April 16, 2020 • 54 mins
Hospitals in hotspots like New York City may have postponed or canceling non-essential surgeries due to the coronavirus, but, you can’t postpone birth. Pregnant mothers are still entering hospitals, sometimes alone, to deliver babies to doctors and nurses in full hazmat gear. On this episode of Next Question with Katie Couric, Katie finds out what it's like — from the perspective of mothers, doctors, and doulas — to give birth in the time of coronavirus.
First, Katie talks to Alicia Biggs, a mom who had to give birth alone at the end of March. Then, Katie checks in with two obstetricians, one from New York Presbyterian in Manhattan and one from the Elmhurst Hospital Center in Queens, to understand the obstacles they face in keeping pregnant and laboring moms healthy and safe. Finally, New York City doula Chantal Traub offers tips to pregnant women and their partners for how to feel safe — and empowered — during a time of uncertainty. Next Question listeners can go to ChantalTraub.com to get their free guide for how to enter birth with confidence and calm. For more, subscribe to Katie's morning newsletter Wake-Up Call at KatieCouric.com.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone, I'm Katie Curic, and welcome to next question today,
Giving birth and the time of coronavirus. When I walked
into the hospital, the hallways are eerily quiet. One mother
surreal experience of going it alone. You saw the doctors,
you saw security guards, and you saw cleaning staff just
(00:23):
really kind of giving you a nod of you got this,
but in a really powerful, yet somber and scary way. Later,
we'll check in with obstetricians in two different New York
hospitals to understand some of the biggest challenges they face
and keeping pregnant mothers safe amid COVID nineteen. When I
tell a patient that her COVID nineteen tests came back positive,
(00:46):
she's terrified and there's a lot of avoidance of wanting
to know the answer to that. Um So, I think
it's the biggest challenge we have is to let our
patients know that it's okay to come seek care. But first,
my next question, how do you have a baby during
a pandemic? Alicia Biggs had already given birth once nearly
(01:08):
two years ago, to a baby girl named Olivia, and
beyond the excitement of planning for their second child, to
take place at the same hospital and with the same doctor.
Alicia and her husband Patrick were really looking forward to
a few crucial things being different this time around. I
really wanted my my mom in the room. She wasn't
(01:28):
in the room for the first pregnancy, and you know,
I really wanted her there for for this one. She's
my best friend, and and just um thought the more
of the merrier for this one. And then another thing
that we thought would be really nice and special that
was a little different was in my first pregnancy, in
my delivery, I had a very healthy baby, but she
(01:49):
needed to go to the nick you at first. So
that initial time where you're you spend with your with
your newborn, I'm kind of on your chest, and just
with your husband and with your family and just really
relishing in the moment of what just happened. We didn't
really get because she was sent into the nick you
so fast. So we were hoping and crossing our fingers
(02:10):
for an easy and healthy delivery where we could have,
you know, shared that moment that people talk about all
the time. Because of the complications of Alicia's first birth
and the already large size of her second baby, Alicia's
doctor planned to have her induced on Marchy, one week
before her due date, at New York Presbyterian Hospital in Manhattan.
(02:33):
But as that date neared, cases of the coronavirus were
growing at alarming rates across New York City, which was
already the epicenter of the virus, and hospitals were being
forced to make some very tough decisions to prevent the
virus from spreading. The week before, we had heard looming
messages from people saying, you know, the hospitals down to
(02:56):
usually you can have two attendees with you, they moved
it down to one. So that means the plans changed
for my mother. But they, you know, everybody was really
messaging me saying, oh, they'll never you know, not let
your your spouse in or your they'll you always have
one person. So I kind of put it out of
my mind that was never going to happen to me.
(03:18):
And the Sunday prior to the delivery, so about three
days before I got a call from my doctor she said,
I have good news and I have bad news. The
good news is there's a full staff in labor and delivery,
which which really just level sets you as to what
is good news. Anymore. The bad news isn't going to
have to break it to you that you can no
(03:39):
longer have your husband in the room. Those are some
of the most difficult phone calls I've had to make.
Dr Alan of Brownstein is Alicia's obstetrician. When she found
out the news that New York Presbyterian Hospital had to
institute severe restrictions due to the coronavirus and was no
longer allowing any partners, family member, or outside support into
(04:01):
the hospital at all, much less the delivery rooms, she
immediately called her patients. They were long phone calls. I
would sit there with them. I I feel horribly that
they were not able to have that person with them,
and how upsetting disappointing that was, and they were obviously disappointed.
Um and that was not an easy conversation to have,
(04:22):
although I do feel like they did understand the reasons
why it was being done and how severe things had
become for the hospital to make that decision that they
couldn't have somebody there. And I would say, I'm going
to do everything I can to make this a great
experience for you, despite the fact that your husband's not
going to be there. I said, make sure you have
(04:43):
your laptop, your phone fired up charged. Don't forget to
bring your charge to the hospital so if it dies
during the delivery, you can still you know, charge it
up and have your husband there. You can have him
on the laptop, on FaceTime, on Zoom, on any platform
so that you can feel like he's with you as
much as possible. For Alicia, the news was devastating. I
(05:03):
just cried to her on the phone, Um, and she
was just unwavering in her support, saying, you you can
do this, and where you're going to do this together
and you will not be alone because I Am going
to be there the entire time and it's you know,
it's you and me and we will figure out a
way to get through this. And she said take a
(05:24):
day to to just figure yourself out. Patrick, where you
crushed when you heard the news, I was. I was
totally heartbroken that Sunday and Monday. It was incredibly difficult,
um and sad. But then there was a shift that
happened on kind of Monday into Tuesday before she gave
birth on Wednesday, where it was this, you know, this
(05:45):
was our new reality and we will we'll get through
this together as much as possible. I took a day
to be very emotional to you know, really just understand
what was going on, and then I, um, I was
a swimmer by background, uh, and really just tried to
use the tools that I had available to me, you know, mentally,
and really then said, okay, here's a day where you
(06:08):
get to decide how you're going to move forward, and
then really treated it as a swimming um and a
swim race, right, It's a you know, swimming is a
very individual, an individual sport that's surrounded by teammates who
support you. I met my husband while swimming, and he understands,
(06:30):
you know, the nuances of how I am of of
when I get into that mode. So we spent the
next days just preparing and kind of getting into that zone.
On Wednesday, March, in the darkness of the early dawn,
Patrick drove Alicia to New York Presbyterian Hospital and watched
(06:51):
from the car as she walked in alone. When I
walked into the hospital, the hallways are are eerily quiet
because no one needs, you know, should be walking hallways
unless they really have to. So I had my bag
and it was clear with my bump where I was going,
um and you saw the doctors, you saw security guards,
(07:12):
and you saw cleaning staff just really kind of giving
you a nod of you got this, but in a
really powerful yet somber and scary way. And when you
when you go immediately to sit down to check in,
they give you a mask and they need to treat
you as though you have COVID, um as though you
(07:35):
have the virus, and they test you immediately when you
get into the room, and then you we I didn't
know results for twelve hours after that. Um, So your
tense because you're having a baby, but you're you're also
just tense because you don't know if you have COVID.
You don't know if the nurses around you might have,
(07:55):
you know, gotten it. So you're everybody's you know, protecting
themselves for the greater benefit of everybody, right, But it's
just really scary. So I didn't find out until right
before I pushed that I had tested negative, which I
was just you know, very tense about and you know,
(08:16):
continue to tell Pat what if I have I was
I was getting more stressed about having COVID than I
was about delivering the baby. Um At first, the whole
thing sounds ridiculously stressful. Just hearing you talk about it,
it's making me feel anxious. Yeah, no, it was. It
was anxious. It was, it was. It was really anxious.
(08:38):
I mean some of the you know, beautiful things that
had come out of it was you know, um, just
understanding what the nurses are and the doctors are putting
them how they're putting themselves out there to make you
feel comfortable. So they you know, I walked in and
they said they gave me a letter, a handwritten letter
signed by all the nurses saying you're not alone, and
(09:03):
you're going to prove to yourself how strong we already
know you are, and we're here for every step of
the way. And you know, everything was just so powerful
that you're you're emotional and you're crying, but because you're
you know, partially sad, partially scared, but partially you know,
you're empowered to to get through this, and you just
have one choice and you have to just get to
the other side and decide, you know, I can either
(09:27):
I need to make this a positive experience. So I
um and they did a great job for me too,
because the way we had it set up was I
had an iPad A. Alicia had an iPad and we
basically space time uninterrupted for thirteen hours, and so she
had it on a little table with her that could
move UM, and the nurses and the doctors talked to
(09:48):
me as if I was in the room the entire time.
They're saying, Okay, we're gonna do this. We're doing this, um,
you know, here going to take her medicine up to
this level. So they did a very um amaze job
of making me feel a part of the entire process,
even though I was They're virtually on an iPad, Alicia,
I wanted to go back and ask you about the delivery.
(10:10):
Did the doctors and nurses look like they were dressed
for some kind of chemical spill? I mean, was that
a strange experience for you versus seeing their faces? Right?
It was? You know, they're in there in full there
in masks. They're also in a shield. Um, they're in
full gloves. You know, you can it's it's hard to
(10:31):
to necessarily get out their demeanor, you know, other than
verbally and and really through their eyes. So you had
it was that's what made it so scary until I
knew that I had tested negative for COVID. It was.
It was a really scary time, which I think helped
with you know, the handwritten letter and just really trying
(10:52):
to read people's eye contact. And but it was a
unique experience, and luckily I had a doctor who had
been my doctor this entire time through you know, my
first birth and also all my appointments of my second birth,
and her comfort. You know, at one point I got quite,
(11:13):
you know, just I just lost, I got my my
emotions got the better of me, and I you know,
I just was crying because this was all just a lot,
and you know, she came in and you know, gave
me that look of we we had we're going to
do this and we're going to get through this, and
you know, you're you're tough, and you just we're going
to be tough together. And so that was really nice.
(11:35):
And so I tried to make it also, you know,
a lighter experience in in terms of they also saw
how petrified I was so trying to combat that. I
brought in plastic wrapped COVID approved sweat bands so that
they could undo them, um and so that you know,
(11:55):
the nurses and the doctor when we were you know,
going through labor could could see that I was this,
you know, this can be fun and this is a
you know, bring it back to that, this is an
amazing experience. So we all did wear sweatbands during the delivery.
Dr Brownstein, what was it like for you helping Alicia.
