Expecting during the Unexpected: Pregnancy and Birth in the Time of COVID-19
For all that has come to a screeching halt in the time of COVID-19, life still goes on. In hospitals, homes and clinics across the country - regardless of social distancing measures and lockdown policies - over 10,000 babies are born each day. And that's in the United States alone.
Even under normal circumstances, giving birth can be an overwhelming and vulnerable experience. But the uncertainties and strict protocols brought on by the COVID-19 pandemic have added an extra layer of anxiety. Accordingly, PCI, a Global Communities Partner, has been helping new and expectant parents navigate how to bring life into a world that has, in many ways, been turned upside down.
As part of the PCI Healthy Start program's aim to eliminate disparities in perinatal outcomes, a San Diego-based team provides support to African American and Black immigrant communities during pregnancy and up to 18 months after a baby's birth. Services include midwifery and doula support, childbirth, breastfeeding and parenting education as well as direct assistance and referrals for mental health counseling, housing, food, education and jobs. The onset of the coronavirus pandemic required a rapid and thoughtful shift in how to safely deliver this critical support.
"The primary way that we do our work is usually in the homes of our clients, so we had to develop a whole new set of protocols," said Lisa Bain, PCI's Healthy Start Director. "We're doing screening questions for symptoms among both our staff and our clients and providing regular care and health education to families through video and phone support. Our [midwives with whom we partner] are able to continue providing in-home support to our clients if they pass the screening criteria and follow all of the other guidance."
Assisting families during the actual childbirth process has been more challenging, however, as many hospitals have limited or banned visitors in labor and delivery wards. To help contain the spread of COVID-19, expectant moms now face the tough decision of having their partner in the room or a midwife or doula - trained professionals they know and trust - by their side.
"They don't want to make that choice and they shouldn't have to, so I've been doing virtual doula services," said Chardá Fontenot, a perinatal navigator and doula for Healthy Start. "A lot of my work is really hands-on but since I can't do any of that, I walk the partner through how to do certain comfort measures and send video tutorials."
She described one situation where she received a FaceTime call from a client who had been in labor for 36 hours and didn't feel like the doctor and nurses were listening to her concerns. She called Fontenot while she was in a great amount of pain and crying.
"I told her the proper medical terminology to use when describing what she was feeling and to let her know her rights," Fontenot said. "Just being there in that moment to help them advocate for themselves while they're in the hospital talking to the nurse or doctor and helping them know what questions to ask."
Even before the COVID-19 pandemic, the United States had the highest maternal death rate of all developed countries, with women of color experiencing the worst health outcomes. Knowing this, Bain said that providing Healthy Start clients with high-quality perinatal care is more critical than ever as hospitals and health systems across the country struggle to keep up with the coronavirus.
"Black mothers are four times more likely to experience a pregnancy-related death compared to white women. This is a population that really needs unique attention if we're going to eliminate these disparities," Bain said. "It will take a coordinated and thoughtful intervention to make that happen."
Khalil and his parents are just one of several San Diego families that PCI's Healthy Start program has assisted during the COVID-19 pandemic. After traveling abroad for work, Khalil's dad had to quarantine from his wife and newborn son for 14 days. Chardá Fontenot, a perinatal navigator and doula with PCI, was able to conduct a virtual visit with the couple, providing breastfeeding tips and vital infant nutrition guidance. Photo courtesy of Chardá Fontenot/PCI
At the beginning of the pandemic, a needs assessment among Healthy Start clients revealed a need for basic baby supplies and groceries, including diapers, baby wipes, formula, toilet paper and disinfecting supplies. With support from Price Philanthropies, UPS and Comerica, staff worked with partners to distribute these essential items to families who could not access them because of job loss, supply or transportation disruptions.
"People have been having a lot of struggles finding basic supplies for their babies, while also adjusting to becoming new parents through a pandemic," said Fontenot, who has virtually supported 46 families so far amid COVID-19. "I'm so glad we are able to continue providing these services."
According to Daniella Lesch, lead perinatal navigator for PCI's Healthy Start program, the past year has been a blur for her and the team due to the tremendous need created by the pandemic.
"Our participants have needed more of our support during this crisis because of all the uncertainty. They ask questions like, 'What's going to happen during my hospital stay?' 'Can I breastfeed if I have COVID-19?' 'My partner and I lost our jobs, so how can we pay rent?' 'Will my children get behind from distance learning?' and so much more," said Lesch, who also serves as a Certified Childbirth Educator and Certified Lactation Counselor.
She described one case where a client of hers was living in a shelter and lost her job due to COVID-19. Lesch helped her with prenatal education and connected her with a doula, but the woman went into early labor and gave birth in a shower at the shelter. She called her doula, who provided her with support during this moment and at the hospital, where she needed translation assistance and additional advocacy. Following this experience, Lesch connected the mother with a partner agency for counseling services. Today, she said the client and her family are living in a transitional apartment and doing well.
"It makes me feel relief that we are connected to great organizations, where we are able to refer our participants for more support," Lesch said. "I am also so proud of the amazing work that we are doing in the Healthy Start program by providing much-needed services and information during a very difficult time."
families were served by PCI's Healthy Start program in 2020, 82% of whom are Black or African American. In response to COVID-19, the team provided emergency support to 128 families. This included financial assistance and supplies such as diapers, water filters and grocery vouchers to ensure clients' safety, hygiene and food security during the pandemic.
Story by Maureen Simpson