COVID-19 and maternal-child health

From the Reproductive Health MIG - Care in the Face of COVID-19

I left for a global health trip to Costa Rica on March 7. We had discussed cancelling the trip, but were told as long as we wore masks and practiced hand hygiene at the airports we could still go.  At that time, Costa Rica was a safe country for travel. That all changed while we were there; the in-country organization decided to send us home early without finishing all of our clinics. Since we arrived, the cases in Costa Rica climbed from one to 26.  For the first time in my ten years of doing these trips, we were evacuated early. The CDC guidelines at that time did not say we needed to be quarantined, but our institution wanted to be safe and placed us on self-quarantine when we returned. Sadly, that meant our students would miss Match Day! A few days later, Match Day and all large gatherings were cancelled for all medical students everywhere as the pandemic worsened.

For maternity and newborn care we are following Society of Maternal and Fetal Medicine Recommendations.  You can also reference updated guidance from the CDC, ACOG and SMFMR for pregnancy and post-delivery.  An essential thing we are doing on the outpatient side is spreading out in-person prenatal visits for average-risk patients, and using telehealth options for in-between visits. For patients that need more frequent visits for antenatal testing, we must be cautious with when we start that testing, for what indications, and at what frequency - to minimize visits and decrease the risk of exposure. We are also recommending that pregnant patients, and all pregnant providers/health care workers, stop working at 37 weeks if possible to decrease risk of having COVID-19 at delivery, as that would require separation from the newborn  for at least two weeks. Small sample sizes have shown no virus in amniotic fluid or breast milk so far, but it is too soon to say this with certainty. We are allowing one support person to be with the patient during labor. If a maternity patient is positive for COVID-19 or is a patient under investigation, they will be separated from the newborn and both patients will be in isolation. The healthy caregiver for the newborn will be able to feed expressed breast milk to the baby if that is the desired feeding method.

SIU's Harry Lausen, DO (left) and OB colleague Ricardo Loret  de Mola provide a Facebook update on maternity and newborn safetyAs a whole, we are doing mostly telehealth visits, with some visits for chronic disease management and urgent issues with the residents.  We are also conducting prenatal visits and well child visits if immunizations are due. We are screening all people for symptoms before they enter our building and the hospital is doing the same. The community has two drive-thru respiratory clinics set up for any patients with symptoms. We are all working differently than we ever have before. But in true family medicine fashion, everyone started volunteering for different roles and redeployment immediately. Despite these scary times everyone--from Environmental services to our department chair--is working to their best abilities to continue caring for our community and show that we are "SIU STRONG."

Dr. Wells is co-chair of the Reproductive Health Care Member Interest GroupShe is a past president of IAFP and owner of Be Well Health, a direct primary care practice in Springfield  

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