Providence Blog: Maternal Safety during COVID-19
Each of us has our own unique set of concerns pertaining to the COVID-19
pandemic, and various degrees of risk factors to consider. In this broadcast
- part of a series done with Covenant Children’s in Lubbock, Texas
- the focus was on maternal safety. Covenant Children’s CEO Dr.
Amy Thompson spoke with Dr. David Lagrew, Executive Medical Director for
Women's Services at St. Joseph Health hospital safety, on a variety
of concerns ranging from pregnancy to post-delivery infant health.
Following is the video and transcript for the broadcast.
Good afternoon. I'm Dr. Amy Thompson. And I'm the Chief Executive
Officer at Covenant Children's Hospital in Lubbock, Texas. And I'm
so grateful to be back again with you guys this week to talk about some
more COVID things. So first of all, I have to just read a bit of a disclaimer.
So, as a reminder, the information provided during this event is for informational
purposes only. And if you have questions around the COVID-19 pandemic,
please visit our email@example.com for medical updates. And this
event is not to create a doctor patient relationship. And any questions
or medical advice discussed should not be considered guidance on what
you should do. For any medical questions, please reach out to your primary
care or health care professional. So thank you guys for joining us today.
It is my pleasure today to introduce to you Dr. David Lowe group, and
he is the executive medical Medical Director for women's services
at St. Joseph's health. And so Dr. Lagrew, thank you so much for being
with us today. And actually all Just started off by saying tell us a little
bit about what it is that you do there at St. Joseph health and just some
of your background.
Sure. Well, thanks start to Thompson. I'm a maternal fetal medicine
doctor by training, but right now I'm doing mainly administrative
duties here in the Southern California region with our 11 ministries that
deliver and help. We're going to ask for moms and babies and things
of that nature. So a lot of quality, a lot of cost containment, helping
people get through various things and obviously, in the midst of the COVID
pandemic, my role has been to educate and help the various hospitals have
ministries develop their protocols and things of that nature. To deal with it.
Fantastic. Well, thank you so much for being with us today and for serving
as our subject matter expert on all things, women and COVID. So I'll
start off with just an easy question about, you know, what have you seen?
Have you seen pregnant women, new mothers who've had the virus? What
has your experience been with that?
Yeah, I would say and we hit it here in California is, you know, we through
our social distancing, and things of that nature, flatten the curve. So
we never reached the sort of panic numbers that they had on the East Coast,
and things of that nature. But having said that, we've also unfortunately
not seen drop off yet we're still the flat part of the curve, if you
will. And so what that means is that we see a number of women who have
developed symptoms during pregnancy and need treatment just a few that
have had to come to the hospital. We've been very fortunate we have
not had a whole lot of extremely sick moms that would have to go in the
ICU. And we've also seen a number of folks who did not know they had
it and in their screening, test positive, and we've had to deal with
that. And so we have to be ready to help screen the baby and protect the
baby as well. So it's a bit of a different spin than the adult doctors
deal with. But, you know, that's why I went into maternity, it's
definitely an interesting field.
Fantastic, thank you. And, you know, we take care of women as well here
at the Children's Hospital in Texas. And we've seen very similar
things to what you're describing in terms of some asymptomatic folks.
And we also have had very low numbers of those pregnant women who have
ended up in an ICU setting - actually very, very low numbers for that.
So talk to me a little bit about pregnancy as a whole. Is there something
in pregnant women that could make them more at risk? Do they have a higher
chance of contracting? You know, with the Coronavirus, it doesn't
matter how far along you are in pregnancy.
You described your experience, and also our experience I think agrees with
the literature; that there isn't - fortunately, knock on wood. Unlike
some things like varicella and influenza, where you can get quite ill
just because you're pregnant and then have the infection. I wouldn't
put COVID-19 in that category. And there is early data that came out of
the few cases in China that a few patients would get extremely ill, but
in general, they didn't see a lot. So I think what we're all trying
to tell patients is, you know, the good news is, pregnancy won't make
it worse. But the bad news is, it doesn't protect either. So to a
certain extent, you know, that you still have to worry about it. And obviously,
we take special precautions, etc. But for me, it's been pretty well
and the same experience. If you look at the effect on the baby, there
doesn't seem to be transmission, in utero. If there's going to
be transmission it's much like we see with influenza and others, where
it's a respiratory spread after birth. And so that allows us to take
precautions and things of that nature and reduce transmission. To the baby.
Great. Thank you so much. So, if you're a pregnant woman, and you're
watching this and you're worried that you have COVID, what is it that
you would suggest that they do?
