- Michael Tonn
At 37 weeks pregnant, Teal Chalek of Shelburne is in what some call the "nesting" phase. The term refers to the tendency women in their third trimester of pregnancy often have to stay close to home — cleaning, organizing and stocking up on essentials — in preparation for the baby's arrival.
In Chalek's case, however, the nesting is not just self-imposed; it's state-mandated. In response to COVID-19, Gov. Phil Scott has issued a "Stay Home, Stay Safe" order, asking Vermonters to stay home, except for essential outings, until at least May 15. For women preparing to give birth, the typical concerns that accompany pregnancy — Will my labor go smoothly? Will my baby be healthy? — have been compounded by a whole new set of worries, ones entirely unique to this moment.
Due to the pandemic, Vermont hospitals have changed their labor and delivery protocols, forcing pregnant women to adapt or find alternative options. Chalek said that every week she's been checking the website of the University of Vermont Medical Center, the hospital where she will give birth, to keep current on the latest changes. (See sidebar for more on new hospital protocols.)
She knows that when she arrives at the hospital, both she and her husband will be screened for coronavirus symptoms and have their temperatures taken. One of her biggest fears, she said, is that her husband will get sick or fail the screening and won't be able to accompany her during the birth of their first child.
Another adjustment for Chalek: She won't be able to have any family or friends visit in the hospital or when she returns home. UVM Medical Center, along with other hospitals around the state, is allowing just one support person per laboring woman, and no postpartum visitors. Chalek was by her sister's side when she gave birth last summer, and had hoped her sister would be there with her.
"Typically, our families would hop right in the car the second we got to the delivery room," said Chalek.
In spite of these changes and more — canceling her baby shower, missing out on a tour of the hospital, worrying about virus exposure while opening packages of baby gear ordered online — Chalek is attempting to keep things in perspective. She's managing her stress by taking online yoga classes, and she's trying not to lose sight of the fact that having a child is still a huge reason to celebrate.
"I know the baby will bring us a lot of light and joy during a pretty dark time," she said. "I keep trying to remind myself that things aren't perfect, but everything will be OK in the end."
Amelie Thurston, nurse educator at UVM Medical Center's Birthing Center, wants to reassure women like Chalek that, though hospital policies have changed, "the Birthing Center feels very much like it always has."
When COVID-19 first hit Vermont, Thurston said, there was concern about how overwhelmed hospitals would be during the virus' peak. But now, there is a sense that Vermont is managing the pandemic well and flattening the curve. "Anxiety has decreased," she said, and there is greater calm among the Birthing Center staff.
Hospital or Home?
Still, some women who never before contemplated home birth are entertaining the idea. In the early days of the outbreak, Chalek started researching home birth, but she didn't pursue it for several reasons. She wanted the option of getting an epidural for pain relief, and she felt she was too far along in her pregnancy to make a big change to her birth plan. She also wondered what would happen if she found a midwife she liked who then ended up getting sick.
Over her 25-year career in Vermont, Peggy Cohen of Burlington's Full Spectrum Midwifery has delivered hundreds of babies, mostly at home. In recent months, she's had an uptick in calls from pregnant women — from the early stages to the last trimester — who were planning to have a hospital delivery but were now interested in home birth.
Some expressed worry about being exposed to the coronavirus at the hospital or having their partners turned away during the hospital screening, Cohen said. Others wanted their older children to be present at the delivery or soon after the birth.
To see whether a woman is a good candidate for home birth, Cohen first does an evaluation based on factors such as medical history and how smoothly the pregnancy has gone up to that point. If a woman qualifies, she can transfer her care to Cohen. And for several weeks after the birth, Cohen visits families to provide postpartum care.
"The beauty of the kind of service we share with people is, we do have a very low volume of clients compared to hospital-based practices, and we do more home visits," she said.
On April 16, Cohen delivered Lucy Chapin's son, Will, at home in Moretown. Chapin is a nurse-midwife at the UVM Medical Center. Pre-coronavirus, she was planning to give birth at the hospital, using a fellow midwife in her practice.
But, said Chapin, the pandemic spurred her and her partner to think about their most "pressing priorities" for her son's delivery. In addition to wanting a safe birth, they hoped their daughter could be present during the delivery. The 5-year-old had been preparing for her sibling's arrival by accompanying Chapin on prenatal visits, watching birth videos and acting as a "mini midwife" by using the Doppler to find the baby's heartbeat.
When visitor guidelines changed at the hospital and Chapin learned that her daughter would not be able to attend the birth, the family started thinking more seriously about home birth. Though she was already 35 weeks pregnant, Chapin had attended home births as a doula and in her midwife training, and she'd also had a low-risk pregnancy.
Chapin delivered baby Will in her bedroom — she described it as a "peaceful and powerful water birth" — with her partner and daughter attending, along with midwife Cohen and midwife apprentice Shari Corr.