(12:16):
Luckily it was her second child, so she wasn't you know,
it wasn't her first rodeo, but it still must have
been pretty stressful. Can you describe what that delivery was like? Right? Well,
she had her husband on the laptop the entire time.
I felt like he was there. I had regular conversations
(12:37):
with her throughout the entire labor process, and I would
just talk directly to him. Um. We tried to make
him as included as possible and just feel like he
was just another person in the in the room. She
was very funny. She said, you know, usually, you know,
Patrick is here with me, and last delivery we had
him were the headband for it, and we were both
(12:58):
wearing the headband together, and she whipped out these brand
new headbands for me and the nurse and she said,
would you be willing to please by or these headbands?
It makes me feel like Patrick is here and in
the room, and we always like absolutely so the nurse
and I were wearing our matching headbands along with Alicia
and going through the whole process and pushing them. We
got pictures of us all with our headbands on, and
(13:20):
it just made it more fun and inclusive, and Patrick
felt like he was there and we were just trying
to be as importive and as there for her as
you could possibly be. How long were you in labor, Alicia?
So I was in labor for about thirteen hours. The
labor and delivery part was went by really fast because
(13:40):
you had all of the support of the of of everybody,
and you know it's building up to this one moment
and then you know the post. The post twenty four
hours and forty eight hours after is I think the
hardest part too, where you just feel loneliness and being
scared because you're sitting with your you're sitting alone with
(14:01):
your thoughts and um, you have a roommate, but everyone's
really scared to to, you know, even talk to each other. Yeah,
So it's just it's it's an interesting environment. What was
it like for you, Pat to see your son on
that iPad screen? It was surreal for sure. I mean
(14:24):
it was, you know, again, not what you had anticipated. Um, so,
you know, after he was born, they bring them over
to the heating table to do measurements and all those things,
and so they picked up the iPad and brought me
over there. So they made me feel the entire time
like I was part of the process. And then the
picking up at the hospital the next day, it was
very special to just you know, Alicia was on the
(14:46):
wheelchair with Jack with a blanket over her, and so
she had the blanket over him basically until she got
to the car and then, um, you know, to see
him for the first time and to hold him and
to put him in the car seat. That would be
a moment that will have kind of etched in my
brain forever, that first time medium outside the hospital Alicia
and patted. Just a few days after you had to
(15:08):
go through this, Governor Cuomo announced an executive order that
rescinded these restrictions so that hospitals in New York allowed
women to have one support partner present during their births.
So did you feel like, gosh, uh, why the heck
(15:28):
did I end up in this window? I did think
it was funny timing. I'm hoping I have, we have
some delayed good karma hanging over us in the future.
But I was, I was, you know, being a second
time mother. I was happy that it was me who
has had the benefit and you know, the fortune to
(15:52):
have a delivery with my husband, and during times like this,
it makes you realize just you know, what's important, and
I was happy to take that place for someone other
than a first time mom, because that's a really it's
it's scary, it's lonely, and you know, doing it when
you have no idea what's going on once you give
birth is just frightening. So I'm I'm really glad that
(16:18):
it happened to me versus some of my other close
friends who were um first time mom's delivering very shortly
after that, and luckily was the band was lifted. Congratulations
to Alicia and Patrick Biggs, to big sister Olivia, and
of course too little Jack Biggs, who will have one
hell of a birth story to tell when we come back.
(16:42):
Dr Alana Brownstein on what we know so far about
pregnancy and COVID nineteen. One of the many things we
don't yet know about COVID nineteen is how the virus
affects pregnant women and their babies, So we wanted to
(17:04):
talk to a few obstetricians about what they are seeing
as well as how their hospitals and pregnant patients are
experiencing all this. We started New York Presbyterian Hospital with
Dr Alana Brownstein, the o B we heard from at
the beginning of the episode. A few things to note
about New York Presbyterian Hospital. It is massive, with multiple
(17:26):
campuses across the New York metropolitan area. It's also one
of the most prominent hospitals, ranked number five in the country.
Dr Brownstein delivers out of the hospital's location on the
Upper East Side of Manhattan, a community that's overwhelmingly white
and ensured. Dr Brownstein answers a few medical questions first
(17:46):
and then walks us through what labor and delivery looks
like right now where she practices. What physiological changes and
biological changes occurred during pregnants that could in fact make
pregnant women more susceptible to certain viruses if not COVID nineteen,
(18:08):
it's too soon to tell, but can you explain what
happens to women that could put them at greater risks?
So we know that pregnant women are at a relative
immune suppressed state um in parts so that the the
mother's body can accept to feed us in their body
which is not their own cells. So we know that
(18:28):
it is decreased in certain ways like that. We also
know that certainly any bodies that they have can be
in lower tighters just because of the plasma volume expansion
that happens naturally in pregnancy. So it is theoretical possible
that your immune systems decrease could make you more susceptible
to certain viruses and make that disease much worse in
(18:49):
pregnancy than not. We just need more time to know
iff that's the case for COVID nineteen or not. But
in Layman's terms, you're saying that the expansion of the
baby can decrease lung capacity just because it's pushing up
on the lungs right, So later in pregnancy, especially where
there's a whole fetus in the in that cavity, it
(19:10):
can make it difficult for the lungs or expand more,
which also sometimes can make it more difficult to know
who has it or not. Because when you talk about
some of the symptoms of COVID nineteen and you talk
about respiratory changes, well, feeling short of breath is a
very common symptom of normal pregnancy, So that can make
it a little bit more challenging to figure out what
(19:31):
it is because your respiratory rate is faster, and certainly
you feel more breathless. It's harder to um take a
deep breath, and it's harder to feel like your lungs
are fully expanding because of that fetus in that area.
What happens when a pregnant woman comes in now to
your hospital is she immediately tested for COVID nineteen. So
(19:51):
any woman that is coming onto the unit gets a
mask right away. Um. If the patient is admitted to
the hospital, then she is immediately tested. If somebody comes
in and is not admitted, then they are not tested
for For example, if a woman thinks that her water
broke and she's coming in and she's evaluated and it
turns out that her water didn't break, she's sent out.
(20:13):
We don't test that person for COVID. If the patient
is admitted for whatever reason it is, whether it's labor,
preternal labor, any other condition going on obstetrically, that patient
is tested for COVID. It does take a few hours
before we get the test back, So we essentially just
treat everybody like they're positive UM, and then anything obstetrically
(20:33):
is done as it normally would be. If she's in labor,
we're managing her labor. She wants pay medicine, she gets
pay medicine. That part doesn't change. It's really more of
UM whether or not she is positive in what that
means for her, the delivery and for the baby afterwards.
But everybody on the unit has a mask on. We're
wearing gloves for everybody, and that's the same across the board.
(20:54):
If we know if somebody who might be positive UM,
we try to call ahead to the hot spook. I
know I have a patient that's coming in that either
I suspect as positive, I know is positive, or any
inkling of that. We make sure we call ahead, We
have a room waiting for them, and we make sure
that they are isolated. What kinds of concerns are raised?
(21:15):
Dr Brownstein if pregnant woman about to give birth test positive,
other than protecting the staff members, is there any risk
to her baby? Is their risk to her in terms
of the delivery, etcetera. So for the delivery part, we
deliver them as we would regardless of their COVID status,
(21:35):
meaning if they are going to have a vaginal delivery,
they can have a vaginal delivery. If they're going to
have a c section, they can. For the baby, the
concern is we want to make sure that it doesn't
get transmitted to the baby. So currently it does not
appear that there's vertical transmission, meaning that the baby would
get the virus just from being inside the mom um.
(21:56):
So it's thought that for the actual delivery process they
can deliver as they normally would. It's more of a
question for postpartum. The babies are not taken away from
the moms, so that's the question. I get a lot,
is my baby taken away from me? If I'm positive.
We generally don't take the baby away from the mom.
The mom the baby can still be with the mother,
but we do try to make sure that the mom
(22:16):
is wearing a mass mom's wearing gloves. We're not having
that direct contact that that baby might get it from
the mother. After the delivery, you're not concerned that the
baby could become infected out of utera. So we are
and not necessarily just during that delivery, but we're concerned
with contact with the mom afterwards that even the mom
(22:36):
just holding the baby. You know, the first thing you
want to do is when you get your newborn is
hold it tight, kiss at snugglet be very close to it.
But all of those things, the baby could get COVID
from that. So generally what they're trying to do is
have the baby be with the mom, but still maintain
that distancing, so being six freed away. If the mom
chooses to breastfeed, then the mom can breastfeed. However, we
(23:00):
try to wash the breast off. We try to make
sure the mom has washed our hands. We want to
make sure there's the mom is wearing a mass the
entire time so she's not breathing directly on it or
the other optionism mom can express breast milk and then
somebody else can feed the baby the breast milk if
they want to do it that way, because there is
a concern that it could be transmitted to the baby,
not in utero, but afterwards just having the contact with
(23:22):
the mother, so we do try to limit that contact.
But it's not like the mom can't be in the
same room as the baby. I think that concern of
having your baby physically taken away from you to another room.
That is very concerning. What about having mothers give birth
prematurely or early because of their COVID symptoms and concerns
(23:43):
about their health and potentially the baby's health. So there
are some situations or the mom just are so sick
that they have to do that. We generally try to
hold off on doing that if we could, just for
the baby's health. UM, We'll try to get the baby
at least to either like thirty two or thirty four
weeks ges station if we have to do that, because
(24:03):
there's such significant morbidity UM for the baby before that
gestational age. But there are situations where moms are that
sick that they do have to convert over and decide
to deliver the baby early for the moms health. What
about during pregnancy? I was getting a lot of questions,
and I'm not a doctor with pregnant women very concerned
if they got COVID ninety obviously for themselves, but very
(24:27):
concerned about the health of their babies developmentally. What do
we know about that? Great questions? So very little, only
that again it's so early that we don't have patients
that have had it very early in the pregnancy and
then carried food a term. Yet, just because it hasn't
been around that long so far, it seems that there
might be a high risk for preterm delivery. UM, we
(24:49):
are concerned about whether or not there could be an
increased risk of either miscarriage or congenital adormalities. But we
haven't seen that yet. UM, it's certainly a concern, and
we're we're getting our huge registry of pregnant women to
see something that we can follow out over time. It's
just too early to know. We're also concerned about the
growth of the baby, so we want to make sure
(25:10):
if the mom is infected as the baby growing well,
so they have to have ways to monitor that as well.