Well, obviously, if they've had an exposure or they had any of the
typical symptoms: the loss of smell or taste, cough, shortness of breath,
or fatigue, pregnant women need to call their healthcare provider. If
they have any symptoms or they've been around folks that they know
to have, certainly they should be screened with testing, and they should
consider quarantining themselves. And so it's general guidance, kind
of like what the non-pregnant world would do. But again, we have the nuances
of some of the subtle symptoms that can be so similar to pregnancy that
makes it a bit tricky.
Yeah, I agree with that. So I've had a lot of questions just from even
some of our patients and you know, folks that are in our outpatient clinics
that are pregnant, that worry about the safety of hospitals, and worry
about, is it safe for me to come to the hospital to have my baby? So what
is it that you would say to those women?
Well, the first thing I can tell you is they are not alone. I think for
many, many weeks, the staff was scared to come to the hospital, right?
We didn't know a lot about the virus. We didn't know a lot about
the transmission. Obviously, we all scrambled to get protective equipment,
etcetera. So in the early days of the pandemic, at least for us, It was
really about controlling fear. Today, with enough protective equipment
and the knowledge base we have on the virus you know, it's made hospitals
a very safe place. My advice is, if you're going to the grocery store,
you know, the reality here is you're a lot safer in one of our labor
and delivery than folks who would be typically doing a lot of a lot of
places they're going to for everyday life. There are people with heart
attacks and strokes and all sorts of things that didn't come in soon
enough, and so I really try to encourage patients to have that conversation
with your doctor or your midwife. And we've used telemedicine a lot.
And I think you make more phone calls. And, you know, there's lots
of the same ways they have communication these days. If you are concerned,
you should understand we're making it as safe as we can. Unfortunately,
there are some [other] side effects. For years - and I'm one of the
guilty parties - make sure to get all your family in on this and make
sure that they can see the baby and let's get family together. And
then all of a sudden, we're whoa, wait a second. Yeah, we may let
your husband or your significant other or that ONE person come in with
you. But everybody else stays at home and watches this on the iPad and
looks at the pictures. So that's been a real problem because again,
I think the expectation most young women have today of having a baby is
having the whole family. Again, if you look at the experience in New York,
the mother who was positive 60% of the time, the dad had a positive for
the virus as well. So, we do know, it's, it's all about reducing
the number of people you're around to reduce the infection risk. And
so we have to do these things.
I agree. And one of the things that I've really that I've really
liked, being part of the Providence family of hospitals is, Providence
has done a really good job of putting out a lot of things. The latest
thing that I saw was the seven steps that hospitals are taking to make
sure that you're safe, when you come in, and to your point, I actually
feel like I can confidently say that I feel like people are more safe
coming into my hospital than going to the grocery store. And exactly,
underscoring the stuff that we're doing in the hospitals with everything
from screening to limiting visitors to absolutely making people adhere
to masking, you know, policies while they're here. You know, certainly
we're taking a lot of precautions even on the floor. And so, I actually
worry much more about people once they go home than I do when they're
actually inside the walls.
Obviously the natural thing is, everybody comes over to see the new baby
and things of that nature and again, you know, the downside to that is
unfortunately every person you're exposed to is potential. risk.
Yep, I agree. What about any other special precautions? Are there any special
precautions that you're taking in the hospital that are unique for
patients that are coming into contact with pregnant women?
Well, again, similar, you know, we follow all the CDC guidelines and, and
different things on protective equipment and visitation, etc. I think
the biggest spin in in labor and delivery is, what are the precautions
you take with the baby after birth? In other words, if parents test negative,
then obviously, you don't have to worry. If they're positive,
then you have to have a conversation with the mom about separating the
baby so they don't transmit it. Or if they decide we actually yeah,
that's a real place for shared decision making because what the data
shows is actually the risk is not huge. For whatever reason, well, anybody
under 20? Yeah, you know, it's a great time to be a teenager. But
anybody that young that the risk of transmission and the risk of serious
diseases is pretty low. But having said that, it's not zero. And so
we have to have those conversations with our moms, if we find out they're
carrying the virus.
Yeah, I agree. And we're doing the same thing. I love that you mentioned
shared decision making, because that's something that we're really
encouraging, are those kind of conversations with the mom to talk about
the risks and benefits in both directions and there's certainly risks
and benefits to either separating yourself from your baby or not separating
yourself and so making sure that we're including the moms and significant
others and making that decision, I'm always a big fan of shared decision
making. What have you seen? I would say, we have about half of our cases
that I feel like have chosen to keep the baby with them with precautions,
and then about half that have chosen to do the two week have someone else.