Though her decision "was not born out of any fear of giving birth at the hospital," Chapin said, citing the UVM Medical Center's "organization and skillful response" to this crisis, she feels that the home birth was the right choice for her family. Of her daughter witnessing the birth, Chapin said, "I have a feeling she will be bonded to her brother through this experience forever."
'On the Other Side'
Elise Schadler of Burlington labored for 29 hours before giving birth to her second child — her daughter, Margot — on April 3 at the UVM Medical Center.
"I was really nervous about being in a hospital and if it would feel like a safe space, and it absolutely did," she said. "I really appreciated how calm and peaceful and normal it felt up there. I think it went exactly how it would have gone if [COVID-19] wasn't happening."
Still, she said, "I'm overwhelmingly thankful that it's over. I'm happy that we're on the other side."
When her son, Finn, was born two and a half years ago via C-section, Schadler stayed at the hospital for four days and had multiple visitors daily.
"That was such a defining feature of being up there with Finn," she said. This time, the hospital felt like a "ghost town." Because she was confined to her room, both during labor and delivery and in the Mother-Baby Unit, she didn't see a single person who wasn't part of the hospital staff during her stay.
Schadler's parents self-quarantined in Massachusetts before traveling to Vermont to care for Finn during Margot's birth. They planned to stay a few weeks to help out, but Schadler worried about how her household would fare once they returned home.
Before the coronavirus, she had planned to keep Finn in childcare while she was home with newborn Margot. And she'd been looking forward to the kind of community support she got when Finn was born, including a meal train. But with childcare centers closed and people stuck at home, she's left to wonder what life will look like for the next few months.
"It's the fear of, What are we going to do here with a toddler and a little girl and a husband who is going to have to go back to work?" said Schadler. "It's going to be rough, but we'll get through it."
What to Expect When You're Expecting — During a Pandemic
Around 2,000 families deliver babies at the University of Vermont Medical Center's Birthing Center each year. Here's what you need to know if you are one of them with an approaching due date.
Prior to a woman coming into the hospital to give birth, explained Birthing Center nurse educator Amelie Thurston, she should call her practitioner, who will do a phone assessment to check for symptoms of COVID-19 or exposure to the virus. At the hospital entrance, there will be an additional screening, including a temperature check.
At the Birthing Center, all women being admitted — even those who are asymptomatic for COVID-19 — are now being given a nasopharyngeal test for the virus. It is sent to the hospital lab, and results are available in roughly three and a half hours, said Birthing Center nurse manager Sandra Sperry in a Facebook Live information session on April 23.
This universal testing model is being done to protect staff, moms, babies and the community, said Thurston. It's based partly on information from areas of the country with a higher number of coronavirus cases; some asymptomatic women have developed complications very abruptly after giving birth, and then have tested positive for COVID-19.
If a laboring woman tests positive for COVID-19, additional protocols will be enacted, explained Sperry. If possible, she will be moved to one of several negative-pressure rooms in the Birthing Center to prevent airborne illness from escaping. Hospital staff entering the room will wear N95 masks, face shields, gowns and gloves at all times.
If a laboring woman's test is positive, her support person will also receive a coronavirus test. If the support person tests negative, he or she will be designated the baby's healthy caregiver. The hospital staff will also discuss with the birthing woman the risks of transmitting the virus to a newborn — the Centers for Disease Control and Prevention recommend the separation of a COVID-19-positive mother and her baby after delivery — so that the parents, along with a pediatrician, can make an informed decision.
Regardless of the COVID-19 status of the laboring woman, all medical personnel are required to wear masks at all times, and Thurston said they are asking both laboring women and their support people to wear masks — brought from home, if possible. She acknowledged that wearing a mask during active labor is not always feasible.
If needed, consultations with anesthesiologists and Neonatal Intensive Care Unit staff are being done via Zoom to minimize people coming into the birthing rooms, said Sperry.
Pre-coronavirus, women were encouraged to move around the Birthing Center, and they often walked the hallways while laboring. Now, women must stay in their assigned room, though they're still allowed to move freely inside it. If they would like something from the Birthing Center refrigerator, hospital staff will bring it to them. In the Mother-Baby Unit, no visitors are permitted and postpartum women must remain in their rooms, unless they've had a C-section and ambulating outside the room is part of their care plan. The hospital cafeterias are still open, said Sperry, and food can be ordered by phone and delivered directly to patients' rooms.
Because a woman's support person is not allowed to leave the hospital and come back, except in the case of an emergency, families should make sure they have reliable childcare and pet care during their stay. Thurston also encourages women to have a backup support person in case their first choice is sick or doesn't pass the hospital screening.
Thurston said there's been an increase in women who are opting for early discharge from the hospital after giving birth, often around 24 hours postpartum. As long as it is safe and feasible, she said, the hospital is supporting those decisions.