We haven't seen it yet, but again only because those
are things that take while to actually develop into see
and it just hasn't been amount enough to see. I
wanted to ask you about maternal mortality. We did two
(25:31):
episodes on maternal mortality, which we're holding for later, but
it's very concerning. There are something like seven hundred to
nine women dying from pregnancy or childbirth every single year
in this country. Not to mention the fifty thousand women
every year who almost die. So how concerned are you
(25:53):
about the impact of COVID nineteen on this skyrocketing maternal
mortality rate. I think it goes back to we need
to make sure that our patients have access, that they
can be seen, that they can get to a hospital
that can care for them, because that is going to
make the difference of how they do and how their
their babies do. And it's very concerning, and this is
(26:16):
just one more, one more layer of things that can
make it harder for those women to get the good
care that they need. The doctors we spoke to for
our maternal mortality Episodes also said it can be crucial
to have support for the mother. There's not only before
and during the pregnancy, but afterwards, since so many complications
(26:36):
can happen after the baby is born and hospitals are
so focused on the health of the baby. What are
your thoughts there, But there's a lot of things that
can happen postpartum um. It's not over once that baby
comes out. You know, people can have um bleeding issues postpartum.
You can get pre aclamps to a blood pressure issues
(26:57):
postpartum um. There's a lot of things that if you
don't have somebody who one knows about it you can
help take care of you. And three recognizing and get
you to your hospital can be major issues. UM and
I think that is a huge problem having that support.
It doesn't end once that baby comes out. It really
goes into the whole hours partum care period as well.
(27:17):
Can tell a medicine be helpful in that regard for
women who have given birth but may not have as
much access to top medical care. I think that we're
seeing the role that telemedicine can play. I think it's
really been shot into the spotlight with everything going on
here where we're trying to keep people at home. UM,
(27:37):
there are a lot of things that you can assess
over the telemedicine visits. You can't do everything, but you
can see the patient, you know. I'll have visits with
my patients who all have them show me their own decision,
you know, have you know, show me what that bleeding
is looking like. I have patients get blood pressure monitors
at home. I have them take their bloo pressure at home,
show me what it shows like, show me what that
(27:59):
number is, and then I can try to do an
assessment whether that's somebody who needs to come in, or
whether that's something I can just speak to them at home.
So it certainly can help, especially in this day and
age or trying to not have people come in. I
think there is a lot of information you can get
with a telemedicine visit. What's your advice, Dr Brownstein for
(28:19):
pregnant women right now, with no end in sight, what
would you tell your patients that might help pregnant women everywhere?
I think the most important thing is what we're telling
all people right now, which is make sure that you're
practicing the social distancing, make sure you're performing hand hygiene
where we're a mask, we're a protective gear. If you're
(28:41):
going out, try to distance yourself from everybody. Um, those
are the things that seem to be working. And I
feel like for the pregnant patients, especially where there's already
a high anxiety and a concern about this pregnancy, to
try to protect themselves as much as they can, This
is a great time to kind of stay inside corn
teen and keep your distance from people as much as
(29:02):
you can for your own protection and for that of
your baby as well. Just across the East River from
Dr Brownstein is the Elmhurst Hospital Center in Queens, a
public hospital that has about five hundred and forty beds
to New York Presbyterians hundred plus. It's located in Jackson Heights, Queens,
(29:27):
which is the most ethnically diverse neighborhood in the country.
It's a very underserved community and the community right now
is being hit very, very hard by the COVID epidemic.
Dr Tracy bone Hemmerdinger is the chief of Obstetrics at Elmhurst.
The population that we generally see at Elmhurst is mixed
community of new immigrants. UM. We see all different ethnic backgrounds. UM.
(29:51):
The number one language spoken is Spanish, followed I think
very closely by Bengali UM. And I think that a
lot of the patient is that we see fall into
the category of people who can't social distance because they
live with large numbers of people in their homes, people
who are responsible for caring for not only many children,
but also their parents and their extended family UH. And and
(30:13):
and people whose jobs are either domestic workers or you know,
people whose jobs and livelihood may be cut off completely
and not have any access to their regular daily needs.
And so I think that that puts them at significant
risk for any illness. Elm Hurst has been called the
epicenter of the epicenter of coronavirus cases, the ground zero
(30:34):
of the epidemic. The fact is Elmer's was one of
the first hospitals hit by corona and it was hit hard.
Elmhurst runs at capacity, so I believe it was running
capacity before the epidemic, and so that's why it became
so difficult, because we needed to figure out ways to
structurally change our hospital to be able to take care
of all of our patients. The very beginning of this,
(30:56):
nobody really knew what was going on and what was happening.
We got at a lot of patients presented and they
didn't know what they were supposed to say or do.
We didn't know what we're supposed to say or do.
The recommendations from the CDC and from the New York
City officials and the New York State officials were changing
every couple of hours, and I would come up with
some kind of a protocol and then it would have
to be changed. And it was very frustrating and difficult
(31:20):
on both sides. On the patient side, and not even
just the patient side. The family members of the patients,
especially for pregnant women, which is what I deal with UM.
And now I would say we're a few weeks into it.
We really got this down and we know how to
manage it. And I think that a lot of our
patients initially were very afraid to come to the hospital,
especially because of all the news the elm Hurst Hospital
has been on the news because we've gotten hit so hard.
(31:42):
And now, UM, I think they feel more comfortable. Are
our senses is starting to come up. Our patients are
more comfortable coming in, and our outcomes are very good.
Dr Bones says half the battle was working out the logistics.
There was a lot the hospital had to figure out
and figure out fast when it came to managing incoming
COVID or suspected COVID cases. With exceptions like labor delivery
(32:05):
and postpartum. Elmhurst is now almost entirely devoted to COVID care.
The physical space was something we had to figure out
how to use and our staff as well. So we
have a triage area that has seven beds for triage,
and we had to put up a wall so that
we could have COVID patients on one side. And non
COOVID patients on another side. And then we had to
do the same thing in our post anesthesia care unit
(32:26):
after c sections, we had to put up a wall
to separate an area where we could put COVID patients
or suspected COVID patients and non COVID patients, um, you know,
and then who could go into those rooms versus who
can who has to go into an isolation room someone
actively coughing with a high fever, whether or not we
have a positive test that patients probably should be isolated, UM,
and so figuring out where we can put those people
(32:46):
and not overrun our our service. And obviously staff has
been affected. UH, nurses and doctors and resident doctors have
all been hit, and we've had many many providers get
sick and be out for sometime, and so that puts
a strain on everything, UM. And so streamlining the system
(33:07):
has to deal with figuring out which staff you have
when and making sure that you have enough staff at
all times. Obviously, many of us would love to go
help our colleagues in the emergency department or in the
medicine I see you, but you have to make sure
you're able to cover everything. And you know, since we're
pretty much the only service in the hospital left that's
non COVID, we want to make sure we're covering our
patients well with experienced physicians and nurses who know how
(33:29):
to handle will be When it comes to how this
virus effects pregnant women, Dr Bones says, there are still
a lot of unknowns, but also a few key and
positive takeaways. The course and pregnant women seems to be
not any worse than it would be for non pregnant women,
which is a very good thing and for and for men.
Women tend to be doing a lot better with the
(33:51):
disease than men. Um so that's a positive thing for
women as well. Uh, we are noticing that are the
transmission from from pregnant woman to her fetus seems to
be almost zero. It's not a d zero, but it's
it's almost zero. So that's a very very good thing
as well. Um And the one thing we've learned, I
think that a lot of people in this hospital and
(34:13):
in the country have learned, is a lot of people
are infected with CODE. We learned that by testing, So
we're testing every single patient now that gets admitted to
the hospital on our floor, and we've noted many, many
patients who are positive and completely asymptomatic, and some of
them become symptomatical later, and some of them never do.
The other thing Dr Bone has learned is you don't
(34:34):
know what to expect when it comes to this new virus,
which makes her job all the more difficult. You've got
to be really cautious because I've seen and again this
is anecdotal, but I've seen it go both ways. I mean,
we had one super sick pregnant woman who ended up
going into the I See You and was very close
to being intubated, and then we as a group interdisciplinary
between high risk obstetrics and I See You and pediatrics,
(34:58):
decided that it would probably be better for her health
to deliver, and we delivered her her baby by C section,
and she miraculously got better after she was delivered, and
she didn't require intubation, and I actually had the privilege
of sending her home on Sunday. Uh flip side, I
had another patient last week who came in for an
uncomplicated scheduled C section and did wonderful, no problems at all,
(35:21):
totally healthy. As I mentioned earlier, we swabbed everybody when
they first come into the hospital, and it was taking
about twenty four or four hours to get the results
back at that point, so we didn't have her results.
And then on post operative day one, about a day
after she had her surgery, all of a sudden, she
decompensated and got very very ill, also requiring oxygen and
I see you care. And then her test came back
positive from days before when she was asymptomatic. So it's
(35:44):
very hard, I think, to to figure out who's gonna
go which way and when, and that's what makes it
so difficult to care for the patient. Before COVID hit,
Elmhurst was very involved with the maternal mortality crisis, particularly
the racial despaired these that see so many more black
and brown women dying due to pregnancy or childbirth, and
(36:06):
Dr Bone notes that COVID nineteen is underscoring that same disparity.
I think that black women, and I think that UM
underserved women in general are being hit harder and men
are being hit harder by this UM. Whether that's because
they have underlying illness or just there there decreased access
(36:27):
to care, I think it's probably a combination of both.
And I don't think that COVID nineteen is going to
be different than anything else. Uh, COVID nineteen doesn't discriminate,
meaning anybody is eligible forgetting it. But I do think
that we're going to see more of this in the
same populations that we see more of other illnesses because
of access to care, and because of limited resources and
(36:48):
and all of the other problems that go along without
As for right now, the biggest obstacle Dr Bone and
her team at Elmhurst face is misinformation. Their fear around
COVID and the fear of contracting it has kept many
pregnant women from coming in to get the care they
may desperately need. We want to take care of our
(37:08):
our patients as we always do, and they're so afraid,
and they're just so afraid to come into the hospital.
