Pregnant women around the world often follow a similar to-do list. After finding a prenatal vitamin, they book doctors' appointments, birth classes and interviews with area pediatricians. They get on a waiting list for a local day care and talk to their bosses about maternity leave.
A worldwide pandemic, though, has shoved those to-do lists into the bottoms of purses and desk drawers, hidden beneath masks and hand sanitizer and Clorox wipes.
"Everyone says, 'Here's what you're supposed to do,' but we can't do any of it," local digital marketing manager, Justine Palkowski said. She is 34-weeks pregnant and hasn't seen her doctor since March. Palkowski's obstetrician is operating at half staff, rotating doctors and nurses to limit the number of people in the office at any given time.
As a first-time mom, Palkowski is navigating new territory without the usual support many women find in prenatal yoga classes, in-person birth classes and from local doulas and consistent doctor appointments.
"You can talk to other moms and read all the baby books, but it all goes out the window," said Palkowski.
The coronavirus pandemic has shattered any sense of normalcy pregnant women may expect during an already emotionally and physically demanding time. The new normal features masks, social distancing and a lot of self-quarantining. But it also includes real fears about the unknown effects of a highly contagious, potentially devastating virus on expecting moms and their unborn children.
"There's a lot of fear and anxiety out there," said Dr. Scott Sullivan, vice chair of MUSC's department of obstetrics and gynecology. "Patients are afraid of getting it themselves and afraid of infecting fetuses and babies. They're afraid of being separated from their babies — and of being alone."
As of July 23, the Centers for Disease Control and Prevention (CDC) reported that recent studies suggest pregnant women with COVID-19 are more likely to be hospitalized and are at an increased risk for admission to intensive care. But, the CDC added, "Much remains unknown."
Sullivan said people's fears about the virus are generally "well-founded," but pregnant women should be careful not to panic about their experiences. Stress, after all, is not good for the baby.
The stress of not knowing what may happen to you or your child if you contract COVID-19 is bad enough, but the pandemic is the cause of more than just health concerns. Sullivan works with a lot of women employed in the hospitality industry who are afraid they may lose their jobs if they haven't already. "It's a terrible time to have your livelihood threatened," said Sullivan, who notes that South Carolina's Medicaid program is actually "fairly generous" with pregnancy coverage for those who need it.
The financial impact of the pandemic and restrictions on who can be in the labor and delivery room has led some women to make last-minute adjustments to birth plans, including moving planned deliveries from hospitals to birth centers, which can cost about one-third of what hospitals cost. Lesley Rathbun, owner of Charleston Birth Place, says the birth center has received a number of new clients transferring during their last few weeks of pregnancy. Birth centers, in addition to being more affordable, don't have some of the more-restrictive rules implemented on who can accompany the mother in hospitals during the pandemic.
Many hospitals right now require incoming patients take a rapid-response COVID-19 test. If a pregnant woman tests positive, there's a chance her newborn baby will be kept in a separate room to decrease their chances of contracting the virus. Smaller centers like Charleston Birth Place don't have the resources for rapid-response tests, and most women will have given birth before results return from a standard test. Birth centers often allow more than one support person to join a pregnant woman in her delivery room — most area hospitals currently only allow one.
"What we're seeing nationwide is that places are starting to look at birth centers as a way to move people out of hospitals to make room for sick people," said Rathbun. "The silver lining is that birth centers are being recognized as a good, safe option for normal, healthy women."
In April, The New York Times wrote about the rise in women using birth centers instead of hospitals. As one midwife said: "It's not that they don't want to be in hospitals; it's that they don't want to be in a COVID hospital." In New York, OB/GYN doctors were being diverted to treat coronavirus patients. Fearful of contracting the virus themselves, an increasing number of expecting moms changed birth plans so that they delivered either at home or in a birth center.
And while MUSC's Dr. Sullivan said South Carolina hospitals haven't seen the bottom falling out in this way "yet" he is always concerned about the health of his staff.
