Childbirth Is Messy. Are Those Who Assist With It Adequately Protected?
Updated on Tuesday April 21, 2020 at 9am
As anyone who has had a baby or been around a birth can attest, it can be a prolonged and messy ordeal. That’s why labor and delivery healthcare workers are concerned about the current shortages of personal protective equipment (PPE) during this pandemic.
"In situations where women are in labor, they breathe heavily while they are pushing. They are coughing and sneezing, so there’s concern that we’re at substantial risk," said Dr. Judette Louis, president of the Society for Maternal-Fetal Medicine.
ideastream’s Anne Glausser looked into why health care workers who assist with childbirth are sometimes not getting the protection they say they need and shared the details with “All Things Considered” Host Tony Ganzer.
So what prompted you to look into the coronavirus and birthing issues?
I talked with an OB doc from the Cleveland Clinic and she first alerted me to this issue, saying the clinic wasn't providing N95 respirator face masks to those who assist with childbirth. So I talked to Dr. Louis with the Society for Maternal-Fetal Medicine about how OB doctors are feeling right now.
"[From] the outpouring of emails that I'm seeing and the posts on social media, they are terrified that the guidelines don't provide them enough protection. And they're seeing these infections among health care workers, and so they're worried for themselves and their families," Louis said.
So Dr. Louis said "guidelines" here. What guidelines?
Currently, guidelines from the U.S. Centers for Disease Control and Prevention (CDC) don’t recommend hospital systems prioritize the use of N95s — the kind that when worn correctly offer the best protection from the coronavirus — for those who work in labor and delivery, even when they have known or suspected COVID-19 patients. The CDC doesn’t classify labor as an “aerosol-generating procedure” so, hence the lack of prioritization during a time of nationwide PPE shortages.
And Louis said hospital leadership across the country has not been very understanding of the unique risks that go into labor and delivery and that many OB doctors still feel very vulnerable.
Zoom in locally: how are Northeast Ohio hospital systems responding?
MetroHealth System recently announced they can sterilize N95 masks in house and now say any employee who wants one can have one. Both Cleveland Clinic and University Hospitals are saying that they are providing N95s to anyone assisting with the birth of a known or suspected COVID patient. UH's Dr. Nancy Cossler said the CDC is kind of wrong on this.
"I have delivered babies for 25 years and I know that I am in close contact with a woman who is often screaming, trying to control her pain,” Cossler said. “I think we also have to walk a line about taking into consideration protecting the caregivers. So I'm not sure that the CDC is correct.”
And I should add that I reached out to the CDC on this story, but they didn't respond to requests for comment.
So University Hospitals and the Cleveland Clinic are providing N95 masks for women who are known or suspected for COVID-19, but not for the others?
Right, for every other birth, staff just get a surgical mask and other PPE like gowns and gloves. Cossler said they have to draw the line somewhere, given the PPE shortage — even though we know people with COVID can be contagious before they show symptoms.
Cossler advocated hard for universal testing of women going into labor so that providers know their status and can make the right preparations to protect the patients and themselves. UH recently changed its policy to allow for universal testing of women going into labor.
We've heard a lot about this situation in hospitals here, but what do we know about home birthing professionals?
Well, I spoke with the head of the Ohio Midwives Alliance, Barbara Lahey, and she basically said that they're doing the best they can with what they've got. And she said that a lot of their members don't have access to N95s, even if they wanted them. She said that midwives are following social distancing and hand-washing guidelines and she thinks their clientele tend to be staying home more anyway, so there's less risk.
Given the current shortages of both PPE and COVID-19 testing, what is the way forward?
The Society for Maternal-Fetal Medicine’s Dr. Louis said she thinks hospitals need to work toward getting N95s for all those working in labor and delivery and most importantly they need to listen not only to CDC guidelines but their on-the-ground leaders who know what they need in order to do the best job possible.
She cited a recent survey in the Journal of the American Medical Association that showed access to PPE and concerns about exposing their families are two of the most common sources of anxiety among healthcare workers, which she says affect their ability to be confident and calm, right at the time the public needs this reassurance the most.
The other thing to note here, and most everyone I spoke to for this story brought it up, is that testing and PPE is important not only for the health of health care providers, but also for the health of the mom and baby, so babies can be properly cared for if the mom has an asymptomatic infection and so that health care workers don’t inadvertently infect the mom or the baby.