How COVID-19 affected pregnancy and delivery for expecting mothers in 2020Jan 18, 2021 03:52PM ● By Alison Brimley
By Alison Brimley | [email protected]
In September 2020, West Jordan native Shaylynne Troester was days away from delivering her first child. The second grade teacher had taken two weeks off work at the recommendation of her doctor. At her 39 week appointment, she made the choice to be induced.
Hospital policy required mothers to be tested for COVID-19 before arriving at the hospital for induction, and Troester was scheduled for induction on a Tuesday. She received her test the previous Thursday, fully expecting it to come back negative. Instead, a few days later, the health department notified her that she was COVID positive.
“If I’d waited to go into labor I wouldn’t have known,” Troester said. “I had no symptoms; I felt completely fine. It was a shock.”
It was frustrating, too: she was asymptomatic and yet had to planned for a labor that would look very different from what she had envisioned. “It was our first baby; we had no idea what we were doing,” she said. “I felt physically fine, but it was a lot to process.”
“I don’t know what to expect”
Berkley Meisenbacher of Midvale is expecting her first baby in May. She works as a medical surgical nurse at Jordan Valley Medical Center West Valley, wears protective equipment at work and said most patients are tested for COVID before being sent into surgery. But there have been a few patients that have “slipped by,” and aren’t tested until after she’s seen them. Before finding out she was pregnant in September, Meisenbacher wasn’t too concerned about getting COVID, because her sister contracted it and recovered fully. But “now that I’m pregnant,” she said, “the thought of getting COVID is very frightening to me. I don’t know what to expect because there is so little research done about COVID because it’s so new.”
There are many unknowns about the risks COVID-19 poses to pregnant women. Of the information we do have, much is positive. It seems there is little risk of a COVID-positive mother transmitting the virus to her baby, and those babies who do contract it after birth tend to recover well. “The best data suggests that in-utero transmission of the SARS-CoV-2 virus is rare, but possible,” said Dr. Erin Clark, an associate professor of obstetrics and gynecology at University of Utah. Unlike a virus like Zika, the novel coronavirus likely does not pose unique risks to unborn babies; that is, “it does not appear to cause birth defects or miscarriage.”
Instead, the threat of COVID-19 to pregnant women is that it magnifies already existing risks. “The most recent U.S. data shows that women who are pregnant are about three times more likely to be admitted to the ICU and to require a ventilator compared to similar women who are not pregnant,” Dr. Clark said. “Pregnant women are also about 70% more likely to die of COVID-19.” Pregnant women with other health issues are at even higher risk.
When it comes to women of color, the numbers are even more alarming. Almost all non-white groups in the U.S. face a disproportionate risk of contracting COVID-19 and a disproportionate risk of adverse pregnancy outcomes. Compounded, these numbers paint a dismal picture.
Still, absolute risk to pregnant women remains low. And given the short time frame researchers have had to gather data, studies’ sample sizes are simply not large enough to paint an accurate picture of the likelihood of severe COVID-related illness during pregnancy.
Despite her diagnosis, Shaylynne Troester delivered her baby without complications. She credits the staff at Jordan Valley hospital for helping her remain calm. Each nurse that entered her room wore full protective gear, and staff tried to limit the number of times they entered the room during labor. But her husband was allowed to be with her, even without a COVID test, and he could come and go freely. In the end, she feels her delivery “wasn’t all that different from normal.”
There was just one sign that the novel coronavirus had entered her body: blood clots in the placenta.
Both pregnancy and COVID-19 individually increase a person’s risk of blood clots; together the risk is even higher. Troester’s doctor mentioned this at her 32-week appointment and told her if she ever were to test positive, she would be closely monitored and put on blood thinners.
“I feel like my doctor was on top of it compared to some of the other doctors I have heard about,” Troester said. “Typically, if you are diagnosed with COVID, they put you on blood thinners right away. A lot of doctors are not following that. Some say it’s not proven.”
When Camille Wright of Draper contracted COVID in her first trimester of pregnancy this August, she received a 14-day course of blood thinners. She was also told that because of the risk of clots, she would not be allowed to carry past 39 weeks. That was OK with her.
Though Wright has fully recovered, her case was not asymptomatic. She found out she was pregnant on a Friday at the beginning of August; that Sunday she was scheduled to leave for a family reunion in Idaho. The Wrights—Camille; her husband, Jonathan; and two children—hadn’t seen any family since December.
