COVID-19: How EvergreenHealth is Protecting Expecting Families
Jennifer (Hamblett) Mohr CNM, ARNP shares how EvergreenHealth is protecting expecting mothers and families with screening on-site, limiting visitors, and taking special precautions during labor.
Melanie Cole (Host): This is the EvergreenHealth podcast on COVID-19 dated 04/29/2020.
Welcome to Check-up Chat with EvergreenHealth. I’m Melanie Cole and today, we’re talking about COVID-19, how EvergreenHealth is protecting expecting families. Joining me is Jennie Mohr. She’s a Certified Nurse Midwife at EvergreenHealth Midwifery Care. Jennie, I’m so glad to have you with us and what an important topic right now, expecting mothers must be terrified. Tell us what are the most common concerns that you’ve heard from families regarding COVID-19 when they are expecting a baby.
Jennifer (Hamblett) Mohr, CNM, ARNP (Guest): Sure. Thank you for having me. It’s a really important time for us to be as kind of communicative to our families and people in our community who are seeking care here at EvergreenHealth about COVID-19 and how we are caring for our families. I would say where one of the biggest changes that we’ve seen in maternity care has been the reduction of in-person visits for our families. And while we are not restricting care that’s necessary by any means, we’re certainly attempting to minimize the amount of traffic, of course encouraging the kind of staying in at home and minimizing exposure especially for our pregnant people who are a little bit higher risk because their immune systems are a little depressed.
And so, in general, what I would say is most families are – the biggest questions are how does this directly affect me, what is it going to look like when I come in to labor and delivery to have my baby at the Family Maternity Center and what can I be doing to protect myself and my baby and pregnancy?
Host: Are you able to use Telehealth for expectant mothers so that for some of those visits they don’t have to come in for?
Jennifer: Exactly. So, we – each clinic I think each maternity clinic between some of our physicians and the midwives here have created a very similar although it’s slightly different, between each clinic algorithm that helps us identify what patients really do need to be seen in person and what can be done through our Telehealth. We are using a couple of different apps specifically Maternity Care. I believe both physicians and the midwives are using the Blue Jeans App so we can do video visits which has been really wonderful and also telephone call visits. So, that kind of whole broad spectrum of Telehealth, we’re doing more than really, we ever have before. Which I think has been a real advantage given what’s going on in our communities.
Host: Certainly it is. Is it safe to deliver a baby at EvergreenHealth? Give a little encouragement and hope to the families that are expecting a baby soon.
Jennifer: Yeah. Well I would say overall, and this is overwhelmingly I probably say this about 50 times a day between the phone and families that I’m seeing in person and individuals, Evergreen has taken great measures and really gone quickly to create an environment to help families feel safe but also be safe. So, there’s certainly the screening that we’re doing from the very beginning or maybe I will even back up before that. So, pretty quickly, as Evergreen was kind of seen as one of the first epicenters of the country, we, our great team and our infectious disease department, Dr. Riedo and the CDC were able to make some pretty quick changes to the number of healthy patients that were coming into our system and reducing nonurgent visits or nonessential visits, what it’s been deemed and so the number, the sheer number of people coming in and out of our not only offices but hospital campus has drastically reduced and this of course reduces the risk to those who are needing to be on campus, the potential for exposures. So, I would say off the bat, we reduced the number of people here at the hospital and then we’re screening everyone who is coming in. we’ve limited the number of entrances into the hospital and so people who are coming in to seek care at the Evergreen ER are not coming in the same entrance that the people who are seeking care for the maternity center or our pediatric unit.
And so that’s been a really important way to just kind of reorganize the flow in the hospital and again reduce risks from our overall healthy population, trying to reduce those that may be at higher risk to either carry COVID or are COVID positive themselves. And then reducing kind of the – that goes along in with that same statement is reducing the number of visitors. So across the board, both in visits that have been deemed essential so off outpatient visits but also in hospital visits, the number of visitors has really drastically been reduced, hospice, COVID patients, maternity care. There are some situations where visitors are allowed and specifically related to what we’re talking about are maternity care. The Family Maternity Unit has really focused wonderfully on this allowing two visitors for every laboring patient. And this is a slightly actually different than what we’re seeing in the community. And the real reason we are doing this allowing two versus restricting it to one is that the mom or person who is pregnant having baby, really deserves a support person and many times, that is indeed the partner or father of the baby, but it is not always. And so that father or partner of the baby also deserves to be present for the birth of that baby. And so providing not only a support person for the pregnant person but also allowing the partner who is the father, the other partner of that new arrival to be present as well.
