Childbirth in the time of COVID: MUSC Health team strives for as normal an experience as possible 

There’s no shortage of things to worry about when you’re pregnant. Add in a global pandemic caused by a disease that doctors are still learning how to treat, and it’s natural for a pregnant woman’s anxiety levels to go through the roof.   

One Charleston woman  is on the other side now, home with her month-old baby boy, and she encourages other pregnant women to take COVID-19 seriously  but not let it deter them from getting health care for themselves and their babies.  

“I had a lot of anxiety during pregnancy about all of this,” said Ellen Burnette. “Once I spent an entire week at the hospital with the baby, I  felt a lot more comfortable with the process of delivering at a hospital.” 

"Once I spent an entire week at the hospital with the baby, I  felt  a lot more comfortable with the process of delivering at a hospital.” 

Ellen Burnette

Burnette stayed after she was discharged so she could be with her son, Noah, in the neonatal intensive care unit at MUSC Shawn Jenkins Children’s Hospital and Pearl Tourville Women’s Pavilion. He arrived a few weeks early and managed to pick a peak COVID time to make his appearance – on the day he was born, MUSC Health Charleston was caring for 108 COVID patients. Nonetheless, Ellen, husband Aaron and little Noah went home safely.   

“I loved all the people who took care of me, and they made me feel really confident and very supported. I would do it again. It was awesome,” Burnette said.  

Burnette and her husband found out she was pregnant right after Thanksgiving, before anyone in the U.S. had even contemplated what 2020 might bring. Her first couple of prenatal visits were typical, but once the pandemic swept over the nation, MUSC Health tightened up its policies for prenatal visits.  

David Soper, M.D., vice chairman of the Department of Obstetrics and Gynecology and senior medical director of women’s health, said that prenatal visits are being conducted as a combination of virtual and in-person visits. The in-person visits are those at which a test will be performed, whether a blood draw, ultrasound or gestational diabetes test, or other care must be administered – for example, for those women who are Rh negative and need a RhoGam shot. In-between visits can be conducted virtually.  

One support person is allowed at each in-person prenatal visit. Burnette was thankful that her husband could come to each visit, as she had pregnant friends elsewhere whose  partners weren’t allowed in.  

“Even the first ultrasound, at 12 weeks, it was mind-blowing for both of us. You couldn't really see him or feel him yet, so when we saw him on the screen, it was like, ‘Oh,  my God, it’s real,’” she said.  

Burnette’s pregnancy progressed normally until 36 weeks, when she began bleeding. She and her husband headed to the hospital, where the medical team performed multiple tests but couldn’t find any reason for the bleeding. She was told to go home but to return if the bleeding continued. When she was still bleeding the following morning, July 12, the couple returned to the hospital. This time, as the team was checking her over, her water broke, and she was admitted.  

MUSC Health performs COVID testing on everyone who is admitted, regardless of reason. This allows the hospital to keep all COVID patients together and away from patients who have tested negative. Pregnant women who know when they’ll be admitted, because they are scheduled for cesarean sections  or inductions, are asked to schedule their COVID tests prior to admission.

Moms who show up in labor are initially placed in a negative pressure room and tested for COVID-19 on the spot.  

“It was not as bad as I thought it would be,” Burnette said. She said everyone had to leave the room for 30 minutes, including Aaron, because the test itself can release the virus into the air if the patient is infected. A nurse in full personal protective equipment (PPE) entered and performed the test, which, Burnette said,  felt a little like the pressure that happens right before a nose bleed. Then Burnette waited out the 30 minutes by herself. Once the time was up, people began to reenter the room, and when the test showed that she wasn’t infected, she was moved out of the negative pressure room to a labor and delivery room in the COVID-free zone.  

"Our use of masking, handwashing and PPE has been very effective in preventing hospital transmission of COVID."

Dr. David Soper

Had she tested positive, then the care team would have also administered an antibody test. Although people can test positive even after recovery, because virus particles remain floating in the bloodstream, if they also have antibodies, then it’s likely been at least two weeks since they were infected, and thus researchers think they are unlikely to be infectious.  

Margaret Dowling, nurse manager of the labor and delivery unit, said women in labor who test positive for COVID-19 are still allowed one support person.  

“Who wants to have their baby by themselves?” she said.  

The staff is vigilant about safety, though. Nurses are assigned to either COVID or non-COVID patients so they aren’t going back and forth between the two, and staff members watch each other as they put on – and especially as they take off – their PPE to ensure layers are removed in the correct order.  

“Our use of masking, handwashing and PPE has been very effective in preventing hospital transmission of COVID,” Soper noted. 