"We have to have enough doctors and nurses to carry on," he said. "That's always been a concern, that we'd lose half our nurses and doctors all at once."
Victoria Winter, who was three days past her due date when we spoke in July, transferred to Charleston Birth Place during her third trimester. Winter started at a traditional OB/GYN but as her due date drew nearer, she didn't feel comfortable with the lack of information she was getting from her delivery hospital.
"Luckily my last pregnancy was really easy, and this one had been the same way," said Winter, who didn't like that at the hospital, "You get treated like you already had the virus." At 37 weeks, Winter started to search for an alternative and found Charleston Birth Place.
"Normally they would like to take people earlier, but they were able to squeeze me in. It's been a huge game changer in my anxiety level," she said.
While Charleston Birth Place is seeing a surge in natural births at its facility, doulas could be seeing their client numbers decline amid social distancing rules.
A doula acts as a pregnant woman's advocate, employed to help expectant mothers through the process of labor as well as to assist with pre and postpartum care.
"It's been very isolating. This is a time in your life where you want people to celebrate you and celebrate your birth and you can't get that in-person touch," said Dawn Oliver, owner of Compassionate Care Doula. Oliver said she's seen a steep decline in clients since the pandemic started. Social distancing and quarantining make it impossible to provide the services she normally does.
While Oliver has pivoted to offering some online services, she said the effect simply isn't the same. Expecting women want in-person services, not a virtual substitute. "The birth- ing moms are just not happy," said Oliver, recalling clients and pregnant women she's spoken to. "They're not looking forward to birth like they used to. Instead of releasing the hormone oxytocin, they're releasing the fight or flight hormone."
Rathbun said she is also concerned about clients' mental states, saying that Charleston Birth Place has seen several preterm births and smaller babies from women who are particularly stressed out during this time.
Oliver said a good way to keep the stress at bay is for new parents to educate themselves as much as they can about what to expect during and after pregnancy.
"Information is really important — evidence-based information. Doulas can give you the verbiage and education and information that you and your partner need to advocate for yourself," said Oliver. "If you can't have a doula, at least have as much information as possible."
And that information and education doesn't stop once your baby arrives. Oliver said many people forget the importance of postpartum care, for mothers and babies.
Local couple Gabe and Tina Gomez welcomed their daughter in March, right before the pandemic hit. Since then, they've struggled with the isolation that has come with these times, keeping their daughter close to home and away from most relatives for her own safety.
This is Gabe's first time being a father and thanks to the pandemic, he isn't sure what normal is anymore. "All these feelings I'm having, I think, 'Is this unique to the time or do parents go through a lot of what I'm feeling?'" said Gabe. "Everything is just overly cautious."
The Gomez parents are lucky enough to work for a company that regularly tests its employees for COVID-19, so there's less uncertainty about their health. Still, the couple have had to limit their new baby's interactions with grandparents and friends. Tina worries that the baby isn't warming up to her abuela, Tina's mother. She also worries that the quarantine and isolation could have a negative impact on their daughter's development.
"I was really excited to go to Mommy and Me classes and to the breastfeeding support center," said Tina. "I wish she could be active and social."
Until life returns to "normal," pregnant women and new babies will be living a different kind of existence than those of the women they read about in their What to Expect books.
MUSC's Dr. Sullivan says his team works hard to stay as up-to-the-minute on coronavirus updates as possible. He encourages expecting women to take advantage of whatever relationship they have, be it with an OB or a midwife or a doula (through virtual visits or otherwise). "It's your best defense, along with common sense — that partnership with your practitioner."
And while Justine Palkowski hadn't seen her doctor since March, at 34 weeks she was finally slated to see her again. Palkowski and her husband have lost their parental leave benefits, but she feels fortunate that she still has a job, albeit one with a reduced salary.
"I recently got an email from one of my pregnancy apps with the subject line, '10 ways to prepare' and it mentioned setting up a support system," said Palkowski. "I can't. It's just gonna be me. [My husband] has to go back to work. It's going to be an interesting time — I'm a little nervous."