They're so afraid of what's going to happen to them
where they're babies. They're afraid of infecting other family members
um and they're afraid, like everybody else is, of of
having it. You know, when I tell a patient that
her COVID nineteen tests came back positive, she's terrified. And
(37:29):
there's a lot of avoidance of wanting to know the
answer to that. UM, So, I think it's the biggest
challenge we have is to let our patients know that
it's okay to come seek care. It's more important for
you and your your health and your baby's health to
come seek care, and that we know what we're doing
and we're going to take care of you and this
is all gonna be okay. And I think our patients
are grateful for that and they're starting to come round.
(37:52):
I have learned that people tend to come together in
a crisis, and that's a very good thing. Um. I
run the department, and at times running a department like
this is difficult. And when this hit, I didn't have
to ask anything more than once. And I haven't heard
a know at all. Everybody has stepped up. We've had
(38:15):
co workers outsick, everybody checks on them every day. UM.
It's just people do come together. And I think it's important,
especially in the climate in this country now, to recognize
that that at in a crisis, America is going to
come together. Dr Tracy bone Hemmerdinger, the chief of Obstetrics
(38:36):
at Elmer's Hospital in Queens, New York. Up next for
all those pregnant women out there and their partners some
tips on how to feel safe and empowered during these
uncertain times. Giving birth during a pandemic is no doubt
(39:06):
a very stressful event, so for those pregnant women and
their family or partners, we wanted to leave you with
some tips for how to reduce anxiety and feel not
only safe but empowered. So the role of the doula
is to offer continuous support. Chantal Troub, who is originally
from Cape Town, South Africa, if you couldn't tell by
(39:28):
her accent, has been an active birth duela in New
York City for nearly twenty years, which means she has
supported a lot of women through some very intimate and
often difficult life changing moments. That's around seven hundred eight
hundred plus births. Now Dulas are commonly thought of as
birth coaches, someone who provides emotional and informational support, but
(39:53):
also and often crucially, a lot of physical support, things
like massage or counter pressure to alleviate back pain during contractions,
or even moving mothers into a more comfortable birthing position.
But with physical support out of the question and severe
restrictions on the number of people who can accompany women
(40:14):
through labor. Seantalas had to figure out how to do
it all virtually. This is not the same as being
in the room with someone. But the one aspect that
I've had to adjust is how do I support my
client without using my hands. Everything else is the same.
Once they're in labor, I set up my computer or
(40:36):
my laptop or my phone, and I in the day,
I'm here in my living room on FaceTime, face to face,
using my voice and my gestures to help them and
to be able to give them cues of connection and safety.
When it became like the nighttime or things got much
(40:59):
more intent, I would hold up in my bedroom with
my phone and my I pad, keeping the room dark.
If their room was dark, I would only turn up
my lights on if their lights were on, so that
I could keep the same ambiance in my home as
in theirs. And again I would give them solid support
face to face and using my voice and using my gestures.
(41:22):
And so far it has worked really well. I was
actually for someone who was not technical savvy at all.
I have been so pleasantly surprised how well this has
worked under these circumstances. First, Chantal share some advice for
those supporting their pregnant partners. So a woman in labor
(41:45):
really needs to feel safe and protected to be able
to let go and open up, to be able to
let her baby out. So feeling safe and feeling supported
and feeling protected is essential. So for the partner to understand,
(42:12):
how can we adjust in this time to create safety
at the times where clearly we are feeling a lot
of fear and anxiety about this disease and about feeling
supported in the ways that we think we may have needed.
(42:34):
So we want to relate on and almost primitive level.
We want to be able to communicate cues of safety
using face to face facial expressions, using our voice, our
tone of our voice, and then our gestures and our postures.
(42:58):
So whether we're supporting virtually or in person. Now this
may change place to place because changes are happening daily.
But as of now, our partners are required to wear
a mask the whole time while they are in the
laboring room until they leave. And so when your mouth
(43:20):
is covered by a mask, you have to learn to
communicate with your eyes. And so you want to learn
to smile, for example, so big that your eyes smile.
You want to be able to use the tone of
your voice and the gesture of your hands. So if
(43:41):
you're able to be in person, then touch is key.
You want to touch the mother, You want to hold
the mother, You want to massage the mother, give counter pressure,
you want to stay close. And this is a lot
of RuSHA on the support person, especially if you weren't
(44:03):
planning to be the main support person. It takes a
lot of focus and stamina to be present and pay
attention for a long period of time. We want to
one communicate face to face. We also want to really
(44:24):
tune in and learn how to listen. We want to
listen to what the mom is saying, hear how she's sounding,
understand her concerns, and to be able to support that.
So that takes a lot of focus and emotional presence,
and we want to prepare for that. So here's a
(44:48):
tip that I've suggested to some of my clients is
on the mask, you can either maybe draw a smile
on your mask, or maybe take a photograph of yourself
smiling and pun that onto your shirt, or even take
pictures of your honeymoon or a happy time together, or
(45:11):
your pet or your puppy or your favorite beach location,
print them out and then take them onto the walls
so you can surround yourself with moments of feeling safe
and at peace and joyful and happy. As for the
moms out there, Chantal's first tip is to understand the
(45:33):
new ambiance of the hospital. She says, it's important to
mentally prepare for what labor and delivery look like right now.
What you have to get used to seeing it is
pretty much like a hazmatted vibe. Everybody is wearing overalls
or gowns. Everybody, all the medical staff or even the
housekeeping are wearing a mask. Their head is covered and
(45:58):
they either wearing goals or a shield. So it's pretty
surreal and something to adjust mentally for. The Other thing
that I would really like you to prepare for is
that at some point during your hospital will stay, you
will be wearing a mask, whether that may only be
entriage or if you happen to test COVID positive, And
(46:24):
that's another adjustment to get used to just laboring with
a mask. So I encourage you to just try a
mask and use that communicating with someone. What does that
I feel like to communicate? How does that change? And
then how does that change when you're needing to breathe
and maybe breathing quite hard. So try you know, exercising
(46:48):
with a mask. Try marching in one spot with a
mask and notice, you know, how does that feel. It
takes some getting used to and I want you to
already know what that feels like before you go in,
once you have some expectation of what your birth experience. Maybe,
like Shantal says, the next step is to learn the
coping mechanisms now for calming the nervous system at any time.
(47:14):
One of the ways to regulate our nervous system is
to start developing a breathing practice. The breath is the
way into common our nervous system. The breath is the
way to manage in contractions. So developing a breathing practice
now is so helpful for now, for labor, for when
(47:36):
the baby cries postpartum. One breathing practice that is incredibly
helpful is a simple belly breath. You can place your
hands on your belly and take a deep breath in
full your belly and take a slow breath out, deep
(47:56):
full belly breaths, long slow exhales, so in hell, breathe
into your belly into your baby. Excel in calms the
(48:16):
nervous system. So when we take an inhale, we bring
an oxygen to our baby, to all our organs, even
the public floor, And when we excel it allows us
to feel safe, to feel open, to feel calm. Chantal
also suggests when those feelings of fear or anxiety do
(48:39):
bubble up, to not push them aside, but actually experience
them and then move on. We don't want to feel
those feelings. Were very good about squashing them down or
pushing them away, or scrolling on Facebook or going and
doing something. But to be able to manage those feel ends,
(49:01):
we want to be able to allow them to be there.
If we allow them to be there and con sit
with them, they usually only lost just a few minutes.
So allow yourself to be with the feeling, feel the feeling,
and let it pass. Now it may come up again
(49:22):
soon after, So we want to develop a practice of
being able to stay with the feelings, acknowledge them, name them,
and feeling scared. Right now, I'm really anxious about the
way this may go. That's okay. We can feel them,
don't push them away. It's important to be able to
(49:43):
sit with them and breathe through them. We have a
moment in this time to actually recognize them for what
they are and transform them and move ourselves more to
how can we feel safe? What makes me feel safe
right now? Does being in a quiet room make me
feel safe? Does having someone look at me and smile
(50:06):
at me make me feel safe? Does have just me
hugging my puppy right now make me feel safe? What
makes us feel safe? Let's explore that so that we
can find ways to use that and support us in labor.
So the more that we learn about what makes us
feel safe, then we can ask for what we need
(50:29):
or set that up for the time that we have
to go to the hospital when all else fails, when
the breathing exercises don't do the trick, or you've acknowledged
all those feelings to no avail, She says, take a
moment to connect with what's behind all of this in
the first place. And lastly, don't forget you're having a baby.
(50:52):
It's a very important time to connect to your baby.
Take the time to talk to your baby, Take the
time to sing to your baby. I have some of
my clients uh either singing lullabys to their babies or
making up a lullaby. If you don't know, this is
something that you can do on your own to your baby,
or spouse or partner can join in where you both
(51:14):
talk to the baby or sing to the baby. But
talk to your baby right now and be honest with
your baby. You can tell your baby, I'm feeling really
scared right now. I'm worried about how it's gonna be
bringing you into the world. Right now. Your baby can
sense your anxiety, so it's okay to communicate to your
(51:34):
baby how you're feeling and how you're going to be
protecting your baby. How are you going to do everything
you can to bring the baby into a safe world.
To talk to your baby now, talk to your baby
during labor, and talk to your baby postpardon. And if
your baby needs to be separated from you for any reason,
(51:54):
then keep talking to your baby, whether it's energetically or
when you are reunited with baby. You can say I'm
so sorry that we had to be separated. I was
so sad to be separated, but I'm so happy to
be reunited with you now and express that to your baby,
because your baby does sense the way that you're feeling.
(52:21):
That was Shantal Trout Adula assisting moms and families in
the New York region. Shantala is put together a guide
exclusively for Next Question listeners that goes over some of
these tips for preparing moms and their partners for giving
birth during the coronavirus pandemic. You can download that at
Shantal Trout that's c H A and T A L
(52:44):
t R a UB dot com. And while you're there,
you can also check out her virtual workshops, including Birthing Strong,
which she designed specifically for helping women who are due
during this pandemic. And that does it for this episode
(53:05):
of Next Question. Stay tuned for next week's show, when
we'll be releasing our special two part series on America's
maternal mortality crisis that's coming up April. And for the
most up to date information on the coronavirus, make sure
to check out the CDC and the World Health Organization websites.
(53:26):
You can also subscribe to my morning newsletter wake Up Call,
where we're diligently compiling the day's most pressing news. You
can do that by going to Katie Correct dot com.
Until next time and my Next Question, I'm Katie Couric,
thank you all so much for listening, and stay safe
and healthy out there. Next Question with Katie Couric is
(53:53):
a production of I Heart Radio and Katie Curreic Media.
