Delivery in Isolation
By: Marla Potter
Tags: Covid 19, Pandemic, Pregnancy, Maternity, Labor And Delivery

When I first heard about the novel coronavirus outbreak in Wuhan in early-mid January, I didn’t think much of it. I was 28 weeks pregnant, and I was focused on finishing my last couple months at my clinic in Downtown Los Angeles before starting maternity leave. It had been a tough pregnancy thanks to debilitating nausea and vomiting for the first 20 weeks, coupled with a generous number of work-related stressors as the lead physician of a busy clinic.

But after a few weeks my attention and concern grew exponentially. As a doctor with a background in public health, I worried about the potential of the virus to wreak havoc on my already vulnerable patient population. And as an expectant mother, I also worried about the risk to my unborn child and me. By early March I felt like I was in a race to start maternity leave before the virus became widespread.

During my last days in clinic I cared for several people with high fevers who were short of breath and coughing severely. I remember thinking “well, if we’ve already reached community transmission in LA, there’s a good chance this is it.” I donned my mask, washed my hands, saw my patients, and hoped for the best.

Soon after starting maternity leave on March 10th, news about community transmission in LA County ballooned. I planned to stay home and isolated for the last few weeks of my pregnancy to avoid any more potential exposures, but the next week I developed painful kidney stones that landed me in the ER twice.

So much for self-isolation.

On my last day of kidney stone pain the coughing started. At first it felt like a dry, scratchy cough, and I convinced myself it was allergies. But the cough worsened, and by day 3 I also had a fever, extreme body aches and fatigue, and shortness of breath. My husband and our 5 year old son were sick as well. My mind went immediately to COVID-19. The time frame fit — my symptoms started 5–7 days after my exposure to patients at work with the same symptoms.

Thankfully my illness course was mild, and, except for a persistent cough, I felt mostly back to normal by day 5. I felt immensely grateful that whatever illness I experienced wasn’t more severe, but my head spun with questions.

Was it COVID-19?

If so, did my persistent cough mean I was still contagious?

Could I pass it to my baby during delivery?

Would I expose my parents when they came to help after the baby was born?

Would it be okay to ask someone to watch our 5 year old during labor knowing we could potentially be contagious?

To add to the complexity, this was all happening when hospitals were running out of PPE, beds, and ventilators. The stakes seemed high. I hadn’t anticipated so many additional variables. No one plans to give birth in the middle of a pandemic.

By the time I saw my OB nurse midwife at 38 weeks, I was still coughing and increasingly anxious about the uncertainties that the next 2–3 weeks would hold. After some convincing, my midwife agreed to order me a test for SARS-CoV-2. I was relieved. Though I knew the test wasn’t highly accurate and results took a long time to come back, I still hoped I could find out my status before going into labor. I tried to think of contingency plans for various scenarios as the days ticked by.

A week later, my results had not come back, and my blood pressure was elevated during my 39 week check-up. The nurse midwife wanted to induce me. I think my chart officially read “induction for gestational hypertension,” but there was also an unspoken urgency in the air because of COVID-19. Staff members were already testing positive for the virus, and L&D nurses were getting quarantined because of exposure. Though I felt woefully unprepared to be induced, I understood my midwife’s concerns.

At that point I was informed one of my deepest fears would become part of my birth story. Since I was a “patient under investigation,” my husband would not be allowed to join me in the delivery suite. I knew this was possible, but the proclamation still hit me like a punch to the gut.

On one of the most important days of our lives, my husband would not be there.

He would not be there to tell me I could do this when everything inside of me was screaming otherwise, to tell me I was strong when I felt so, so weak, or to welcome our second son into the world.

I would labor alone to bring our son into the world in the middle of a pandemic.

As I struggled to grasp my new reality, I was ushered into a delivery room. The room was designed to feel warm and inviting; it had large windows that overlooked a beautiful courtyard and reflecting pool. Instead, it felt sterile and lonely.

As I sat there I started to replay the events of the day in my mind: I had left home in a hurry that morning. I barely called out “bye” to my husband as I left. I didn’t even hug my son, but instead reminded him not to play his toy violin too loudly as I rushed past him. I hadn’t finished packing my hospital bag. I hadn’t even skimmed through those books on how to deliver a baby that I had studied so thoroughly during my first pregnancy. I hadn’t practiced any focused breathing or centering meditations. And now I was sitting alone in a cold room, still unsure if I was a carrier of the coronavirus, unsure if I remembered how to deliver a baby, and realizing that I would be doing it all alone.

It was strange to be in labor while under isolation precautions. Anyone who entered my room had to be in full PPE, with a plastic yellow gown, gloves, mask and face shield. Because PPE was so scarce at the time, people only entered when necessary. I had one dedicated nurse who stayed with me for her entire shift, only leaving for her lunch break. Otherwise, my room lacked the normal buzz of staff regularly coming in and out.

Before the labor pains became unbearable, I tried to occupy myself by texting, calling, and video conferencing with loved ones. Thank God for smartphones and the gift of connectedness they brought me during that difficult time. Even so, I still struggle to articulate how bizarrely quiet it felt to be there, about to undergo one of the most significant experiences of my life without any of my loved ones by my side.

The nurse and nurse midwife who helped me deliver my baby were very kind, and I was grateful for them. They helped me set up a video call with my husband while I was pushing so that he could be “virtually present.” Though it certainly wasn’t the same as having him physically with me, I appreciated the gesture.

Shortly after delivering we found out that my SARS-CoV-2 test had come back negative, and the isolation precautions relaxed. Staff still had to wear masks and gloves, but no one had to suit up into full isolation gear to see me, and I could keep my newborn in my room. My husband was still not allowed to join me because no visitors were allowed into the postpartum unit that didn’t come with the patient from the delivery room. This made the postpartum hospital stay emotionally and physically tough. I was mourning the absence of my husband during these precious first couple of days of our son’s life. I was also missing having an invaluable extra set of hands to help me adjust pillows, pick up the baby, or walk to the bathroom as my exhausted and torn body recovered.

Thankfully, I had no significant complications, and I was discharged about 36 hours after giving birth. Two and a half days after my hospital journey began, I met my husband in front of the hospital and introduced him to our son. We loaded up the minivan and drove back home to navigate our new normal.

When I reflect on the first 3 months of my baby’s life, I have mostly happy memories: the gentleness with which my 5 year old embraced his new brother when they first met, the sound of my baby’s giggling, and how he loves to smile when he sees faces.

However, when I do find a rare quiet moment, my mind drifts back to those chaotic and lonely yet sacred three days surrounding his birth. Like so many things in this pandemic, it was not the experience we had hoped or planned for, but it has forever become a part of our story.