Birth during COVID-19 Pandemic
Birth during the COVID-19 Pandemic
I’m Sarah with Expecting and Empowered! I’m a pelvic floor physical therapist at Krystle’s clinic! You may have seen me in the Facebook group, doing some writing on the E&E blog, and also providing E&E Online Sessions. My second baby, Lucy was born on 6/18/2020. Over the last 4 weeks I’ve taken some time to reflect on both of my birth stories. I’m hoping my experience as a second-time mom and pelvic PT will be helpful for both new and repeat mamas. I’ve been induced and gone into labor naturally, had an epidural early on and an epidural later in the process, sustained some birth trauma the first time and had a relatively easy postpartum course this second time. I’ve linked relevant content along the way to help people with labor positions, provide some insight on pushing with an epidural, and will conclude my story with some solidarity for other pregnant and newly postpartum women during this worldwide pandemic.
For background, my first baby came at 37 weeks +1 day. I had what was (almost) a premature rupture of membranes, meaning that my water broke even though I was not in active labor. When your water breaks for many medical providers it starts a 24-hour clock within which you must have your baby due to increased risk of infection. For this reason, I was induced. Having an induction meant I was given the drug Pitocin through an IV to stimulate my uterus to contract. Despite receiving Pitocin, it was difficult to get me into active labor. It ultimately required not only a lot of Pitocin, but also re-breaking my water and an epidural. Due to the continuous fetal monitoring that is performed when somebody receives intravenous Pitocin, I was relatively chained to the space in and around my bed. The way they monitor your baby is to strap a device to your tummy with a flimsy elastic band that slips around like crazy and needs constant adjusting to get good information on the baby’s heart activity. Even though I could have (and probably should have!!) walked around pre-epidural, these were not choices that felt like they were an option (even though they totally were!!). Sixteen hours later, it was time to push! Like many women are told, I was told to hold my breath and bear down AS HARD AS POSSIBLE to get the baby out ASAP. I had a 2nd degree tear that very nearly entered the territory of 3rd degree ( see our post on Healing from perineal tears). Even though I was a pelvic floor therapist and “knew better” I still succumbed to the pressure put on my by the OB, L&D nurse and everyone in the room. My daughter had an NICU stay for a few days but ultimately we took home a healthy baby girl.
Fast forward to 2020. A global pandemic is happening and nobody knows for sure what the right answers are for women in pregnancy. I listened to podcasts, read medical news and journals, and tried desperately to find any quality information on best practices for birth during COVID-19 (shout out to the Evidenced Based Birth Podcast, highly recommend). I was fortunate enough to have had my 20 week ultrasound (where they show you all your baby’s growing body parts!) pre-pandemic, so my husband was able to attend. My heart really goes out to women who had to do all their appointments without a partner, especially those “big news” ultrasounds.
I finally went into labor the night before my scheduled induction on my due date. Because the initial plan was an induction, I was instructed to go the day before to get my COVID test completed. If you’re not having a planned induction or c-section, they’ll likely want you to do a rapid COVID test when you arrive at the hospital to have your baby. Drive-thru COVID testing was terrifying, it truly felt like something out of a horror movie to have all these healthcare workers in full face shield/Personal Protective Equipment (basically looking like a Haz-Mat suit) shove Q-tip ALL THE WAY through my nose into my throat. I cried real tears driving back home because it was so unnerving.
I was fairly uncomfortable in the day preceding the start of my labor. There were definitely contractions happening, but nothing through which I couldn’t continue on with my day. After shutting my laptop for the day at 7PM, I stood up and my water broke! After shoving dinner down our faces and quick showers, we went to the hospital. I was certain I was imminently going to have our baby, contractions were about 3 minutes apart and I was certain they were STRONG. Since I was COVID-negative, we were admitted and treated as such (no special COVID unit, Matt had freedom of movement about the hospital provided he wore his mask). I stripped down into the hospital gown, reluctantly let them insert a capped IV, and I got ready to greet my child. The hours passed and things got INTENSE. I was so certain that I would certainly be able to handle labor naturally this time around without an epidural. I knew all the different positions and used most of them for at least a short period of time at some point (Positioning for Labor and Delivery). The issue for me was that my labor was was ALL in my back. It was tough. After pacing the room and trying every position in the book, I went into my zone with breathing and spent a few hours on my hands and elbows clutching a large bean bag pillow for dear life. My husband did an amazing job giving me counter-pressure through my hips, and honestly that was the only thing that kept me going as long as I did. IV pain meds took the edge off for an hour but honestly it didn’t really do too much. I had my water broken (again). I kept praying and praying I would progress and be ready for my babe at any minute… but my cervix just would not dilate past 5-6 cm (10 cm being the goal). Finally at 4AM, I told my L&D nurse in no uncertain terms that I needed an epidural…. NOW! My body, I think, was fighting the pain and would not progress to the next stage of labor. I was also acutely aware in my mind that I needed to reserve some strength to push this baby out. I was SO TIRED after laboring though the night. Mercifully, the epidural allowed me to progress. After a little 30 min nap, I was in transition to the 2nd stage of labor and ready to push.
