Interview: Baby Deliveries During the COVID-19 Pandemic

By Wendy Osher

Maui Now interviews Dr. Stacy Ammerman, OB-GYN from the Maui Memorial Medical Center. Dr. Ammerman will answer questions about deliveries during the COVID-19 pandemic.

Is it safe to have a baby at the hospital during the pandemic?

“I 100% think it’s safe to have a baby at the hospital at this time.  Despite the pandemic, despite COVID, the hospital continues to be the safest place to have your baby, ” said Dr. Ammerman.

“I definitely understand their concerns.  When women are pregnant, they already have kind of an underlying level of anxiety that can occur just with all the changes and all the things that are happening.  This has heightened it for sure,” said Dr. Ammerman.

“We’ve been very lucky–number one as a state–to have one of the lowest cases in the nation.  So we have done a really good job of managing our numbers here.  The hospital has put a lot of protocols in place to ensure safety for patients and for babies coming into the hospital.  That has been very reassuring and patients can really be definitely comfortable that they’re entering into a safe place to have their babies,” said Dr. Ammerman.

What protocols are in place to safeguard the patient, staff and community?

“One of the biggest ones that has occurred recently is universal testing is now occurring int he hospital.  What that means is anybody who is getting admitted to the hospital–whether it’s through the emergency department, direct admit, or labor and delivery–is getting tested, regardless of whether or not they have symptoms,” said Dr. Ammerman.

“We had already been doing this in the community for patients that were also scheduled for surgeries, scheduled c-sections, scheduled inductions.  But now we have the ability to do more rapid testing in the hospital.  So once the patient arrives, they have a nasopharyngeal swab done by a nurse and that result is back usually within about three hours.  So it’s really helpful in knowing whether this patient is going to be higher risk to other patients, to other employees in the hospital, and where they need to be in the hospital,” said Dr. Ammerman.

“Other things that are occurring and have been occurring for a while are temperature checks.  So anybody who comes into the hospital is having a symptom check every day, a temperature check everyday, and they’ll all get a mask to wear while they are in the hospital.  So everybody has a mask on at all times,” said Dr. Ammerman.

“In addition, the hospital does have adequate PPE for the appropriate scenarios.  The hospital has never been cleaner.  I do feel that we are doing a really good job taking care of the patients and ensuring their safety,” said Dr. Ammerman.

What’s the protocol for PPE and is it different for vaginal vs c-section birth?

“Just in general, everybody has a mask on while they are in the hospital.  So during labor, that might mean your nurse has a general surgical mask on.  When we get to the second stage of labor, which is when a patient is pushing, which is when we are a little bit more concerned with aerosilization in the room–the nurse, the doctor, anyone who is going to be in the room with the patient–will wear an N95 and usually have a surgical mask over that.  We have protective eye wear and we have protective head gear, and then we have a gown on during deliver–and this is the same for a cesarian section,” said Dr. Ammerman.

“The mom who is delivering and her partner will also have a mask on during their stay at the hospital, including during labor,” said Dr. Ammerman.

Is the support person tested every day?

“The support person gets screened downstairs when the patient arrives at the hospital.  So they have a symptom check.  They have a temperature check.  They’re given a mask.  During their stay–as you may or may not know–there’s a visitor policy now at the hospital where in labor and deliver, you can only have one support person with you at all times. So they are encouraged to try and stay with the mom for the most part and try not to go in and out of the hospital and minimize that as much as possible,” said Dr. Ammerman.

“They are screened every day with a symptom check and temperature check.  They are not COVID tested though because they are not an admitted patient, so they do not get COVID testing while at the hospital,” said Dr. Ammerman.

How does the no visitor policy impact the maternity tours usually offered to expectant mothers?

“Unfortunately, they’ve had to halt the tours because they just don’t want a lot of unnecessary people coming into the hospital that don’t need to be there.  So the tours halted, but they are working on doing a virtual tour, which should hopefully be available on the website soon–which would be really nice and helpful to have on there anyway, despite the pandemic,” said Dr. Ammerman.

“They also usually offer child birth classes at the hospital and that has, again, had to be put on hold. But I think they are going to be doing some virtual classes coming up in the future,” said Dr. Ammerman.

What are the concerns if any have you seen from expectant moms, and what would you say to them?

“I think they’re highly concerned about their own welfare and the welfare of their babies that they are going to be giving birth to; and just making sure that they really are going to be in a safe place for delivery.  Unfortunately we have one hospital.  We don’t have a separate COVID hospital.  So when people are sick, they have to come to the hospital,” said Dr. Ammerman.