The reunion was “well done,” she said, held in an old campus dormitory. Every family had its own lodging and bathroom. Indoors, everyone wore masks; all meals were eaten outside. No one was allowed within 6 feet of Camille’s grandparents. “We had a great time,” she said.
But the day before reunion ended, one cousin came down with a headache. The next morning, as everyone was packing to leave, he couldn’t taste anything. The Wrights were supposed to spend more time in Idaho but instead went home.
A week later, everyone in her household had tested positive for COVID-19. Wright said she got it the worst and describes her husband as having “a head cold,” while her 3- and 1-year-old children had “runny noses for maybe an hour.”
Within a week, she had learned both that she was pregnant and COVID-positive. And though she felt unwell, it wasn’t always possible to know whether her symptoms—nausea, intense headache and fatigue—could be attributed to COVID or early pregnancy. “I always get pretty sick with pregnancy,” she said. But this time, she spent “six days in bed. I have never done that in my life.”
Wright never felt so sick that she was truly alarmed. She hadn’t even had a prenatal appointment yet but called her doctor and was prescribed blood thinners. At her 12-week appointment, she learned more about the pandemic-era policies: that she wouldn’t carry past 39 weeks, an extra ultrasound would be done at 32 weeks and at 35 weeks they would begin stress tests. “Most of these are preventive, because they don’t really know,” Wright said.
Recently she heard of a study underway in Utah to investigate whether COVID patients without symptoms severe enough for hospitalization would benefit from taking common medications to reduce the risk of blood clots. “I’m so glad I was on [blood thinners],” she said. “But I wonder, ‘Would it have been good for my husband to be on them? My kids?’”
A “baby bust”
Unsurprisingly, the uncertainties associated with the pandemic—and accompanying financial crisis—has experts predicting a serious decline in births in the coming year. A November article in “The Atlantic” proclaimed “Here Comes the COVID-19 Baby Bust” and cited economists who predicted 300,000 to 500,000 fewer births in 2021.
But should prospective parents allow the risks of COVID to determine their family planning? “My job revolves around talking to women about potential pregnancy risks, which exist for every pregnancy, regardless of circumstances,” Dr. Erin Clark said. “I describe all pregnancies as a ‘leap of faith,’ since even with the recommended cautious optimism nobody knows with certainty how things will turnout. ‘The leap’ just feels a bit wider during the current pandemic.”
Berkley Meisenbacher said that despite the unknowns, now felt like the right time for her and her husband to start their family. “We both realize that this pandemic isn’t going to last forever,” she said. “What’s most important to us is family, and even though I’m pregnant during a pandemic, we are thrilled to be having a baby.”
COVID-19 didn’t strongly influence Camille Wright’s decision to get pregnant either. “Before pregnancy, I scanned [the research] a little bit,” said Wright, who is also trained as a nurse, but she didn’t worry too much because she knew there wasn’t a lot of data. After her diagnosis, she started digging into the data more and became more worried. “I began to have thoughts of, ‘Oh no, what did I just do? Was I irresponsible?’”
But her doctor put her at ease, telling her, “You can’t put your life on hold.” Ever since her 20-week ultrasound, where the baby was found to be growing normally, she’s felt at ease.
While a vaccine promises to soon help the world regain some normalcy, some women may have concerns about receiving a vaccine whose safety data is lacking when it comes to pregnancy. “While pregnant women are at higher risk for severe COVID-19, pregnant women have unfortunately not been included in the current vaccine trials,” Clark said. “The theoretic risk from vaccination is low and the potential benefit is high, but pregnancy data is desperately needed.”
Though she’s not on the frontlines, Meisenbacher may be ahead of the general public in line to receive a COVID vaccine because of her job. “I think before I decide to get it, I would do my own research to see if there are any rules or regulations about pregnant women receiving the vaccine,” she said. “It would make sense to give pregnant people the vaccine first because they are high risk, however because we don’t really know the effects of course there’s going to be some cautionary guidelines.”
Today, Troester and Wright are fully recovered. Troester’s baby never did test positive or show any symptoms of COVID-19, and eventually both her mother and mother-in-law were able to come help her during the early postpartum weeks. She wore a mask for the first few days with her baby but didn’t let her diagnosis stop her from breastfeeding and doing skin-to-skin time.
“Babies are faring so well,” she said. “That’s the greatest blessing of COVID.”
Her advice? “I just would say if you are pregnant and you think you do have COVID, just get tested,” said Troester. “I had no symptoms, but I could have thrown a blood clot, and we both could have died.”