The executive producers are Katie Kurk, Courtney Litz, and Tyler Klang.
The supervising producer is Lauren Hansen. Our show producer is
Bethan Macaluso. The associate producers are Emily Pinto and Derek Clements.
Editing by Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing
(54:14):
by Dylan Fagin. Our researcher is Gabriel Loser. For more
information on today's episode, go to Katie Curik dot com
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For more podcasts for My Heart Radio, visit the I
Heart Radio app, Apple podcast, or wherever you listen to
(54:34):
your favorite shows.
Hi everyone, I'm Katie Curic, and welcome to next question today,
Giving birth and the time of coronavirus. When I walked
into the hospital, the hallways are eerily quiet. One mother
surreal experience of going it alone. You saw the doctors,
you saw security guards, and you saw cleaning staff just
(00:23):
really kind of giving you a nod of you got this,
but in a really powerful, yet somber and scary way. Later,
we'll check in with obstetricians in two different New York
hospitals to understand some of the biggest challenges they face
and keeping pregnant mothers safe amid COVID nineteen. When I
tell a patient that her COVID nineteen tests came back positive,
(00:46):
she's terrified and there's a lot of avoidance of wanting
to know the answer to that. Um So, I think
it's the biggest challenge we have is to let our
patients know that it's okay to come seek care. But first,
my next question, how do you have a baby during
a pandemic? Alicia Biggs had already given birth once nearly
(01:08):
two years ago, to a baby girl named Olivia, and
beyond the excitement of planning for their second child, to
take place at the same hospital and with the same doctor.
Alicia and her husband Patrick were really looking forward to
a few crucial things being different this time around. I
really wanted my my mom in the room. She wasn't
(01:28):
in the room for the first pregnancy, and you know,
I really wanted her there for for this one. She's
my best friend, and and just um thought the more
of the merrier for this one. And then another thing
that we thought would be really nice and special that
was a little different was in my first pregnancy, in
my delivery, I had a very healthy baby, but she
(01:49):
needed to go to the nick you at first. So
that initial time where you're you spend with your with
your newborn, I'm kind of on your chest, and just
with your husband and with your family and just really
relishing in the moment of what just happened. We didn't
really get because she was sent into the nick you
so fast. So we were hoping and crossing our fingers
(02:10):
for an easy and healthy delivery where we could have,
you know, shared that moment that people talk about all
the time. Because of the complications of Alicia's first birth
and the already large size of her second baby, Alicia's
doctor planned to have her induced on Marchy, one week
before her due date, at New York Presbyterian Hospital in Manhattan.
(02:33):
But as that date neared, cases of the coronavirus were
growing at alarming rates across New York City, which was
already the epicenter of the virus, and hospitals were being
forced to make some very tough decisions to prevent the
virus from spreading. The week before, we had heard looming
messages from people saying, you know, the hospitals down to
(02:56):
usually you can have two attendees with you, they moved
it down to one. So that means the plans changed
for my mother. But they, you know, everybody was really
messaging me saying, oh, they'll never you know, not let
your your spouse in or your they'll you always have
one person. So I kind of put it out of
my mind that was never going to happen to me.
(03:18):
And the Sunday prior to the delivery, so about three
days before I got a call from my doctor she said,
I have good news and I have bad news. The
good news is there's a full staff in labor and delivery,
which which really just level sets you as to what
is good news. Anymore. The bad news isn't going to
have to break it to you that you can no
(03:39):
longer have your husband in the room. Those are some
of the most difficult phone calls I've had to make.
Dr Alan of Brownstein is Alicia's obstetrician. When she found
out the news that New York Presbyterian Hospital had to
institute severe restrictions due to the coronavirus and was no
longer allowing any partners, family member, or outside support into
(04:01):
the hospital at all, much less the delivery rooms, she
immediately called her patients. They were long phone calls. I
would sit there with them. I I feel horribly that
they were not able to have that person with them,
and how upsetting disappointing that was, and they were obviously disappointed.
Um and that was not an easy conversation to have,
(04:22):
although I do feel like they did understand the reasons
why it was being done and how severe things had
become for the hospital to make that decision that they
couldn't have somebody there. And I would say, I'm going
to do everything I can to make this a great
experience for you, despite the fact that your husband's not
going to be there. I said, make sure you have
(04:43):
your laptop, your phone fired up charged. Don't forget to
bring your charge to the hospital so if it dies
during the delivery, you can still you know, charge it
up and have your husband there. You can have him
on the laptop, on FaceTime, on Zoom, on any platform
so that you can feel like he's with you as
much as possible. For Alicia, the news was devastating. I
(05:03):
just cried to her on the phone, Um, and she
was just unwavering in her support, saying, you you can
do this, and where you're going to do this together
and you will not be alone because I Am going
to be there the entire time and it's you know,
it's you and me and we will figure out a
way to get through this. And she said take a
(05:24):
day to to just figure yourself out. Patrick, where you
crushed when you heard the news, I was. I was
totally heartbroken that Sunday and Monday. It was incredibly difficult,
um and sad. But then there was a shift that
happened on kind of Monday into Tuesday before she gave
birth on Wednesday, where it was this, you know, this
(05:45):
was our new reality and we will we'll get through
this together as much as possible. I took a day
to be very emotional to you know, really just understand
what was going on, and then I, um, I was
a swimmer by background, uh, and really just tried to
use the tools that I had available to me, you know, mentally,
and really then said, okay, here's a day where you
(06:08):
get to decide how you're going to move forward, and
then really treated it as a swimming um and a
swim race, right, It's a you know, swimming is a
very individual, an individual sport that's surrounded by teammates who
support you. I met my husband while swimming, and he understands,
(06:30):
you know, the nuances of how I am of of
when I get into that mode. So we spent the
next days just preparing and kind of getting into that zone.
On Wednesday, March, in the darkness of the early dawn,
Patrick drove Alicia to New York Presbyterian Hospital and watched
(06:51):
from the car as she walked in alone. When I
walked into the hospital, the hallways are are eerily quiet
because no one needs, you know, should be walking hallways
unless they really have to. So I had my bag
and it was clear with my bump where I was going,
um and you saw the doctors, you saw security guards,
(07:12):
and you saw cleaning staff just really kind of giving
you a nod of you got this, but in a
really powerful yet somber and scary way. And when you
when you go immediately to sit down to check in,
they give you a mask and they need to treat
you as though you have COVID, um as though you
(07:35):
have the virus, and they test you immediately when you
get into the room, and then you we I didn't
know results for twelve hours after that. Um, So your
tense because you're having a baby, but you're you're also
just tense because you don't know if you have COVID.
You don't know if the nurses around you might have,
(07:55):
you know, gotten it. So you're everybody's you know, protecting
themselves for the greater benefit of everybody, right, But it's
just really scary. So I didn't find out until right
before I pushed that I had tested negative, which I
was just you know, very tense about and you know,
(08:16):
continue to tell Pat what if I have I was
I was getting more stressed about having COVID than I
was about delivering the baby. Um At first, the whole
thing sounds ridiculously stressful. Just hearing you talk about it,
it's making me feel anxious. Yeah, no, it was. It
was anxious. It was, it was. It was really anxious.
(08:38):
I mean some of the you know, beautiful things that
had come out of it was you know, um, just
understanding what the nurses are and the doctors are putting
them how they're putting themselves out there to make you
feel comfortable. So they you know, I walked in and
they said they gave me a letter, a handwritten letter
signed by all the nurses saying you're not alone, and
(09:03):
you're going to prove to yourself how strong we already
know you are, and we're here for every step of
the way. And you know, everything was just so powerful
that you're you're emotional and you're crying, but because you're
you know, partially sad, partially scared, but partially you know,
you're empowered to to get through this, and you just
have one choice and you have to just get to
the other side and decide, you know, I can either
(09:27):
I need to make this a positive experience. So I
um and they did a great job for me too,
because the way we had it set up was I
had an iPad A. Alicia had an iPad and we
basically space time uninterrupted for thirteen hours, and so she
had it on a little table with her that could
move UM, and the nurses and the doctors talked to
(09:48):
me as if I was in the room the entire time.
They're saying, Okay, we're gonna do this. We're doing this, um,
you know, here going to take her medicine up to
this level. So they did a very um amaze job
of making me feel a part of the entire process,
even though I was They're virtually on an iPad, Alicia,
I wanted to go back and ask you about the delivery.
(10:10):
Did the doctors and nurses look like they were dressed
for some kind of chemical spill? I mean, was that
a strange experience for you versus seeing their faces? Right?
It was? You know, they're in there in full there
in masks. They're also in a shield. Um, they're in
full gloves. You know, you can it's it's hard to
(10:31):
to necessarily get out their demeanor, you know, other than
verbally and and really through their eyes. So you had
it was that's what made it so scary until I
knew that I had tested negative for COVID. It was.
It was a really scary time, which I think helped
with you know, the handwritten letter and just really trying
(10:52):
to read people's eye contact. And but it was a
unique experience, and luckily I had a doctor who had
been my doctor this entire time through you know, my
first birth and also all my appointments of my second birth,
and her comfort. You know, at one point I got quite,
(11:13):
you know, just I just lost, I got my my
emotions got the better of me, and I you know,
I just was crying because this was all just a lot,
and you know, she came in and you know, gave
me that look of we we had we're going to
do this and we're going to get through this, and
you know, you're you're tough, and you just we're going
to be tough together. And so that was really nice.
(11:35):
And so I tried to make it also, you know,
a lighter experience in in terms of they also saw
how petrified I was so trying to combat that. I
brought in plastic wrapped COVID approved sweat bands so that
they could undo them, um and so that you know,
(11:55):
the nurses and the doctor when we were you know,
going through labor could could see that I was this,
you know, this can be fun and this is a
you know, bring it back to that, this is an
amazing experience. So we all did wear sweatbands during the delivery.
Dr Brownstein, what was it like for you helping Alicia.
(12:16):
Luckily it was her second child, so she wasn't you know,
it wasn't her first rodeo, but it still must have
been pretty stressful. Can you describe what that delivery was like? Right? Well,
she had her husband on the laptop the entire time.
I felt like he was there. I had regular conversations
(12:37):
with her throughout the entire labor process, and I would
just talk directly to him. Um. We tried to make
him as included as possible and just feel like he
was just another person in the in the room. She
was very funny. She said, you know, usually, you know,
Patrick is here with me, and last delivery we had
him were the headband for it, and we were both
(12:58):
wearing the headband together, and she whipped out these brand
new headbands for me and the nurse and she said,
would you be willing to please by or these headbands?
