By Jenny McCoy
Thornton resident Taylor Taylor (her first name is the same as her last name) doesn’t consider herself a “germaphobe.” But when the first cases of the novel coronavirus (COVID-19) emerged in Colorado nearly two weeks ago, the 27-year-old significantly upped her hygiene practices. She started carrying disinfectant wipes in her purse; she instituted a “no hugging, no personal contact” policy with friends who had recently traveled domestically; and she and her husband, Jimmy Taylor, cancelled a trip to Texas for a friend’s wedding.
“I'm a little worried with the quickness of the spreading and people not knowing if they have it,” Taylor said last Thursday of the disease, which, as of press time, had confirmed cases that included upwards of 200 Coloradans, more than 5,880 Americans and more than 201,000 worldwide.
Taylor’s worry—and the resulting precautions she’s taking—are driven, in part, by the fact that she is 18 weeks pregnant.
Taylor is one of thousands of Coloradans currently expecting during the COVID-19 pandemic, a scenario that can present additional concerns beyond the collective worry many of us are experiencing right now: Are pregnant women at higher risk for getting sick from the virus? If a woman does get the virus while pregnant, is the unborn baby’s health at risk? Is it safe to deliver in a hospital where COVID-19 patients may be present? What are the alternatives?
According to the Centers for Disease Control and Prevention (CDC), the answer to those first two questions is a frustrating, “we don’t know.”
Because COVID-19 is still being studied, it’s not currently known if pregnant women have a greater chance of getting sick from the virus compared to the general public, and it’s also unknown if they are more likely to become seriously ill as a result. Though the CDC does not list pregnant women among people at high risk of getting particularly sick from the virus, there is reason to believe mothers-to-be could be somewhat more susceptible than the general public.
“Pregnant women experience changes in their bodies that may increase their risk of some infections,” explained a CDC webpage on pregnancy and COVID-19. “With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness.”
It’s also unknown right now if a mother having COVID-19 could cause problems during the pregnancy, or impact the health of the baby after birth. So far, no infants born to women with COVID-19 have tested positive for the virus, according to the CDC, but the agency cautions that this information comes from a small number of cases, and it’s not yet known whether women can transfer the virus to the baby either during pregnancy or delivery.
So what should expecting Coloradans do in the meantime? For now, the CDC is advising pregnant women take the same precautions as the general public—wash hands often with soap and water for at least 20 seconds; avoid touching eyes, nose and mouth with unwashed hands; avoid close contact with people who are sick; and maintain distance from other people as more communities see local spread of the virus.
Westminster resident Erin Cuzzoni, 28, is almost 27 weeks pregnant with her first child. Last Thursday, she had tickets to a Post Malone concert at the Pepsi Center. [Editor’s note: we previously reported on the controversy surrounding this concert going ahead despite concerns over community transmission and risk to Pepsi Center workers.] But after she thought about being around “all the people” and going through security where they would touch her—and everyone else’s—bags, Cuzzoni decided it was “probably best not to go.” (The next day, Gov. Jared Polis announced a ban on gatherings of 250 people or more; and on Monday, the White House recommended Americans avoid groups of 10 people or more.)
Beyond individual decisions and government directives, local hospitals and centers are enacting new policies in an attempt to protect all patients—pregnant folks included.
Under new protocols at Rose Medical Center in Denver, for example, all visitors are screened before entering the hospital, Julie Hogan, assistant vice president of marketing at Rose, said on Friday. This screening takes place in separate lines: one for expecting mothers and their guests; one for surgical patients; and one for suspected COVID-19 patients as well as everyone else visiting the hospital. If anyone screens positive—for example, if they have a cold or cough, or they’ve recently traveled to an area with a high number of COVID-19 cases—then a decision is made about whether it’s appropriate to let that person into the hospital, said Hogan.
“If it's a patient and the patient needs medical care, we're going to take care of that patient, obviously,” Hogan said. “But again, just trying to limit the influx of unnecessary traffic.”
After screening, expectant parents are then funneled to the obstetrics ward, which is its own separate unit that can only be accessed after passing security, said Hogan. When it comes to labor, only two guests can be in the delivery room at a time, said Hogan. The hospital, which delivers about 75 babies a week, also suspended breastfeeding support-group meetings and in-person tours; moved classes for expecting parents online; and removed shared waiting-room spaces and other communal gathering areas, like coffee shops.
“You're either in a patient room, or you're not in the building,” said Hogan. Rose Medical Center is part of HealthONE, a Denver metro area hospital and provider system, and these protocols and restrictions apply to all hospitals in the network, according to Stephanie Sullivan, a spokesperson for HealthONE.
UCHealth, which operates hospitals and clinics across Colorado, Wyoming and Nebraska, is also limiting visitors to all areas of their hospitals, including labor and delivery rooms. “For their safety and the safety of others, new parents may only have two visitors at a time,” a UCHealth spokesperson said via email on Friday, March 13. On Sunday, March 15, they updated that policy to just one visitor every 24 hours.
Good Samaritan Medical Center, a SCL Health hospital in Lafayette, seems to be taking precautionary measures as well.