“What is nice about Labor & Deliver at Maui Memorial is that it really is kind of an isolated unit.  We don’t have other doctors or nurses walking through our unit or floating in and out; so the people that are there are the people that are there to deliver your baby, take care of you–the anesthesiologist that’s there to give you your epidural. And we are kind of a separate area.  With all the new protocols in place, I feel like it’s very safe for sure–for moms and their partners to be there, and not worrying whether they’re picking up the virus, if they’re going to be passing it to their baby, if they’re going to be bringing it home to their families,” said Dr. Ammerman.

“Definitely it’s an understandable concern, but I just really do want to reassure people that it definitely is a safe place and every doctor and nurse that I know would not hesitate to have their baby in that hospital right now,” said Dr. Ammerman.

What are the extra precautions being taken to protect newborns?

“The newborns are rooming in with the moms as much as possible.  All of the procedures–whether it’s medication administration or baths are done at the bedside with the mom in the room.  The babies do need a hearing test before they leave the hospital and that is done in the nursery.  They are not really allowing anybody in the nursery that’s not a physician or a nurse unless the mom really does have to come in because the baby is so sick that they can’t be outside of the nursery.  But other than that, they’re trying to keep the babies as protected as possible” said Dr. Ammerman.

“With that, we really are trying to discharge these patients that are healthy and don’t have any need to stay in the hospital longer than they need to as soon as we can,” said Dr. Ammerman.

If someone is identified as a Person Under Investigation for COVID-19, what is done; and what is done if an expectant mom tests positive?

“So we’ve been really lucky that this has not occurred yet, but we are definitely ready for it when it does happen.  We have isolated off three rooms in the end of the postpartum ward that are off on their own.  They have separate HEPA filters in place; and they are ready so if we do have a person under investigation or a positive mom, they’ll go to that room, they would labor in that room, and then they would stay and have their postpartum care in that room,” said Dr. Ammerman.

“In addition, full PPE would be used at all times, so not just during a delivery, but anytime anybody is in that room with the patient.  They would be assigned just one nurse.  During a shift they would have just one nurse going in and out; and that nurse would not be assigned to any other patients on the floor.  We’re definitely ready for it,” said Dr. Ammerman.

“If they have to have a cesarean section and they are a positive patient, then they would actually be having surgery in the main Operating Room,” said Dr. Ammerman.

Without the tours in place, what’s the best way to get in touch with Labor & Delivery?

“They can call the hospital directly if they have any specific hospital policy questions.  It’s also the same number that you call when it’s time to have your baby, or you’re not sure if you need to go into the hospital or not.  The direct number to Labor & Delivery is 242-2436.  In addition, I would just encourage patients, if they’re just having general concerns or questions about what to expect during labor, to first talk to their OBGYN–go to their doctor and discuss your concerns, get your questions answered, because they might be able to answer these questions so that we don’t overload the hospital.  But definitely, Labor & Delivery is there to answer any questions that may come up,” said Dr. Ammerman.

With discussion of a “Second Wave” is there any advice or thoughts from your experience? 

“I feel like with this first outbreak, we learned a lot.  We went through a lot of changing policies as we gained more information with the virus.  So I feel like we’re definitely a lot more prepared for a second wave with having the appropriate testing in place, the appropriate policies already in place, (and) appropriate PPE.  The outpatient clinics too in addition to the hospital have been making their own policies and potentially screening patients outside, not allowing partners or visitors to come in with them to the appointments, (and) doing more telemedicine.  So we’re already prepared in that sense,” said Dr. Ammerman.

“I feel like this first wave has prepared us for the second wave; and we will be able to act very efficiently when we start seeing evidence of a second wave occurring, so that we’re not starting behind the ball already.  We’re already going to be ahead of the game,” said Dr. Ammerman.

Any final thoughts, especially for new mothers, where everything is new to them?

“I just really want to keep an open dialogue with your OBGYN.  I discussed the fact that when you’re pregnant, you do sometimes have a higher level of anxiety and it’s been shown with studies of the pandemic that levels of anxiety are for sure going up during pregnancy,” said Dr. Ammerman.

“And pregnancy just feels different right now.  Postpartum feels different.  People aren’t having baby showers; they’re not having gender reveal parties; they’re not having 10 people show up to the hospital to congratulate them.  So just really making sure that you have a good core support person at home, and making sure that you address any concerns with your physician so that we can address them right away and help you manage the situation,” said Dr. Ammerman.