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 will be born today. 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 current global pandemic have added an extra layer of anxiety. Accordingly, PCI, a Global Communities partner, has been navigating how to help new and expectant parents bring life into a world that has become increasingly unfamiliar to everyone.

“[This pandemic] has turned the birth world completely upside down, but our clients still need us,” said Chardá Fontenot, a perinatal navigator and doula for PCI’s Healthy Start program in San Diego. “I’ve told them I have extended work hours now. They can text me early, call me late. Whenever they need me.”

Ayla and Khalil are two of 10 Healthy Start babies who were born during the coronavirus pandemic. Their families have been assisted by PCI perinatal navigator and doula Chardá Fontenot.

As part of Healthy Start’s aim to eliminate disparities in perinatal outcomes, Fontenot 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, 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.”

During the first weeks of PCI’s response to COVID-19, Fontenot learned of a client whose husband had been in Italy for work when news of the coronavirus was just beginning to hit headlines. Although he was back in San Diego in March, he had to quarantine himself in a hotel room while his wife and two-month-old baby were at home alone.

“Not having your partner there for 14 days in all this mess and wondering if your husband is OK is a lot,” Fontenot said. “It was good that I was able to check in on them virtually throughout that time to answer any questions they had about the baby. I was even able to do a lactation support video call with them while he was in the hotel room and she was in her bedroom nursing.”

Assisting families during the actual childbirth process has been more challenging, however, as many hospitals are limiting or banning 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.

Desire Moore is one of 30 Healthy Start clients whom Chardá Fontenot has assisted during the COVID-19 pandemic. She gave birth to her baby Phoenix just two weeks into the public health crisis and shared that Fontenot’s virtual support helped her communicate her needs and rights to hospital staff during a lengthy and painful delivery. / Photo courtesy of Desire Moore

“They don’t want to make that choice and they shouldn’t have to, so I’ve been doing virtual doula services,” Fontenot said. “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. “… A lot of calls have been that. Telling them what their rights are, what they can say ‘no’ to, or ‘I want this to happen.’ 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.”

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 have been working with partners to distribute these essential items to families who cannot access them because of job loss, supply or transportation disruptions. Items are ordered online and shipped directly to clients’ homes when possible, but staff were also given personal protective equipment and guidance on how to minimize contact with families who are unable to receive items via mail.

“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 30 families and had 10 babies born so far amid COVID-19. “I’m so glad we are able to continue providing these services.”

PCI recently conducted a needs assessment among Healthy Start families in San Diego to inform COVID-19 response efforts. Nearly two-thirds of those who responded said one or both parents have been laid off or furloughed since the onset of the pandemic. Of those who still have a job, 81 percent are unable to work from home.

With support from Price Philanthropies, UPS and Comerica, PCI has been working with partners to safely distribute basis baby supplies and groceries to families struggling to access these essential items. Chardá Fontenot, a perinatal navigator and doula for Healthy Start, holds up a recent delivery.