Birth rates have been declining in the United States for years, and they only continued trending downward during the COVID-19 pandemic. Still, nearly 300,000 patients gave birth every month throughout the pandemic, according to the United States Census Bureau.¹ As the close-contact nature of childbirth contradicted essential COVID-19 protocols, a series of new challenges confronted labor and delivery healthcare staff, birthing patients, and their families.

These challenges led to the creation of new safety guidelines in every childbirth setting—many of which could influence the practice of delivery far beyond the pandemic.

1. Limitations on Visitors

In the early days of the pandemic, some had to give birth without their partners present.² Hospitals have since relaxed this requirement, but strict limits remain on how many guests may visit postpartum. Clear communication about visitation policies and the reasons behind them have proven helpful in minimizing the frustration of patients and families, reports The American Journal of Maternal Child Nursing.³ The journal suggests that video communication tools can help relieve the separation stress caused by these protocols.

The authors also emphasize that hospitals and healthcare providers must be careful to consider the unintended consequences of COVID-19 protocols on patients and their families. Restrictions that erode emotional support, for example, may lead to increased risk for postpartum mood disorders. Mitigation strategies may include enhanced screening for these concerns.

2. Reliance on Technology

In addition to connecting patients to their loved ones, technology has made it easier for staff to provide high-quality care while minimizing contact—and inadvertent transmission—with patients.

- Video conferencing allows subspecialists to provide consultative services, hospital chaplains to impart spiritual guidance, and counselors to offer emotional support without the risk of infection.
- Electronic fetal monitoring minimizes the need for frequent bedside care to evaluate fetal well-being so that even one or two staff members can manage multiple active laboring patients at once.
- Fetal spiral electrodes⁴ have also found a new utility in the age of COVID-19, allowing for continuous fetal monitoring during labor without the constant need for readjustment of an external Doppler belt.

Learn more about the unique role fetal spiral electrodes play in labor and delivery.

3. Precautions for Staff

Minimizing interactions between nurses and patients is part of a larger effort to prevent potential COVID-19 spread throughout the unit, says the American Journal of Obstetrics & Gynecology.⁵ Limited contact with patients contradicts what bedside labor and delivery nurses are trained to do, but it has become necessary in a time when it's safest to assume that every mother is potentially infectious. (Because most units are often unable to screen patients for COVID-19 who arrive at the hospital in labor due to either time or testing constraints, universal precautions are common.⁶)

Most labor and delivery units also maintain rooms or wards for patients who are known to be COVID-positive, providing a space where healthcare workers can treat them in isolation. Unfortunately, many COVID-positive parents must also isolate themselves from their newborns for extended periods of time, creating unique issues with bonding, breastfeeding, and newborn care.

4. Shorter Stays Postpartum

As long as there is no increased harm to the patient or newborn, shorter hospital stays have become much more common. A study published in the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine found that after COVID-19 protocols were implemented, 49% of the study's participants had postpartum stays of only one night after vaginal delivery.⁷ Surprisingly, the percentage of patients who stayed two nights or fewer after cesarean delivery was reported at 41%.

These shorter stays—compared with a more traditional stay of two days after vaginal delivery or three or four days after cesarean—were not associated with an increased risk of adverse outcomes for the patient or newborn, potentially marking a change in management that continues beyond the COVID-19 pandemic.

Resiliently Carrying On Despite Constraints

Since early 2019, labor and delivery healthcare staff have had to take on larger patient assignments, work longer hours, and manage more acutely ill patients than usual—all in a resource-scarce environment. Meanwhile, pregnant patients have found themselves with anxieties and questions about how COVID-19 might affect their birthing experience.

However, when they work together, healthcare staff and expectant parents can navigate these new constraints while still achieving healthy and safe deliveries.

Howard Herrell, M.D. is an award-winning teacher and respected vaginal surgeon. He writes about OB/GYN in general as well as evidence-based medicine and value-based care. He is known internationally for his innovation in vaginal hysterectomy. He is based in Greeneville, TN, USA.

REFERENCES

1. https://www.census.gov/library/stories/2021/09/united-states-births-declined-during-the-pandemic.html

2. https://www.abc.net.au/news/2021-07-15/partners-banned-visiting-newborn-babies-blacktown-hospital-covid/100296208

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373388/

4. https://services.gehealthcare.com/gehcstorefront/p/2109004-001?catalogCode=01&keyword=2109004-001

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