It makes me feel like Patrick is here and in
the room, and we always like absolutely so the nurse
and I were wearing our matching headbands along with Alicia
and going through the whole process and pushing them. We
got pictures of us all with our headbands on, and
(13:20):
it just made it more fun and inclusive, and Patrick
felt like he was there and we were just trying
to be as importive and as there for her as
you could possibly be. How long were you in labor, Alicia?
So I was in labor for about thirteen hours. The
labor and delivery part was went by really fast because
(13:40):
you had all of the support of the of of everybody,
and you know it's building up to this one moment
and then you know the post. The post twenty four
hours and forty eight hours after is I think the
hardest part too, where you just feel loneliness and being
scared because you're sitting with your you're sitting alone with
(14:01):
your thoughts and um, you have a roommate, but everyone's
really scared to to, you know, even talk to each other. Yeah,
So it's just it's it's an interesting environment. What was
it like for you, Pat to see your son on
that iPad screen? It was surreal for sure. I mean
(14:24):
it was, you know, again, not what you had anticipated. Um, so,
you know, after he was born, they bring them over
to the heating table to do measurements and all those things,
and so they picked up the iPad and brought me
over there. So they made me feel the entire time
like I was part of the process. And then the
picking up at the hospital the next day, it was
very special to just you know, Alicia was on the
(14:46):
wheelchair with Jack with a blanket over her, and so
she had the blanket over him basically until she got
to the car and then, um, you know, to see
him for the first time and to hold him and
to put him in the car seat. That would be
a moment that will have kind of etched in my
brain forever, that first time medium outside the hospital Alicia
and patted. Just a few days after you had to
(15:08):
go through this, Governor Cuomo announced an executive order that
rescinded these restrictions so that hospitals in New York allowed
women to have one support partner present during their births.
So did you feel like, gosh, uh, why the heck
(15:28):
did I end up in this window? I did think
it was funny timing. I'm hoping I have, we have
some delayed good karma hanging over us in the future.
But I was, I was, you know, being a second
time mother. I was happy that it was me who
has had the benefit and you know, the fortune to
(15:52):
have a delivery with my husband, and during times like this,
it makes you realize just you know, what's important, and
I was happy to take that place for someone other
than a first time mom, because that's a really it's
it's scary, it's lonely, and you know, doing it when
you have no idea what's going on once you give
birth is just frightening. So I'm I'm really glad that
(16:18):
it happened to me versus some of my other close
friends who were um first time mom's delivering very shortly
after that, and luckily was the band was lifted. Congratulations
to Alicia and Patrick Biggs, to big sister Olivia, and
of course too little Jack Biggs, who will have one
hell of a birth story to tell when we come back.
(16:42):
Dr Alana Brownstein on what we know so far about
pregnancy and COVID nineteen. One of the many things we
don't yet know about COVID nineteen is how the virus
affects pregnant women and their babies, So we wanted to
(17:04):
talk to a few obstetricians about what they are seeing
as well as how their hospitals and pregnant patients are
experiencing all this. We started New York Presbyterian Hospital with
Dr Alana Brownstein, the o B we heard from at
the beginning of the episode. A few things to note
about New York Presbyterian Hospital. It is massive, with multiple
(17:26):
campuses across the New York metropolitan area. It's also one
of the most prominent hospitals, ranked number five in the country.
Dr Brownstein delivers out of the hospital's location on the
Upper East Side of Manhattan, a community that's overwhelmingly white
and ensured. Dr Brownstein answers a few medical questions first
(17:46):
and then walks us through what labor and delivery looks
like right now where she practices. What physiological changes and
biological changes occurred during pregnants that could in fact make
pregnant women more susceptible to certain viruses if not COVID nineteen,
(18:08):
it's too soon to tell, but can you explain what
happens to women that could put them at greater risks?
So we know that pregnant women are at a relative
immune suppressed state um in parts so that the the
mother's body can accept to feed us in their body
which is not their own cells. So we know that
(18:28):
it is decreased in certain ways like that. We also
know that certainly any bodies that they have can be
in lower tighters just because of the plasma volume expansion
that happens naturally in pregnancy. So it is theoretical possible
that your immune systems decrease could make you more susceptible
to certain viruses and make that disease much worse in
(18:49):
pregnancy than not. We just need more time to know
iff that's the case for COVID nineteen or not. But
in Layman's terms, you're saying that the expansion of the
baby can decrease lung capacity just because it's pushing up
on the lungs right, So later in pregnancy, especially where
there's a whole fetus in the in that cavity, it
(19:10):
can make it difficult for the lungs or expand more,
which also sometimes can make it more difficult to know
who has it or not. Because when you talk about
some of the symptoms of COVID nineteen and you talk
about respiratory changes, well, feeling short of breath is a
very common symptom of normal pregnancy, So that can make
it a little bit more challenging to figure out what
(19:31):
it is because your respiratory rate is faster, and certainly
you feel more breathless. It's harder to um take a
deep breath, and it's harder to feel like your lungs
are fully expanding because of that fetus in that area.
What happens when a pregnant woman comes in now to
your hospital is she immediately tested for COVID nineteen. So
(19:51):
any woman that is coming onto the unit gets a
mask right away. Um. If the patient is admitted to
the hospital, then she is immediately tested. If somebody comes
in and is not admitted, then they are not tested
for For example, if a woman thinks that her water
broke and she's coming in and she's evaluated and it
turns out that her water didn't break, she's sent out.
(20:13):
We don't test that person for COVID. If the patient
is admitted for whatever reason it is, whether it's labor,
preternal labor, any other condition going on obstetrically, that patient
is tested for COVID. It does take a few hours
before we get the test back, So we essentially just
treat everybody like they're positive UM, and then anything obstetrically
(20:33):
is done as it normally would be. If she's in labor,
we're managing her labor. She wants pay medicine, she gets
pay medicine. That part doesn't change. It's really more of
UM whether or not she is positive in what that
means for her, the delivery and for the baby afterwards.
But everybody on the unit has a mask on. We're
wearing gloves for everybody, and that's the same across the board.
(20:54):
If we know if somebody who might be positive UM,
we try to call ahead to the hot spook. I
know I have a patient that's coming in that either
I suspect as positive, I know is positive, or any
inkling of that. We make sure we call ahead, We
have a room waiting for them, and we make sure
that they are isolated. What kinds of concerns are raised?
(21:15):
Dr Brownstein if pregnant woman about to give birth test positive,
other than protecting the staff members, is there any risk
to her baby? Is their risk to her in terms
of the delivery, etcetera. So for the delivery part, we
deliver them as we would regardless of their COVID status,
(21:35):
meaning if they are going to have a vaginal delivery,
they can have a vaginal delivery. If they're going to
have a c section, they can. For the baby, the
concern is we want to make sure that it doesn't
get transmitted to the baby. So currently it does not
appear that there's vertical transmission, meaning that the baby would
get the virus just from being inside the mom um.
(21:56):
So it's thought that for the actual delivery process they
can deliver as they normally would. It's more of a
question for postpartum. The babies are not taken away from
the moms, so that's the question. I get a lot,
is my baby taken away from me? If I'm positive.
We generally don't take the baby away from the mom.
The mom the baby can still be with the mother,
but we do try to make sure that the mom
(22:16):
is wearing a mass mom's wearing gloves. We're not having
that direct contact that that baby might get it from
the mother. After the delivery, you're not concerned that the
baby could become infected out of utera. So we are
and not necessarily just during that delivery, but we're concerned
with contact with the mom afterwards that even the mom
(22:36):
just holding the baby. You know, the first thing you
want to do is when you get your newborn is
hold it tight, kiss at snugglet be very close to it.
But all of those things, the baby could get COVID
from that. So generally what they're trying to do is
have the baby be with the mom, but still maintain
that distancing, so being six freed away. If the mom
chooses to breastfeed, then the mom can breastfeed. However, we
(23:00):
try to wash the breast off. We try to make
sure the mom has washed our hands. We want to
make sure there's the mom is wearing a mass the
entire time so she's not breathing directly on it or
the other optionism mom can express breast milk and then
somebody else can feed the baby the breast milk if
they want to do it that way, because there is
a concern that it could be transmitted to the baby,
not in utero, but afterwards just having the contact with
(23:22):
the mother, so we do try to limit that contact.
But it's not like the mom can't be in the
same room as the baby. I think that concern of
having your baby physically taken away from you to another room.
That is very concerning. What about having mothers give birth
prematurely or early because of their COVID symptoms and concerns
(23:43):
about their health and potentially the baby's health. So there
are some situations or the mom just are so sick
that they have to do that. We generally try to
hold off on doing that if we could, just for
the baby's health. UM, We'll try to get the baby
at least to either like thirty two or thirty four
weeks ges station if we have to do that, because
(24:03):
there's such significant morbidity UM for the baby before that
gestational age. But there are situations where moms are that
sick that they do have to convert over and decide
to deliver the baby early for the moms health. What
about during pregnancy? I was getting a lot of questions,
and I'm not a doctor with pregnant women very concerned
if they got COVID ninety obviously for themselves, but very
(24:27):
concerned about the health of their babies developmentally. What do
we know about that? Great questions? So very little, only
that again it's so early that we don't have patients
that have had it very early in the pregnancy and
then carried food a term. Yet, just because it hasn't
been around that long so far, it seems that there
might be a high risk for preterm delivery. UM, we
(24:49):
are concerned about whether or not there could be an
increased risk of either miscarriage or congenital adormalities. But we
haven't seen that yet. UM, it's certainly a concern, and
we're we're getting our huge registry of pregnant women to
see something that we can follow out over time. It's
just too early to know. We're also concerned about the
growth of the baby, so we want to make sure
(25:10):
if the mom is infected as the baby growing well,
so they have to have ways to monitor that as well.
