Distancing while due: The coronavirus is rapidly changing pregnancy

As hospitals in the region cancel appointments and postpone some surgeries to make room for an expected surge of patients sick with the new coronavirus, Erin Gilbert is nine months pregnant.

The 34-year-old teacher lives with her husband in Horsham, Montgomery County — the Pennsylvania county that’s seen the highest number of cases. She’s spent the last few days monitoring Abington Hospital–Jefferson Health’s visitation policy. Earlier this week, she thought her parents and in-laws could be in the waiting room when the baby is born.

Now, when she’s in labor — she was due Tuesday — she’s only bringing her husband.

“We’ve been trying for almost five years,” Gilbert said Monday. “Now we’re finally about to bring a baby home, and this happened. Everybody has to wait a little bit longer to meet her.”

The spread of the coronavirus has rapidly changed the very nature of pregnancy, causing some women to make last-minute changes to their delivery plans and others to wonder if they’re distancing themselves from others enough to stay healthy. There are new questions about navigating pregnancy during a global pandemic, most of which aren’t answered in the baby books.

Hospitals and medical centers across the country are gearing up for an expected surge of patients needing urgent care as a result of the coronavirus. And they’re working to still accommodate the other patients, including women who are pregnant and due to give birth during a time when hospital capacity is uncertain and visitor policies stringent.

But women shouldn’t be concerned about space. “There will be beds. You will have providers,” said Wadia Mulla, director of obstetrics and maternal fetal medicine and medical director of labor and delivery at Temple University Hospital.

Mulla said even though hospitals are planning for a “huge influx” of coronavirus patients, they are set up to care for women in labor, and have also identified two rooms where laboring women with symptoms of COVID-19, the disease caused by the new coronavirus, can be properly cared for and isolated.

She said pregnant women who contract the virus are at a higher risk for pneumonia and preterm birth. Some testing has been done, she said, and it doesn’t appear that the virus transmits in the womb. Two small studies conducted in China found no evidence of transmission from mother to baby late in the pregnancy.

Some women are still fearful of being in hospitals, afraid to come into contact with a patient or health-care worker who has contracted the virus. Mulla said Temple, like most hospitals, is taking extreme care to keep coronavirus patients isolated from everyone else.

Meanwhile, providers who specialize in home births have experienced an uptick in calls from women inquiring about how to deliver outside a hospital. Asasiya Muhammad, who owns Inner Circle Midwifery in Germantown, said more women than usual are calling to schedule home births, saying the hospital they planned to use now has strict policies that mean they can’t have a full support team.

But Muhammad said women who are pregnant shouldn’t rush to home birthing if it’s not something they wanted to do before the coronavirus spread.

“Home birth should be an option because you’re a good candidate, not just because you’re afraid to be in the hospital,” she said. “You could end up back in the hospital for not being the right candidate to be outside the hospital in the first place.”

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Muhammad said the best candidates are women without underlying conditions or pregnancy complications. If a woman is identified as being well enough for a home birth, she said she and several other midwives in Philadelphia are offering services at a discount to women transferring to a home birth plan late in the pregnancy.

Most hospitals in the region have clamped down on visitation, instituting new policies allowing women in labor to have just one partner or labor coach with them.

That means women like Leah Falk, who plans to deliver at Pennsylvania Hospital, couldn’t be accompanied by both her husband and the doula, a trained labor companion, whom she’s been planning with for five months.

“This is a really essential thing to me,” said Falk, 34, of South Philadelphia. “The doula is a constant presence, someone who knows you, someone who you’ve talked through your desires and priorities with, someone who is comfortable with your partner.”

Falk and her husband haven’t decided whether he or the doula would accompany her if the policy remains in place. She said she hopes the policy changes by mid-May when she’s due.

Officials at Penn Hospital didn’t respond to a request for comment. Mulla said she and her colleagues at Temple, which has the same policy in place as of this week, recognize “it’s very difficult for patients to not have that group of people.”

“It’s just not going to be feasible,” she said.

» READ MORE: Philly-area hospitals watching for staffing gaps as coronavirus closes schools

Policies could change more by May 24, Annie Schuster’s due date. But based on the growth trajectory, she could go into labor earlier. An executive assistant who lives in Manayunk, Schuster, 34, has nearly eliminated in-person contact with anyone who isn’t her husband, electing to go on walks or sit on her front porch when she’s getting stir crazy.

The greatest challenge over the last several weeks has been trying to figure out what to do and what not to do. When should she stop going to the gym? Was work safe?

“I want to do what’s best,” she said. “But if no one knows what to do, you’re left wondering every time you do something if you’re doing something wrong.”

Mulla said women should call their providers for guidance if they have any questions and shouldn’t be afraid to go to a medical facility for care unrelated to the coronavirus.

Still, hospitals have become the front lines of battling an outbreak that no one knows the real extent of yet. Health-care workers across the world have been described in terms usually reserved for soldiers headed to war.

Gilbert went into labor Tuesday night. She and her husband plan to name the baby girl Avery Brienne, as in Brienne of Tarth, the Game of Thrones character.

She was a warrior.