And so to ensure that, the presence of – and again, in many cases, that is the same person, but it is not always. And so we have allowed two people for every laboring patient and not to be rotated. So, it’s going to be the same consistent two people and ideally, they stay with the pregnant person from the moment they are coming in until when they leave our system. And as of yesterday, here at Evergreen are universally screening every pregnant patient coming into our labor and delivery unit.
Host: So important Jennie, really because when you’re having a baby, to have a few people around you that you love and can support you is so important as you say. What can a mother expect if she has suspected or positive COVID-19 when you’ve done your screening, then what happens?
Jennifer: Yeah sure. So, because we are just talking about labor and delivery specifically, I’ll talk first about that but there is – I mean it is very distinctly different experience whether we’re talking about someone who is currently pregnant and remote or far from delivery and someone who is actually in labor or coming in for perhaps a scheduled C-section or an induction of labor. And this is all very new. So, just like I think our whole community has become used to really knowing that things are changing kind of on a daily, hourly; now that we are a little bit out from our community peak, we’re kind of seeing things change more on a weekly basis.
But in the maternity unit, we just started universal testing yesterday. So, we’re really excited about it. it’s been an important step that we’ve worked towards and the capacity of testing in our system here in house has increased and that’s allowed us to move to this point. So, once you come in, everybody will be screened and not everybody with the laboring patient but just the patient herself and then if it looks like – so it will be a quite rapid turnaround within one to two hours if it looks like that baby is going to come quickly. If this is something that probably will take some time, then the test may take a little bit longer. Prior to the testing, and this isn’t recommended so these are strong, strong recommendations but at no point is this something that’s being forced, right, so this is an option in maternity care specifically but overall, medical care, we’re really moving towards a model of family centered care or shall we say like informed patient care. So, that families and patients are really getting the opportunity to gather the information and make the best decision for themselves and their families, understanding our strong recommendation but also being able to determine or at least to be active participants in their own care.
So, again, strong recommendation for testing. We are universally doing it, however there is the option to choose to opt out of that. Until the test returns back, we are recommending everybody is masking and you will see universal masking in our hospital with all of our employees, those who have no direct patient care, maybe wearing cloth masks but any care provider or employee who has direct patient contact will be wearing a surgical mask for the extent of their stay here or treatment here in the hospital and that’s merely because we have good evidence that both parties masking even in the absence of symptoms is super important.
Now if a patient tests negative, then the – while they are laboring are not required to wear a mask. Prior to the testing coming back if it is able to, we are strongly encouraging that masking although this may be challenging as women are laboring. And positive patients again, really the intention is to keep them masked as much as possible during that. If a patient does come back positive for COVID, then their ability to have visitors comes down to one person. So, they still are allowed one person but instead of two, it comes down to one and that is specifically because we do know in labor and delivery specifically during the pushing phase, we put everybody in the room, that’s in the vicinity of that delivering mama at risk for exposure for COVID.
Host: What very important and specific information you’ve given Jennie, I’m sure that expectant parents really appreciate this podcast. Now is it safe to breastfeed? Are there any extra precautions you’d like women to take about breastfeeding whether or not they test positive?
Jennifer: Yeah sure. I would say the hospital, we have again, a whole algorithm that really helps not only our physicians and midwives and nurses but also our families kind of navigate this really challenging time. Kind of again what we’re seeing probably worldwide, countrywide and then down into our community is there is so little known about COVID-19, the pathophysiology of this virus and kind of how it affects us as individual people. And inherently, our pregnant population and our neonates or our brand new babies are of the highest – they are in the highest vulnerable market. Now what we’re seeing – I know market is kind of not the best, the highest population, highest risk population. Pregnant women, although some of – some can get very sick in general, we are not seeing COVID-19 be as challenging for the pregnant population as other viral illnesses have been. That being said, we still want to keep our moms protected and safe.
But our newborns, it’s incredibly reassuring is that there is no evidence, it doesn’t mean it can’t happen, but there is no evidence that if a mom is positive for COVID that even the course of labor and delivery, that’s she going to expose her baby to COVID-19. So, there are viruses that very easily transfer between mom and baby when we’re pregnant and then at delivery and this does not seem to be one.
