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While so many businesses are shut down and people are staying at home, there’s one thing that will keep happening no matter what—women are still having babies and need access to safe maternity care during the COVID-19 pandemic.

In this dangerous and uncertain time, we wanted to know what’s going on in labor and delivery (L&D)—at least from one nurse’s perspective.

Morgan Michalowski, CNM, WHNP-BC, IBCLC, RN, who works at a large urban, educational and research medical facility in Chicago, Illinois took time to answer our questions regarding the state of L&D.

What are hospitals currently doing (or should do) to keep their maternity/L&D patients safe right now? 

Hospital-wide we have a visitor restriction in place, but in L&D we allow one support person to be with the mother. We are universally testing anyone admitted to the hospital for COVID and, in L&D specifically, utilize rapid point-of-care testing. It takes just a few minutes to determine if she is COVID positive.

Hospital workers in L&D wear N95s with a surgical mask over it when in contact with any patient, even if they are not COVID positive.

How are things different in the midst of COVID-19? Is someone still allowed to be with the mother during labor/delivery?

The first two months, March and April, were a whirlwind. From creating new policies to providing high-quality care to figuring out how to promote bonding when NICU restrictions limit parental access, it was a steep learning curve for all.

We do allow one support person with a mother during labor, delivery, and postpartum. That visitor has to stay at the hospital with the mother through discharge. This seems to be working fine for the moment. We have had patients express interest in leaving the hospital as soon as possible, so they can be home with the rest of their family. Our team has been accommodating those requests. One of the biggest hurdles was figuring out how to support mothers if they’re separated from their baby due to a NICU admission. Most NICUs don’t allow any visitors, which is really tough on a lot of families. We coordinate video calls and check-ins so they feel connected to their baby, but it’s not the same.

What changes have occurred during COVID-19 that you think should be permanent either for the near future or forever?

One strategy in responding to COVID has been to expand the scope of practice for Nurse Practitioners and Midwives, which is having a positive and meaningful impact on care. I hope more states allow for this and continue this practice post-COVID.

Universal testing for COVID will become standard of care, in the same way that TB tests are required prior to starting school or a new job.

What’s happening with the newborns to keep them safe?

Healthy term newborns born to mothers without COVID room in with their mother until discharge. If mom and baby are low-risk, we try and discharge them within 24 hours. During that time, mom and her support person are required to wear masks.

If a mom is COVID positive, her baby goes to NICU until discharge.

Is everyone involved—mother, guest, child—getting tested?

We are currently only testing the mother, no one else. If mom is COVID positive, the NICU handles the care and testing of the baby.

Have the guidelines changed for when Mom and child are released?

No. While we try and discharge clients as quickly as possible, making sure they’re safe with adequate follow-up care is of the utmost importance. If a mom and baby are low-risk with a vaginal delivery, we discharge around 24 hours. If she’s low-risk, but had a c-section, discharge is around 72 hours.

Regarding post-natal care: are moms/newborns getting home nurse visits if

necessary? Is any other treatment happening or have some things moved to

telehealth?

Most postpartum visits can be handled through telehealth. We do see them in person for the six-week postpartum visit. We do not send anyone to the house.

Is there any other information that is important for our readers to know?

I think it’s important for readers to know that hospital workers are doing their very best to keep you, your loved ones, and themselves safe. Some of the restrictions—and the implication those restrictions have on the laboring mother—might not make sense or feel supportive. Every woman deserves to give birth with support and care in a safe environment. We are doing our best to make sure she gets all three.

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