OB-GYN DOs talk about labor, delivery and prenatal care during COVID-19

In late March, several New York City health systems forced women in labor to deliver alone, without a partner or support person in the room, in an effort to slow the spread of the COVID-19 pandemic.

That rule was rescinded quickly, but was in place long enough for Thomas Dardarian, DO, an OB-GYN outside of nearby Philadelphia, to see the effects. This was during a time when he was perusing construction equipment catalogues for PPE, and rapid testing was not readily available, as it is for his hospital now.

“We saw a mass influx of patients from New York, many of whom grew up here,” he said. “They all came back to deliver here, because we didn’t have the no-partner regulation. That was an issue, because we’d have patients come before we could test them for COVID-19.”

Since COVID-19 started, The DO has been speaking with osteopathic physicians about their experiences during the pandemic. If you are a physician and would like to be featured in an interview as we continue our COVID-19 coverage, please email abrown@osteopathic.org.

This week we spoke with three OB-GYNs: Dr. Dardarian, Octavia Cannon, DO, from Charlotte, and Germaine Earle-Cruickshanks, DO, from Boston. In this edited Q&A, they describe the ways their work, both in the maternity wards and clinics, has been upended by the pandemic.

What does labor/delivery look like during COVID-19?

Dr. Earle-Cruickshanks: Deliveries are usually this very happy time, and an intimate thing, and that’s all been fractured. We’re all gowned up for it in PPE. We have to use a lot more eye contact, and use more expression with our eyes. It’s made us have to think outside the box in that way.

Dr. Cannon: Normally I wouldn’t wear a mask for normal vaginal delivery, but now, of course, I do. It’s especially important because you could get spit on your face, just from a patient pushing and blowing their breath out.

Things like that, I never really thought about before COVID-19. Of course after deliveries, I’d always wash my face and use an alcohol swab, but it didn’t worry me so much then, and it does now. It’s making me rethink whether I’m going to wear a mask all the time now, even when this is over.

What procedures are in place to minimize the risks of possible exposure in your maternity ward/hospital?

Dr. Cannon: All patients admitted for labor/delivery, as well as their one allowed support partner, are screened for COVID-19. We do the nasal swabs, which some of the patients have said are ‘worse than the labor pains.’ But we don’t have a choice. We’re doing everything we can.

Before we can go into the hospital, we have an app that we use to enter in our name and temperature and say if we feel well. It has to give you a green light before you can come in and see patients.

Dr. Dardarian: We’ve been trying to get patients out of the hospital more quickly after delivery to reduce our utilization of resources. A lot of times we’re discharging patients who had a vaginal delivery after 24 hours, which of course, is a lot shorter than the typical two-night stay.

Patients over 65 who have emergency issues, we bring them in as the first patients of the morning. We move other prenatal visits back to decrease exposure to the more vulnerable populations.

What challenges have you faced with patients in labor who have, or are presumed to have, COVID-19?

Dr. Dardarian: The biggest challenge has been patients who are short of breath. We had one woman who, though it was her third baby, was
hypoxic and couldn’t push. Luckily since it was her third child, we were able to do an operative vaginal delivery. But as soon as the baby was out, she was intubated and had to go to the ICU.

We’ve had patients who have been first-time moms who come in and just can’t tolerate pushing. So they get a C-section right off the bat. But it’s evaluated on a case-by-case basis.

Dr. Cannon: We have rooms sectioned off for any COVID-19-positive deliveries (though we haven’t had any we know of), and a plan to immediately take the baby to a separate room that has negative pressure. We have everything ready, and still do.

Have you had to reassure patients in labor that having their child at a hospital is safe, and if so, how?

Dr. Earle-Cruickshanks: Patients don’t really want to come to the hospital right now. I’d argue that it’s actually safer than other public places, given that we have very strict procedures and standards. But people are still more afraid.

I have come to the conclusion that my role right now is to create that calmness for them in this time, and reassure them that we’ll take care of them.

How has outpatient care changed?

Dr. Dardarian: Pretty much everything is telemedicine now, and annual check-ups have been pushed back. So our gynecology patient volume is way down.

On the obstetrics side, we’ve been doing telemedicine as well. Our patients have been able to get their own Dopplers, blood pressure cuffs and their own scales, so we can do some of those visits that way. The OB-GYN world was sort of slow to take up telemedicine, but COVID-19 has forced us, and payers, to embrace it.

Dr. Earle-Cruickshanks: It can be confusing and discombobulating trying to communicate what is normally a fairly intimate interaction, in our field, to a phone call.

We have a specific algorithm laid out that determines which regular visits can be virtual versus which must be seen in person. For emergencies, we absolutely still see patients in person.

Dr. Cannon: Our front desk staff has plexiglass at check-out and check-in. You don’t realize how many droplets you release when you talk, but the plexiglass shows it all. It’s amazing.

What changes to patient interaction have been the most difficult to get used to?

Dr. Cannon: I am a hugger. It’s been horrible for me to not be able to hug my patients, especially if I’m seeing them for an annual exam or a postpartum exam. That’s usually who I am, and what I do, so that’s been sad for me, personally.

Once the baby’s born, I like to hold the baby and talk a little bit. A lot of patients want to take pictures and things like that, but you can’t do that now.

You’re constantly thinking about every move. The uncertainty is frightening. I don’t know when I’m going to feel OK doing the things I used to do, or if I ever will.

Related reading:

What practicing medicine could look like after COVID-19

How to do telemedicine in the time of COVID-19