I would say here on the west coast, it's actually more choosing not
to have separation, with agreement to keeping cribs six feet away. And
when they're handling the baby, put a mask on, wash their hands, wear
a gown, that sort of thing. You know, and then of course, the other question,
that natural follow up to that is what about breastfeeding? And we know
risk. You know, I think that the folks, you know, the Pirates of EA, are
pretty clear on that, that the risk of that is pretty low. And the benefits
are still pretty high. And in that conversation, it really weighs towards
still breastfeeding. But again, there are people you know... it's
an interesting thing. There are people who say, Oh my gosh if I gave my
baby something! I'm okay with not being around it. And then of course
you have that other side, and they don't know, I mean they've
read and understand enough to say Gosh it's a small risk and I just
have to be near my baby.
Yeah, so let's move the conversation and let's talk about the baby.
Say you have a mom who comes in and she tests positive for COVID and then
she has the delivery and that baby actually has to end up either in the
NICU or in some you know, some type of special care nursery and with that,
what happens in that situation?
So again, the baby is unlikely to come out with the infection. All babies
would then be screened at 24 and 48 hours with testing and then if negative
obviously managed that way. I think the tricky thing is there are women
who are earlier in pregnancy, their water breaks, they go into premature
labor or they're just so sick, that we're really worried about
them and we deliver their baby. And so in those cases, especially with
an extremely premature baby, it's the prematurity that's the big
risk actually more so than the infection. But clearly, it's not good
and especially when we run into special care nurseries. We've really
tried to incorporate the parents in the care but in these cases, we just
can't do that. So I think it's interesting that our nurses - and
I don't know, for you guys back in Texas - but for our nurses, a number
of them go out of their way to say, you know what, mom, dad, we're
here to take care for your baby and we promise you, we'll give them
love and attention and everything we can do, and they have really stepped
up to make that part of their job.
Yeah, I agree with that. I feel like this question for us has been the
hardest question, which is when you have a baby in the NICU, you know,
by definition, those parents are going to be very, very worried. And then
you have a mom who's testing COVID positive and obviously, we can't
let that mom you know, into the NICU with other babies. And so I agree
with you, we've had a lot of our nursing staff step up. I have never
used so many iPads in my life to make sure that family and friends can
see what's going on. We've got some cameras at the Children's
Hospital - view cameras. And so we have those already in our NICU where
typically we use that for you know, other family members or so that someone's
able to see their baby when they're not there and we certainly that's
been a blessing for us to have something like that so that those moms
are able to see those babies
Yeah, I think you're gonna see more of that. We're testing out
certain cameras and different things so even in labor, and even with people
proofing and things of that nature - obviously camera angles are an issue
- and in the mother baby unit. We actually hit labor and delivery, like
when the dads are deployed overseas. Yeah, and I mean, it's not the
same, I get that, but it's definitely a lot of fun for, you know,
the right people. Obviously, it's another shared decision making with
the patient herself that she's the boss, you get to decide and is
the bottom line.
So if a mom takes a baby home, you know, irrespective of if she has tested
positive or not, what kind of symptoms are different [for the baby] than
the symptoms that we think about? Obviously, you can't ask your newborn
if they can still smell, this kind of thing. So what are the things that
they should be looking for?
Yeah, I mean, I think to your point, that's, I mean, you can't
ask them if they're tired, or ask if the formula or the breast milk
tastes the same, right? So they can't taste anything. So really, you're
down to what's the breathing, how irritable do they seem, you know,
all the different things that babies do. And I think what most of our
pediatricians say is you just have to be on the safe side. So there's
something funny going on in any call sooner rather than later. Again,
for the most part, not a lot of people are seeing sick babies. And so
the good news is the risk is probably pretty small. But again, you know,
that's your baby. It's 100%. Right? So you really have to be careful.
Yep, I agree with that. So I'm still a practicing pediatric hospitalist.
So actually, when I'm still on during the weekends, I've been
one of the ones taking care of some of those babies, to the COVID-positive
moms. And that's exactly the thing that we tell them. And the thing
that's difficult and this is difficult, in all kinds of illnesses,
not just COVID with babies is, you know, there's a reason that we
have specific criteria that make us worry, you know that babies are sick
and those are very nonspecific temperatures. greater than 100.4, you know,
and we just call it generalized fussiness. And if they're not feeding
well, babies just have very nonspecific signs that they're not well,
and so I think making sure that those folks stay in contact with their
primary care doc's or like you said, taking advantage of some of the
telemedicine and things like that that they can do.