“They put a lot of hand sanitizer out [and] wipes,” Taylor said of a visit in early March. She also said that during that visit, she had to fill out several questionnaires regarding her travel history, if she’d been in contact with people who’d traveled to high-risk areas, and if she’d experienced any symptoms herself. Seeing these measures “makes me feel good that they're trying to do everything they can to prevent [infection] as best as they can, within reason,” she said.
Yet despite these precautions at metro area hospitals, some pregnant Coloradans are considering alternative settings for their labor and delivery with the thought that they may be safer.
On Thursday, Candace McCollett, an administrative assistant at Beginnings Birth Center in Colorado Springs, said she’d received several phone calls from women interested in transferring their care from a hospital to the birth center over fears of the virus.
Renee Clark, MSN, CNM, nurse-midwife and director of the new graduate fellowship program at The Birth Center of Boulder, said one patient on Thursday expressed concern over going to the hospital for a routine ultrasound since the check-in area was located near the emergency room, where she felt she might be in close proximity to potential COVID-19 patients.
“We're reminding our clients that we have a much more contained space right now for them to have the babies,” said Miki Tynan, co-founder of Hygge Birth and Baby, a Denver-based birth center. “We really are only having babies within our center and [patients] getting prenatal care, as opposed to being in a hospital where there's potentially exposure from emergency rooms or from other wings.”
As of midday on March 18, Hygge Birth and Baby is screening all clients and visitors for COVID-19 symptoms, and taking temperatures as well. Tynan said they are limiting entry to essential staff and patients only, “with obviously everybody aware to look for any type of warning signs that they may have,” she added. The center also cancelled certain classes and is now having folks sign up for breastfeeding support class beforehand so that attendees can be pre-screened.
Tynan said they have definitely received more interest from people wanting to switch from the hospital to the birth center. In fact, during a midday phone interview, Tynan said that just in the last 20 minutes, they had two patients transfer care to Hygge from the hospital.
Jennifer Dossett, an independent home-birth midwife registered in Colorado, said on March 12 that she hadn’t heard from any expectant mothers who were interesting in switching care from a hospital to a home birth, but wouldn’t be surprised if there is more interest in home birth options in the coming weeks, depending on how well the virus is contained.
Right now, Taylor, who is due in August, is still planning to deliver her baby at Good Samaritan Medical Center. But she acknowledges “that could change” if the number of cases continues to climb.
Lafayette resident Stephanie Palmer LeBlanc, who is currently 17 weeks pregnant and plans to deliver at Centura Health’s Avista Adventist Hospital in Louisville, hasn’t thought much about switching to an independent birth center. “If it's something that I need to worry about, it seems like a later date would be more prudent given how quickly things are changing,” she said.
But LeBlanc, a 33-year-old physician’s assistant at Pediatrics West, a primary care practice in Wheat Ridge, did describe a family who came into the Pediatrics West office on March 14 with a newborn: “They expressed a level of anxiety being in the hospital while so many appointments were being cancelled, to keep people from coming into the hospital” because of the coronavirus risk, LeBlanc said, adding that other families had expressed similar sentiments as well.
On Friday, Hogan said she had not heard of any patients requesting to switch from the hospital to an independent birth center because of the virus. “We are of the belief that a hospital is the safest setting in which to have a baby, and we've got mom covered,” she said. “Any decision about transporting any type of patient, that is a physician decision and it's [made] patient by patient.”
McCollett did mention one patient at Beginnings Birth Center chose to switch care from the birth center to the hospital, as she felt the hospital would be better equipped to care for her baby if the child were to contract the virus.
According to Clark, midwives at the Birth Center of Boulder and at Boulder Community Hospital are planning to meet to discuss what the coming weeks might look like, and develop shared approaches to care for pregnant women who are fearful to come to both hospitals and birth centers in light of the outbreak.
Yet there may not be enough midwives to meet an increase in demand for birth centers or home births. Financial and other barriers limit the availability of these options, especially for families who are insured by Medicaid. Multiple midwifery centers in the Denver metro area have closed in the last year.
Beyond the obvious health concerns, COVID-19 is triggering additional stress for growing Colorado families.
“I’m trying really hard not to panic, but it’s starting to get a little crazy,” Aurora resident Erin Kirk said last Thursday. Kirk, 32, is currently 33 weeks pregnant with her first child. “I am struggling to feel prepared to have the baby, while also trying to prepare for being in this pandemic situation. It’s just kind of a lot to deal with at once.”
Kirk’s husband, Casey Kirk, manages the Lowry Beer Garden in Denver, and she worries that the virus could affect his business. “It’s definitely not the best time to be losing any money,” she said. “That’s also been stressful.”
Stressed is how LeBlanc feels overall about the virus.
“The feeling of unknowns when you're pregnant is already a little bit anxiety-producing,” she said. “Will my baby be healthy? Will my delivery be what I want it to be? And so add to that anxiety, okay, if I get sick, how sick will I get?
“It affects my pregnancy in a time when everybody's feeling that sort of community anxiety. It's tough. It's not fun.”
To combat the stress, she’s asked loved ones to stop texting her news articles. Instead, she sticks to content like the CDC website.
“It is so boring and dry,” she said. “But also, it is factual.”