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 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, 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 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 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 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 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. 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 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. 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 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 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, 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 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 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 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 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 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, 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 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, 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 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, 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, 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. 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 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 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 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. 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 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 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, 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. 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, 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. 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 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 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 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 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 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 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 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 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 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 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 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. 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 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 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 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, 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 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 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 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 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 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. 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 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. 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? 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, 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. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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. 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, 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 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 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 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 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, 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. 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 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 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, 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 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. 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 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 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 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 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 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 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 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 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, 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, 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 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 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 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 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 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 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. 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 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 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 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 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 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 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 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 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. 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 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, 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. 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. 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 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 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 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 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 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 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 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 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 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 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. 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 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 full belly breaths, long slow exhales, so in hell, breathe into your belly into your baby. Excel in calms the 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 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, 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 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 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 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 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. 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 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 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, 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. 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 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 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. 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 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 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. 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