My only problem now is that I was NUMB with this epidural… super numb. The epidural with my first birth was amazing… I felt no pain with a STRONG urge to push and Ava was in the world in 15 minutes. (I will re-iterate here that I don’t believe this is actually a good thing she came out so fast the first time. The way I got her out was with incredibly high-pressure pushing. After delivery the first time I had lightheadedness, vomiting, and a large perineal tear from holding my breath. I had to hand my Ava back within a few moments of holding her for the very first time to vomit repetitively into a bucket).
My epidural was different with this second birth. Grateful as I was for the pain relief, I could not tell when a contraction was happening at all due to the complete lack of any sensation. All the cues from own body letting me know when it was time to push were erased. Knowing that pushing is more effective when coupled with uterine contractions, I asked my nurse to help me by telling me when a contraction was peaking so I could push at the right time. My nurse was very supportive of my goal of directing my own pushing (see our blog on Breathing and Pushing during Delivery). She had me feel my baby’s head, and gave me a TON of helpful feedback on the pushes that were productive and those that were not. I will give this advice to all mamas out there.. pushing without holding your breath will probably take longer. This is okay. A hospital-based medical team will not want you to do it this way, I had to really advocate for myself that I AM NOT GOING TO HOLD MY BREATH!! The OB and everyone else in the room was trying to tell me to “just do it” i.e. hold my breath and forcefully close my throat and bear down hard. I was not in distress, the baby was not in distress… there was NO reason why I needed to hold my breathe and aggressively bear down to get this baby out.
My confidence in my ability to use my abdominals while exhaling combined with the helpful feedback from the nurse is what allowed me to be successful. Without all the the E&E workouts, there is no way I would be as in-tune with my body. I think a hand mirror would have been very helpful as well so I could have seen my baby crowning and what each push was doing for myself. At the very end, I did need to do a few pushes holding my breath to get the baby out. But I firmly believe that knowing how to switch between open-airway (also known as self-directed or open-glottis) and breath-holding (also known as directed, closed-glottis) strategies was very helpful to decrease the trauma to my pelvic floor. For some further “light” reading, see this journal article HERE.
The medical staff had a difficult time positioning me comfortably, I really would have preferred to give birth on my side. I did end up giving birth on my back. At E&E we talk about how much better it is for the vast majority of women to give birth in a position other than your back. I had already made a big stink about self-directed pushing, and I didn’t feel like fighting any more. The average hospital-based birth team generally do not acknowledge how delivering a baby on your back is not ideal for most women. My hope is that other laboring women will be stronger where I was weak in this regard and make the medical team reposition them to a side lying position to take pressure off the pelvis and pelvic floor. This was a concession for this birth that I regret making. At the end of it, my beautiful Lucy came out healthy and screaming :)
Giving birth during a global pandemic at a community hospital in Milwaukee did not feel all that different from my first birth. The staff was wearing more personal protective gear and we did not have as much freedom of movement around the hospital, but the actual birthing part was similar. What was different this time around was the lack of visitors immediately after the birth. As second time parents, it was actually incredibly nice to just have that time to ourselves with our new baby in the hospital. It was wonderful not to have to worry about covering up to breastfeed or trying to make myself look halfway presentable for a continuous line of friends and family to visit.
Coming home, however, was a vastly different story. My parents don’t live in WI and it was an extended conversation as to whether or not my mom would come. While my responsibly quarantined in-laws were able to help us, my heart was heavy that we couldn’t have friends and extended family come over and see and hold our baby as we normally would have done. The constant tension of trying to decide what feels safe, and the feeling that any new person is risky to your newborn is incredibly stressful for any new parent. There are currently unique and awful circumstances preventing new families from introducing their baby to loved ones and getting the help they deserve. New mamas need in-person support and it feels particularly cruel that this is being ripped away from women at a time when they truly could use it the most.
I am incredibly lucky in so many ways, and I am also glad that this was not my first go-around with birth. This is a particularly difficult time to have a new baby. If you or any mama you know needs some support, I encourage people to reach out to their loved ones, mental health providers, and this Expecting and Empowered community. We are here and will continue to be here to serve and support our mamas and their families! I’m navigating my early postpartum period, postpartum guide in hand, here with you :).
Email Sarah at expectingandempowered@gmail.com or onlinesessions@expectingandempowered@gmail.com