We haven't seen it yet, but again only because those
are things that take while to actually develop into see
and it just hasn't been amount enough to see. I
wanted to ask you about maternal mortality. We did two
(25:31):
episodes on maternal mortality, which we're holding for later, but
it's very concerning. There are something like seven hundred to
nine women dying from pregnancy or childbirth every single year
in this country. Not to mention the fifty thousand women
every year who almost die. So how concerned are you
(25:53):
about the impact of COVID nineteen on this skyrocketing maternal
mortality rate. I think it goes back to we need
to make sure that our patients have access, that they
can be seen, that they can get to a hospital
that can care for them, because that is going to
make the difference of how they do and how their
their babies do. And it's very concerning, and this is
(26:16):
just one more, one more layer of things that can
make it harder for those women to get the good
care that they need. The doctors we spoke to for
our maternal mortality Episodes also said it can be crucial
to have support for the mother. There's not only before
and during the pregnancy, but afterwards, since so many complications
(26:36):
can happen after the baby is born and hospitals are
so focused on the health of the baby. What are
your thoughts there, But there's a lot of things that
can happen postpartum um. It's not over once that baby
comes out. You know, people can have um bleeding issues postpartum.
You can get pre aclamps to a blood pressure issues
(26:57):
postpartum um. There's a lot of things that if you
don't have somebody who one knows about it you can
help take care of you. And three recognizing and get
you to your hospital can be major issues. UM and
I think that is a huge problem having that support.
It doesn't end once that baby comes out. It really
goes into the whole hours partum care period as well.
(27:17):
Can tell a medicine be helpful in that regard for
women who have given birth but may not have as
much access to top medical care. I think that we're
seeing the role that telemedicine can play. I think it's
really been shot into the spotlight with everything going on
here where we're trying to keep people at home. UM,
(27:37):
there are a lot of things that you can assess
over the telemedicine visits. You can't do everything, but you
can see the patient, you know. I'll have visits with
my patients who all have them show me their own decision,
you know, have you know, show me what that bleeding
is looking like. I have patients get blood pressure monitors
at home. I have them take their bloo pressure at home,
show me what it shows like, show me what that
(27:59):
number is, and then I can try to do an
assessment whether that's somebody who needs to come in, or
whether that's something I can just speak to them at home.
So it certainly can help, especially in this day and
age or trying to not have people come in. I
think there is a lot of information you can get
with a telemedicine visit. What's your advice, Dr Brownstein for
(28:19):
pregnant women right now, with no end in sight, what
would you tell your patients that might help pregnant women everywhere?
I think the most important thing is what we're telling
all people right now, which is make sure that you're
practicing the social distancing, make sure you're performing hand hygiene
where we're a mask, we're a protective gear. If you're
(28:41):
going out, try to distance yourself from everybody. Um, those
are the things that seem to be working. And I
feel like for the pregnant patients, especially where there's already
a high anxiety and a concern about this pregnancy, to
try to protect themselves as much as they can, This
is a great time to kind of stay inside corn
teen and keep your distance from people as much as
(29:02):
you can for your own protection and for that of
your baby as well. Just across the East River from
Dr Brownstein is the Elmhurst Hospital Center in Queens, a
public hospital that has about five hundred and forty beds
to New York Presbyterians hundred plus. It's located in Jackson Heights, Queens,
(29:27):
which is the most ethnically diverse neighborhood in the country.
It's a very underserved community and the community right now
is being hit very, very hard by the COVID epidemic.
Dr Tracy bone Hemmerdinger is the chief of Obstetrics at Elmhurst.
The population that we generally see at Elmhurst is mixed
community of new immigrants. UM. We see all different ethnic backgrounds. UM.
(29:51):
The number one language spoken is Spanish, followed I think
very closely by Bengali UM. And I think that a
lot of the patient is that we see fall into
the category of people who can't social distance because they
live with large numbers of people in their homes, people
who are responsible for caring for not only many children,
but also their parents and their extended family UH. And and
(30:13):
and people whose jobs are either domestic workers or you know,
people whose jobs and livelihood may be cut off completely
and not have any access to their regular daily needs.
And so I think that that puts them at significant
risk for any illness. Elm Hurst has been called the
epicenter of the epicenter of coronavirus cases, the ground zero
(30:34):
of the epidemic. The fact is Elmer's was one of
the first hospitals hit by corona and it was hit hard.
Elmhurst runs at capacity, so I believe it was running
capacity before the epidemic, and so that's why it became
so difficult, because we needed to figure out ways to
structurally change our hospital to be able to take care
of all of our patients. The very beginning of this,
(30:56):
nobody really knew what was going on and what was happening.
We got at a lot of patients presented and they
didn't know what they were supposed to say or do.
We didn't know what we're supposed to say or do.
The recommendations from the CDC and from the New York
City officials and the New York State officials were changing
every couple of hours, and I would come up with
some kind of a protocol and then it would have
to be changed. And it was very frustrating and difficult
(31:20):
on both sides. On the patient side, and not even
just the patient side. The family members of the patients,
especially for pregnant women, which is what I deal with UM.
And now I would say we're a few weeks into it.
We really got this down and we know how to
manage it. And I think that a lot of our
patients initially were very afraid to come to the hospital,
especially because of all the news the elm Hurst Hospital
has been on the news because we've gotten hit so hard.
(31:42):
And now, UM, I think they feel more comfortable. Are
our senses is starting to come up. Our patients are
more comfortable coming in, and our outcomes are very good.
Dr Bones says half the battle was working out the logistics.
There was a lot the hospital had to figure out
and figure out fast when it came to managing incoming
COVID or suspected COVID cases. With exceptions like labor delivery
(32:05):
and postpartum. Elmhurst is now almost entirely devoted to COVID care.
The physical space was something we had to figure out
how to use and our staff as well. So we
have a triage area that has seven beds for triage,
and we had to put up a wall so that
we could have COVID patients on one side. And non
COOVID patients on another side. And then we had to
do the same thing in our post anesthesia care unit
(32:26):
after c sections, we had to put up a wall
to separate an area where we could put COVID patients
or suspected COVID patients and non COVID patients, um, you know,
and then who could go into those rooms versus who
can who has to go into an isolation room someone
actively coughing with a high fever, whether or not we
have a positive test that patients probably should be isolated, UM,
and so figuring out where we can put those people
(32:46):
and not overrun our our service. And obviously staff has
been affected. UH, nurses and doctors and resident doctors have
all been hit, and we've had many many providers get
sick and be out for sometime, and so that puts
a strain on everything, UM. And so streamlining the system
(33:07):
has to deal with figuring out which staff you have
when and making sure that you have enough staff at
all times. Obviously, many of us would love to go
help our colleagues in the emergency department or in the
medicine I see you, but you have to make sure
you're able to cover everything. And you know, since we're
pretty much the only service in the hospital left that's
non COVID, we want to make sure we're covering our
patients well with experienced physicians and nurses who know how
(33:29):
to handle will be When it comes to how this
virus effects pregnant women, Dr Bones says, there are still
a lot of unknowns, but also a few key and
positive takeaways. The course and pregnant women seems to be
not any worse than it would be for non pregnant women,
which is a very good thing and for and for men.
Women tend to be doing a lot better with the
(33:51):
disease than men. Um so that's a positive thing for
women as well. Uh, we are noticing that are the
transmission from from pregnant woman to her fetus seems to
be almost zero. It's not a d zero, but it's
it's almost zero. So that's a very very good thing
as well. Um And the one thing we've learned, I
think that a lot of people in this hospital and
(34:13):
in the country have learned, is a lot of people
are infected with CODE. We learned that by testing, So
we're testing every single patient now that gets admitted to
the hospital on our floor, and we've noted many, many
patients who are positive and completely asymptomatic, and some of
them become symptomatical later, and some of them never do.
The other thing Dr Bone has learned is you don't
(34:34):
know what to expect when it comes to this new virus,
which makes her job all the more difficult. You've got
to be really cautious because I've seen and again this
is anecdotal, but I've seen it go both ways. I mean,
we had one super sick pregnant woman who ended up
going into the I See You and was very close
to being intubated, and then we as a group interdisciplinary
between high risk obstetrics and I See You and pediatrics,
(34:58):
decided that it would probably be better for her health
to deliver, and we delivered her her baby by C section,
and she miraculously got better after she was delivered, and
she didn't require intubation, and I actually had the privilege
of sending her home on Sunday. Uh flip side, I
had another patient last week who came in for an
uncomplicated scheduled C section and did wonderful, no problems at all,
(35:21):
totally healthy. As I mentioned earlier, we swabbed everybody when
they first come into the hospital, and it was taking
about twenty four or four hours to get the results
back at that point, so we didn't have her results.
And then on post operative day one, about a day
after she had her surgery, all of a sudden, she
decompensated and got very very ill, also requiring oxygen and
I see you care. And then her test came back
positive from days before when she was asymptomatic. So it's
(35:44):
very hard, I think, to to figure out who's gonna
go which way and when, and that's what makes it
so difficult to care for the patient. Before COVID hit,
Elmhurst was very involved with the maternal mortality crisis, particularly
the racial despaired these that see so many more black
and brown women dying due to pregnancy or childbirth, and
(36:06):
Dr Bone notes that COVID nineteen is underscoring that same disparity.
I think that black women, and I think that UM
underserved women in general are being hit harder and men
are being hit harder by this UM. Whether that's because
they have underlying illness or just there there decreased access
(36:27):
to care, I think it's probably a combination of both.
And I don't think that COVID nineteen is going to
be different than anything else. Uh, COVID nineteen doesn't discriminate,
meaning anybody is eligible forgetting it. But I do think
that we're going to see more of this in the
same populations that we see more of other illnesses because
of access to care, and because of limited resources and
(36:48):
and all of the other problems that go along without
As for right now, the biggest obstacle Dr Bone and
her team at Elmhurst face is misinformation. Their fear around
COVID and the fear of contracting it has kept many
pregnant women from coming in to get the care they
may desperately need. We want to take care of our
(37:08):
our patients as we always do, and they're so afraid,
and they're just so afraid to come into the hospital.
They're so afraid of what's going to happen to them
where they're babies. They're afraid of infecting other family members
um and they're afraid, like everybody else is, of of
having it. You know, when I tell a patient that
her COVID nineteen tests came back positive, she's terrified. And
(37:29):
there's a lot of avoidance of wanting to know the
answer to that. UM, So, I think it's the biggest
challenge we have is to let our patients know that
it's okay to come seek care. It's more important for
you and your your health and your baby's health to
come seek care, and that we know what we're doing
and we're going to take care of you and this
is all gonna be okay. And I think our patients
are grateful for that and they're starting to come round.
(37:52):
I have learned that people tend to come together in
a crisis, and that's a very good thing. Um. I
run the department, and at times running a department like
this is difficult. And when this hit, I didn't have
to ask anything more than once. And I haven't heard
a know at all. Everybody has stepped up. We've had
(38:15):
co workers outsick, everybody checks on them every day. UM.