Yeah, I mention for the pediatricians and in the same way, I mean, we say
it is as an obstetrician gynecologist: The only time we'll get mad
is if you don't call. In other words, you have to leave that expectation
that Hey, guys, if you have a question, I'm worried, right? Because,
you know, mothers know. The dads, not so much, but the mothers know. That's
I agree. And I used to laugh in residency, there was a particular nurse
that we had that worked at our newborn nursery. And when she would call
us, she would say something very nonspecific, like, Dr. Thompson, this
baby just isn't looking right. And that was enough that we would come
upstairs knowing that, you know, they can have these very nonspecific
signs that can mean things. Okay, so this is the question that all the
Mamas and all the mother in laws have out there. They're like, okay,
so you're not letting me in the hospital, which we understand. But
when is it okay for me to go? My son is married to this wonderful woman
and they've had a baby. So when is it that I can feel safe to go to
the house and what precautions would you have those folks take as they
go visit those babies at the house?
Well, I'm not so sure there's any hard and fast answer to that
one, right. I mean, I'll tell you one thing, there's, I guess
there's no good answer. So I think, again, it depends on what's
the risk factor the Grandma has. In other words, the bottom line is probably
in this scenario, the bigger danger is to the grandmother not to the mother
in law, because she gets infected, she's much, much more likely to
have symptomatic infection, she's more likely to get sick. And so
you think about it, you know, it's how exposed were the mother and
the dad and the baby? You know, by being out and about and things of that
nature. So, again, I don't think there's any hard and fast answer.
I mean, no, unfortunately, obviously, if the mother or the baby was under
suspicion, then you’ve got to wait a couple of weeks or at least,
the symptom phase, I think it's three to ten days after the onset
of symptoms. Then you really can feel pretty safe. But again, I think
that depends on if grandma's got diabetes or hypertension, or overweight
and things of that nature, maybe, maybe not. You know, it's a tough one.
I agree and I think that we've been encouraging those same very things.
We encourage some shared decision making with the family, but making sure
that you understand some of those specific dynamics within the family
to make a good informed decision. What we want is that we wait a month
out for everyone to be able to get to enjoy good health and new babies.
So I know that everyone feels like they need to see everyone immediately,
but it's much more important that we're safe and, you know, keep
everybody you know, healthy. And this is a question that is dear to my
heart. In some of the things that we do I have worried about moms that
are either pregnant and have decided to stay at home and, or you know,
they've had a baby. And so they feel like they need to stay in and
keep the baby and themselves quarantined. And I've seen a lot of dialogue
about making sure that we are calling out that we want to take care of
the mental health of those of those moms. And I think it's hard enough
to be quarantined. And I certainly remember when I had both of my babies,
without COVID how nervous I was to take them out. And so I think it's
the right inclination, you know, to want to stay in and stay at home for
the orders, but anything that that you would call out on that specifically?
Well, as you know, in pregnancy, and particularly in the postpartum period,
we're very worried about anxiety, depression, being exacerbated regardless
of this going on and obviously when it's not only that fear and all
that stuff, separation and things of that nature of the pandemic. But
then we have people worried about jobs or people have gotten furloughed
or laid off or things of that nature. You know, my colleague in mental
health here tells us overall, the Southern California suicide hotline
that we have, yeah, the calls are up like 8,000%. Yeah, it's an amazing
number of people that are being stressed. So again, to your point, I think
isolating yourself and doing some of these things that are really looking
for the warning signs, of course, we could be helping you screen yourself
for depressive symptoms and things of that nature. And then really, yeah,
the take home message and all that is, is please ask for help. It's
that sort of thing.
I agree and I just wanted to make sure that we call that out on this discussion
about this because certainly if you're at home and you're watching
us and and you're having symptoms or you're worried that you have
symptoms, you know of depression, either pre or post your delivery, please
make sure that you call your ob gyn office, or some you know, someplace
where you can get some help for those things. We know that that's
a real struggle during the middle of this. Well, Dr. Lagrew, this has
been super fun today to see you and you do great work for us in the women's
and children's Institute. Here at Providence I've had the privilege
of getting to watch some of your work. I'm going to let you have one
last anything else you would like to make sure you know you say or or
anything about COVID and in pregnancy
You know, I'll go back to my comment. The only time we'll get mad
is if you don't call. Yeah, I think this of all that's true of
all pregnancies, right? But I think During this time period, now's
the time to have a relationship with your provider and your loved ones.
Just realize it's hidden, everybody. And you know, I always tell people,
it's one thing to have an infection, one thing to have pregnancy,
and it's all together another thing to have both at the same time,
so early on.
Awesome. Well, thank you so much for joining us today. Your expertise is
so appreciated. And thanks for taking time out of your day. If you have
joined us, thank you guys for joining us. And please continue to send
in questions if you have questions, or for sure, feel free to reach out
to any of your providers during your pregnancy. So thank you guys so much
and be blessed.
Ok, thanks, Dr. Thompson.