GRANTHAM — As she prepares to welcome her second child sometime in the next couple of weeks, Jenna-Lee Doss is trying to stay positive.
Doss, a 27-year-old nurse who lives in Grantham, said in a phone interview this week that she is feeling “very pregnant” and is looking forward to holding her daughter in her arms.
Though Doss expects to receive the same high quality care she received from the midwives and other providers at Dartmouth-Hitchcock Medical Center when she also delivered her son Eliott two years ago, her anticipation of the event this time around is accompanied by “a little bit of overshadowing of anxiety,” she said.
Doss said she is worried about the risk of COVID-19 infection involved in sending Eliott to someone else’s home while she is in labor; that something might change and prevent her husband, Jamie, from attending the delivery; and about navigating the postpartum period without her family’s help with household chores such as cooking and cleaning.
“That support, you just can’t put a price tag on that,” Doss said.
Doss and other expectant mothers in this time have to alter their birth and postpartum plans to adapt to COVID-19 social distancing measures. Doing so, has lead some women to birth at home when they wouldn’t have otherwise and led some from out of state to call at least one Upper Valley hospital looking for a quieter place to deliver. The pandemic also has put a pause on fertility treatments for some seeking to build their families.
From the data available so far, pregnant women do not seem to be at an increased risk of developing serious symptoms from COVID-19, the respiratory illness first identified in Wuhan, China, late last year. But pregnant people are at a higher risk of developing serious symptoms from other respiratory infections such as the flu, according to the Centers for Disease Control and Prevention. Infants also can develop serious symptoms.
To reduce the risk to pregnant women, newborns and health care workers, providers are changing the way they care for expectant mothers in this time, moving to telemedicine for most prenatal care and for child birth classes. They now require everyone in the birthing room to wear a mask, including the laboring mother. If the mother is at risk of having contracted COVID-19, hospitals require that the baby be separated from the mother at birth.
“It has been a lot,” said Dr. Julie Braga, who directs obstetrics and gynecology at Dartmouth-Hitchcock.
While DHMC has not yet had to manage a delivery with a mother who has tested positive, providers are prepared for such a possibility, Braga said. Though patients and providers are all under increased stress due to COVID-19, Braga said they have had time to prepare and have the necessary protective equipment.
“I want to reassure people that it is safe to deliver here,” she said.
As hospitals have restricted women to a single support person during delivery, some have sought out home birth midwives. For Katie Bramhall, who is preparing to open a new birth center in Hanover with fellow midwife Meghan Sperry this summer, the COVID-19 pandemic has brought in more patients, spurring the business Gentle Landing Midwifery to double its staff, adding another midwife and an assistant.
But to ensure safety for all during this time, they have changed the way they practice, moving away from in-person pre- and postnatal visits unless necessary, providing patients with tools for monitoring babies’ heartbeats, blood pressure cuffs and baby scales.
Everyone in the birthing room wears a mask, including the mother, Bramhall said. The midwives, who have an office in Lebanon, have largely moved away from hands-on assistance during labor and are instead learning to use their voices more to provide support during labor’s early stages.
They are no longer performing water births, where babies are born in a bath tub, because Bramhall said she can’t be sure it is safe. She also is not caring for women known to have or likely to have COVID-19.
A case of that type “belongs in the hospital, in my opinion,” she said.
Providers at Gifford Medical Center in Randolph have been fielding some calls from people from other states such as New York looking to come to Vermont to deliver their babies, said Dr. Joshua White, Gifford’s chief medical officer.
White said Gifford is accepting such patients as long as they remain symptom-free for the 14-day quarantine recommended for people coming to Vermont from other states.
“It is doable,” he said.
Doulas typically offer in-person support to birthing women and their partners. But because hospitals are now restricting women to one support person in the delivery room, Sharon-based doula Mary Etna Haac is offering telephone and video support to women during labor. She also has seen an increased interest in her childbirth classes, which she is now teaching online.
Haac said many of her discussions with pregnant women right now are focused on helping them to reduce their anxiety and fear.
“I think it’s a time when there’s a lot of vulnerability,” Haac said.
To help quell those feelings, Haac said she tries to help women, some of whom are survivors of sexual trauma or previous traumatic birth experiences, feel safe, calm and comfortable by finding things about the pregnancy and birth that they can control. She also is soothing the nerves of partners who were expecting to have a doula there for added support during the birth.
Haac said she and other doulas are also focused on supporting families during the postpartum period when they may have expected to have friends and family over to help out.
Instead of being physically present, Haac said she is “helping people feel heard and feel supported” by phone and video conferencing.
“It might be a different type of support than what was originally envisioned,” she said.
COVID-19 has put a pause on fertility treatments for those still seeking to become pregnant, said Dr. Jennifer Brown, who co-owns the Colchester, Vt.-based Northeastern Reproductive Medicine which has an office in White River Junction.
The clinic is still working with patients via telemedicine and plans to reopen in May, Brown said.
She said that patients’ chance of success would not be affected by a pause of a couple of months. But, she said, they “couldn’t stop for a year.”
For now, Doss, the Grantham mother, is managing the physical discomforts of late pregnancy by walking around her Eastman neighborhood, monitoring her blood pressure from home and staying in touch with her providers as she prepares for the new arrival.
Doss’s husband Jamie is a third-year medical student at Geisel School of Medicine at Dartmouth and is considering becoming an OB/GYN. He had hoped to help deliver Eliott, but couldn’t due to a birth complication. This time around, he hopes to assist, Doss said.
“Nobody ever wants to miss the birth of their child,” Doss said. And, in Jamie’s case, “This would potentially be a delivery where he could be helpful.”
While Doss said that would be their preference, she is trying to navigate the potential conflict between the desire for that special moment and the need to keep everyone safe.
“It’s a hard balance,” she said.
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.