For example, new moms might consider pumping and allowing an uninfected family member to feed the baby. It’s important to remember that the virus is spread through respiratory droplets, so anyone having contact with the new baby should take precautions by washing their hands and wearing a face mask to minimize the infant’s exposure to the virus.
The COVID-19 outbreak is an evolving pandemic, so it’s important that we stay informed as health care providers and up to date on recent developments, especially pertaining to vulnerable populations like pregnant women and babies.
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