However, the close contact after labor and delivery specifically around breastfeeding definitely puts the neonate or the new baby at risk for picking up this infection. And so, I really encourage families to take a look and kind of look into or at least know that their care providers are looking both to the CDC and the WHO for guidelines on this. And because these two organizations work kind of with different perspectives, we are going to see a slightly different recommendation between the CDC which is our national organization is really encouraging to pump breast milk and feed the baby a distance from the mom. Because the risk is really just unknown about the potential significance that COVID can have on these newborns. The WHO takes a little bit more direct approach saying that we really have a lot of information about the benefits of breastfeeding and with appropriate protection, meaning mom is doing good personal hygiene, handwashing and wearing a mask while skin to skin with baby and while breastfeeding; that breastfeeding is something that can be supported.
So, here in Evergreen, we have again, it’s an informed care decision making model. And so we present families with the safest recommendation that we have at this point is to completely separate mom from baby. Just to say it’s challenging, minimizes it. It is incredibly challenging to imagine being separated from your baby especially if you are stable. So, someone who is very sick, and who wouldn’t be able to care for their baby, because of COVID-19, then of course then separation makes a lot of sense. Now of course, for our families who are saying what if I test positive, I’m feeling well, and I’m doing well.
Again, the kind of most black and white way to look at this recommendation is there is a distinct separation between mom and baby. Which means baby is not in the room with mom. However, there is pretty good evidence that while – if we can keep baby safe in an isolette, do these are kind of often when babies are quite sick and they need to be transferred from the maternity unit to our NICU unit, these are the kind of little incubators that babies are in. They are see through. You can see baby. You can touch baby through them, through an area that allows you to get into the incubator. We’re encouraging that moms who would prefer to have their baby in their room but are also understanding the significance of COVID and would like to continue to do some distancing, that we have baby in these isolettes. It will help them keep warm and stable whenever they are not skin to skin or breastfeeding with mom. And when they are skin to skin or breastfeeding with mom, that mom or whoever is taking care of that baby is masked. If they or anybody in their household has tested positive for COVID.
Host: Wow. Such a comprehensive answer Jennie. Thank you so much and before we wrap up, how can you help couples manage expectations and try not to stress out too much? Give us your best advice, at this time when their expecting a baby. It’s just such an exciting time and such a scary time all at once even under normal circumstances. Help us out here.
Jennifer: Yeah. Well what I would say to all pregnant families and pregnant people, it’s stressful often having a baby. Sometimes that stress decreases a bit when we’ve had babies before. But the situation that we’re currently in, the COVID-19 has really thrown a lot of unknowns into our general environment, right and in general, pregnancy and birth is unknown even when we’ve had babies before. So, what I would reassure families and specifically pregnant people is that you’re not alone. That so many people are going through the same stresses and worries that you are and that your care providers are well-versed in kind of talking you through and it’s normal to feel what you’re feeling. In general, when we’re headed towards labor and delivery, there’s a loss of control that is a little scary every single time and it just so happens that right now we’ve got a little bit more out there in the world that makes things feel a little bit more uneasy.
So, what I would say is you’re not alone. The uneasiness is normal and ask as many questions as you can and know that your care providers, your nurses, midwives, physicians that are around you have you and your baby’s best interest in mind and we’ll give you all the information that helps you best take care of baby. And really, everybody’s hearing it over and over. The best thing you can do is if you don’t need to be out, stay in. if you are touching any door handles or things that other people are touching in the public environment, that we are really washing our hands with soap and water as much as possible using hand disinfectant in the interims when that’s not possible and really masking at all trying to keep our distance from people who are not in our direct home environment.
Host: Great information Jennie. So, well put and such a good hopeful message for expectant parents that you’ve given today about the safety of delivering their baby at EvergreenHealth. We invite you to reach out to your provider if you have questions about the safety measures EvergreenHealth is taking to ensure the wellbeing of mothers and their families. To stay up to date on information regarding COVID-19, please visit the Coronavirus Hub. That concludes this episode of Check-up Chat with EvergreenHealth. Please remember to subscribe, rate, and review this podcast and all the other EvergreenHealth podcasts. I’m Melanie Cole.