It's just people do come together. And I think it's important,
especially in the climate in this country now, to recognize
that that at in a crisis, America is going to
come together. Dr Tracy bone Hemmerdinger, the chief of Obstetrics
(38:36):
at Elmer's Hospital in Queens, New York. Up next for
all those pregnant women out there and their partners some
tips on how to feel safe and empowered during these
uncertain times. Giving birth during a pandemic is no doubt
(39:06):
a very stressful event, so for those pregnant women and
their family or partners, we wanted to leave you with
some tips for how to reduce anxiety and feel not
only safe but empowered. So the role of the doula
is to offer continuous support. Chantal Troub, who is originally
from Cape Town, South Africa, if you couldn't tell by
(39:28):
her accent, has been an active birth duela in New
York City for nearly twenty years, which means she has
supported a lot of women through some very intimate and
often difficult life changing moments. That's around seven hundred eight
hundred plus births. Now Dulas are commonly thought of as
birth coaches, someone who provides emotional and informational support, but
(39:53):
also and often crucially, a lot of physical support, things
like massage or counter pressure to alleviate back pain during contractions,
or even moving mothers into a more comfortable birthing position.
But with physical support out of the question and severe
restrictions on the number of people who can accompany women
(40:14):
through labor. Seantalas had to figure out how to do
it all virtually. This is not the same as being
in the room with someone. But the one aspect that
I've had to adjust is how do I support my
client without using my hands. Everything else is the same.
Once they're in labor, I set up my computer or
(40:36):
my laptop or my phone, and I in the day,
I'm here in my living room on FaceTime, face to face,
using my voice and my gestures to help them and
to be able to give them cues of connection and safety.
When it became like the nighttime or things got much
(40:59):
more intent, I would hold up in my bedroom with
my phone and my I pad, keeping the room dark.
If their room was dark, I would only turn up
my lights on if their lights were on, so that
I could keep the same ambiance in my home as
in theirs. And again I would give them solid support
face to face and using my voice and using my gestures.
(41:22):
And so far it has worked really well. I was
actually for someone who was not technical savvy at all.
I have been so pleasantly surprised how well this has
worked under these circumstances. First, Chantal share some advice for
those supporting their pregnant partners. So a woman in labor
(41:45):
really needs to feel safe and protected to be able
to let go and open up, to be able to
let her baby out. So feeling safe and feeling supported
and feeling protected is essential. So for the partner to understand,
(42:12):
how can we adjust in this time to create safety
at the times where clearly we are feeling a lot
of fear and anxiety about this disease and about feeling
supported in the ways that we think we may have needed.
(42:34):
So we want to relate on and almost primitive level.
We want to be able to communicate cues of safety
using face to face facial expressions, using our voice, our
tone of our voice, and then our gestures and our postures.
(42:58):
So whether we're supporting virtually or in person. Now this
may change place to place because changes are happening daily.
But as of now, our partners are required to wear
a mask the whole time while they are in the
laboring room until they leave. And so when your mouth
(43:20):
is covered by a mask, you have to learn to
communicate with your eyes. And so you want to learn
to smile, for example, so big that your eyes smile.
You want to be able to use the tone of
your voice and the gesture of your hands. So if
(43:41):
you're able to be in person, then touch is key.
You want to touch the mother, You want to hold
the mother, You want to massage the mother, give counter pressure,
you want to stay close. And this is a lot
of RuSHA on the support person, especially if you weren't
(44:03):
planning to be the main support person. It takes a
lot of focus and stamina to be present and pay
attention for a long period of time. We want to
one communicate face to face. We also want to really
(44:24):
tune in and learn how to listen. We want to
listen to what the mom is saying, hear how she's sounding,
understand her concerns, and to be able to support that.
So that takes a lot of focus and emotional presence,
and we want to prepare for that. So here's a
(44:48):
tip that I've suggested to some of my clients is
on the mask, you can either maybe draw a smile
on your mask, or maybe take a photograph of yourself
smiling and pun that onto your shirt, or even take
pictures of your honeymoon or a happy time together, or
(45:11):
your pet or your puppy or your favorite beach location,
print them out and then take them onto the walls
so you can surround yourself with moments of feeling safe
and at peace and joyful and happy. As for the
moms out there, Chantal's first tip is to understand the
(45:33):
new ambiance of the hospital. She says, it's important to
mentally prepare for what labor and delivery look like right now.
What you have to get used to seeing it is
pretty much like a hazmatted vibe. Everybody is wearing overalls
or gowns. Everybody, all the medical staff or even the
housekeeping are wearing a mask. Their head is covered and
(45:58):
they either wearing goals or a shield. So it's pretty
surreal and something to adjust mentally for. The Other thing
that I would really like you to prepare for is
that at some point during your hospital will stay, you
will be wearing a mask, whether that may only be
entriage or if you happen to test COVID positive, And
(46:24):
that's another adjustment to get used to just laboring with
a mask. So I encourage you to just try a
mask and use that communicating with someone. What does that
I feel like to communicate? How does that change? And
then how does that change when you're needing to breathe
and maybe breathing quite hard. So try you know, exercising
(46:48):
with a mask. Try marching in one spot with a
mask and notice, you know, how does that feel. It
takes some getting used to and I want you to
already know what that feels like before you go in,
once you have some expectation of what your birth experience. Maybe,
like Shantal says, the next step is to learn the
coping mechanisms now for calming the nervous system at any time.
(47:14):
One of the ways to regulate our nervous system is
to start developing a breathing practice. The breath is the
way into common our nervous system. The breath is the
way to manage in contractions. So developing a breathing practice
now is so helpful for now, for labor, for when
(47:36):
the baby cries postpartum. One breathing practice that is incredibly
helpful is a simple belly breath. You can place your
hands on your belly and take a deep breath in
full your belly and take a slow breath out, deep
(47:56):
full belly breaths, long slow exhales, so in hell, breathe
into your belly into your baby. Excel in calms the
(48:16):
nervous system. So when we take an inhale, we bring
an oxygen to our baby, to all our organs, even
the public floor, And when we excel it allows us
to feel safe, to feel open, to feel calm. Chantal
also suggests when those feelings of fear or anxiety do
(48:39):
bubble up, to not push them aside, but actually experience
them and then move on. We don't want to feel
those feelings. Were very good about squashing them down or
pushing them away, or scrolling on Facebook or going and
doing something. But to be able to manage those feel ends,
(49:01):
we want to be able to allow them to be there.
If we allow them to be there and con sit
with them, they usually only lost just a few minutes.
So allow yourself to be with the feeling, feel the feeling,
and let it pass. Now it may come up again
(49:22):
soon after, So we want to develop a practice of
being able to stay with the feelings, acknowledge them, name them,
and feeling scared. Right now, I'm really anxious about the
way this may go. That's okay. We can feel them,
don't push them away. It's important to be able to
(49:43):
sit with them and breathe through them. We have a
moment in this time to actually recognize them for what
they are and transform them and move ourselves more to
how can we feel safe? What makes me feel safe
right now? Does being in a quiet room make me
feel safe? Does having someone look at me and smile
(50:06):
at me make me feel safe? Does have just me
hugging my puppy right now make me feel safe? What
makes us feel safe? Let's explore that so that we
can find ways to use that and support us in labor.
So the more that we learn about what makes us
feel safe, then we can ask for what we need
(50:29):
or set that up for the time that we have
to go to the hospital when all else fails, when
the breathing exercises don't do the trick, or you've acknowledged
all those feelings to no avail, She says, take a
moment to connect with what's behind all of this in
the first place. And lastly, don't forget you're having a baby.
(50:52):
It's a very important time to connect to your baby.
Take the time to talk to your baby, Take the
time to sing to your baby. I have some of
my clients uh either singing lullabys to their babies or
making up a lullaby. If you don't know, this is
something that you can do on your own to your baby,
or spouse or partner can join in where you both
(51:14):
talk to the baby or sing to the baby. But
talk to your baby right now and be honest with
your baby. You can tell your baby, I'm feeling really
scared right now. I'm worried about how it's gonna be
bringing you into the world. Right now. Your baby can
sense your anxiety, so it's okay to communicate to your
(51:34):
baby how you're feeling and how you're going to be
protecting your baby. How are you going to do everything
you can to bring the baby into a safe world.
To talk to your baby now, talk to your baby
during labor, and talk to your baby postpardon. And if
your baby needs to be separated from you for any reason,
(51:54):
then keep talking to your baby, whether it's energetically or
when you are reunited with baby. You can say I'm
so sorry that we had to be separated. I was
so sad to be separated, but I'm so happy to
be reunited with you now and express that to your baby,
because your baby does sense the way that you're feeling.
(52:21):
That was Shantal Trout Adula assisting moms and families in
the New York region. Shantala is put together a guide
exclusively for Next Question listeners that goes over some of
these tips for preparing moms and their partners for giving
birth during the coronavirus pandemic. You can download that at
Shantal Trout that's c H A and T A L
(52:44):
t R a UB dot com. And while you're there,
you can also check out her virtual workshops, including Birthing Strong,
which she designed specifically for helping women who are due
during this pandemic. And that does it for this episode
(53:05):
of Next Question. Stay tuned for next week's show, when
we'll be releasing our special two part series on America's
maternal mortality crisis that's coming up April. And for the
most up to date information on the coronavirus, make sure
to check out the CDC and the World Health Organization websites.
(53:26):
You can also subscribe to my morning newsletter wake Up Call,
where we're diligently compiling the day's most pressing news. You
can do that by going to Katie Correct dot com.
Until next time and my Next Question, I'm Katie Couric,
thank you all so much for listening, and stay safe
and healthy out there. Next Question with Katie Couric is
(53:53):
a production of I Heart Radio and Katie Curreic Media.
The executive producers are Katie Kurk, Courtney Litz, and Tyler Klang.
The supervising producer is Lauren Hansen. Our show producer is
Bethan Macaluso. The associate producers are Emily Pinto and Derek Clements.
Editing by Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing
(54:14):
by Dylan Fagin. Our researcher is Gabriel Loser. For more
information on today's episode, go to Katie Curik dot com
and follow us on Twitter and Instagram at Katie Currich.
For more podcasts for My Heart Radio, visit the I
Heart Radio app, Apple podcast, or wherever you listen to
(54:34):
your favorite shows.
Host
Katie Couric
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