 

Patients and visitors have their parts to play, too. 

“We ask patients to wear masks, whether they’re COVID positive or not, if they can, their whole time here,” said Katy Decker, nurse manager of the mother-baby unit.  

If the mother has COVID, then her support person is asked to remain in the room with her for the entirety of her stay. Nurses will bring food to the room. If she doesn’t have COVID, then her support person is free to go to the cafeteria or even home but is asked to consolidate trips so as to limit their exposure to others.

Dowling and Decker noted that women who are about to deliver aren’t the only ones in the Pearl Tourville Women’s Pavilion. Women who are admitted to the hospital with COVID complications and also happen to be pregnant will be cared for in the pavilion, regardless of how far along in the pregnancy they are. Because a low oxygen level is one of the complications of COVID, the health care team needs to be able to monitor the baby as well as the mother to ensure both are getting enough oxygen. If the woman becomes very ill, she may be transferred to the intensive care unit in Ashley River Tower, which is connected to the women and children’s hospital by a skybridge. 

At one point in July, Dowling said, the pavilion housed nine COVID patients. Four were delivering but five had been admitted because of COVID complications. Those five recovered and went home without delivering, she said.  

Burnette, who was admitted around 10 a.m. on a Sunday,  but didn’t deliver until 7 p.m. the following day, said the labor and delivery experience was great.  

“The whole team was so nice. Aaron was blown away. He said, ‘I watched the whole thing,  and I thought I wouldn’t. It was so beautiful,  and it was nothing like on TV. It’s not scary!’ The whole experience was so awesome,” she said.  

 

Unfortunately, upon delivery, little Noah wasn’t breathing well.  

“I could tell they were having trouble getting him to cry because they were like, ‘Hey buddy, come on. Come on. It’s your birthday; let’s hear you talk. Come on.’ And there was no sound. There was a little here and there,” she said.  

After a brief goodbye, Noah was whisked away to the stabilization room, and Burnette was taken to the mother-baby unit. Around midnight, the medical team said she was stable enough to visit the NICU in a wheelchair.  

“Of course it didn't even look like my baby. He looked like a very sick baby with a million cords and monitors and IVs and breathing tubes and craziness all over him. That was very emotional,” she said.  

Burnette spent most of her hospital stay, even before she was discharged, in Noah’s room and continued to stay there after she was discharged.  

If Noah hadn’t needed NICU care, the two would have stayed in a room together on the mother-baby floor.

Rooming protocols 

Pediatrician Michelle Amaya, M.D., and neonatologist Julie Ross, M.D., developed the hospital protocol for how to handle a newborn whose mother tests positive for COVID-19. Amaya said that the American Academy of Pediatrics initially recommended separating newborns from mothers who test positive. That obviously caused a lot of distress, so the MUSC Children’s Health team came up with a three-pronged approach for the regular nursery.  For the sick babies requiring care in the NICU, separation continues to be recommended.

Working together, parents and the care team would decide upon the strategy for each family. In the first scenario, recommended by the AAP as the safest option, the baby would be cared for by a nurse in a separate room. In the second, the baby would room-in with the asymptomatic caregiver designated by the mother. The caregiver would need to stay in the room with the newborn and would not be able to go to the mother’s room. In the third, the baby would room-in with the mother and her chosen healthy support person. Both mother and support person would wear a mask at all times; wash hands vigilantly, but especially before handling the baby; and roll the bassinet six feet away when not actively caring for the baby.  

Most people, Amaya said, chose the third option of caring for the baby in the mother’s room while taking safety precautions. The care team also likes this option because it allows them to model safe care techniques for the family to continue using when they go home. And the AAP recently validated that approach, indicating it has so far found no difference in the infection rates of newborns whether they were cared for by a nurse outside the room or by the masked mother using careful handwashing inside the room, Amaya said.  

Amaya estimated that the regular nursery has cared for about 30 babies born to COVID-positive women in the last five weeks. Decker said the staff has remained upbeat, even amidst the stress. Just like the rest of the community, staff members are tired of isolation and social distancing. But they’re also the ones who must deal with the results of people not abiding by public health guidance.  

Dowling and Decker both noted they are constantly updating their staffs on the latest COVID guidelines as researchers learn more about this disease.  

“It's an ever-changing atmosphere,” Decker said.  

As for the Burnette family, they are deep in those newborn days of feed, diaper, sleep and repeat. Noah has regained his birth weight, and his parents are delighted with him.  

“I would totally do the whole thing all over again,” Burnette said.