Anna Jackman was six months pregnant then COVID-19 beat. The 36-year-old Long Island resident had made plans to welcome her first child. Plans for her sister and husband to attend the delivery, plans for a doula to be with her, plans for how she wanted the birth to go. “I had the natural worries as a Black woman,” she told CBS News. “Will I be pressured into certain things? Will I be protected?”
But the pandemic disrupted Jackman’s plans, just as it has for thousands of pregnant women in the United States. Jackman was worried that it was carrying the virus, but she was also worried that the burden of the virus would compromise the care she received during pregnancy and delivery. Jackman delivered her baby in June after spending months on the potentially worst case.
“Before I went to the hospital, I told my husband, ‘Please do not let her kill me,'” she said. “I had a very big fear of dying.”
The US has an incredibly high maternal mortality rate compared to other industrialized countries, with 17.4 moms dying per 100,000 live births in 2018 – compared to nine mothers dying for every 100,000 live births in the UK, seven in Canada, and five in Japan.
The CDC estimates that 60% of those deaths occurred. The data also show clear racial differences: Black women are three to four times more likely to die from pregnancy- and child-related causes than white women.
Black families and communities have long been committed to making pregnancy and childbirth safe and happy experiences. But could the pandemic put them at even higher risk?
“Many of the reasons cited for the higher Black maternal mortality rate and the higher rate of COVID-19 in the Black community are the same,” said Drs. Heather Irobunda, in OB-GYN at NYC Health + Hospitals / North Central Bronx. “The core of these reasons stems from systemic racism that leads to higher rates of underlying disease such as hypertension or diabetes, which can increase the risk of death not only by COVID-19, but also in pregnancy-related deaths.”
“In addition, there are concerns about implicit bias and its impact on health care delivery, particularly in Black mothers.”
Doctors are worried that patients will “fall through the cracks” between virtual visits. Expected parents raise their concerns about COVID, only nutrition, and isolate a newborn raise. Could these factors contribute to even more common deaths?
“It was frustrating to go alone”
Stefani, a 30-year-old from North Carolina who delivered identical twin boys on April 22, said she was lonely and confused at times during the pandemic. Stefani asked to be identified only by her first name.
“My husband attended every appointment with me until I was about 30 weeks old, which is when I was told he could no longer accompany me because of the virus,” she said. “It was frustrating to go alone, seeing how hard it was for me to run independently, the bigger I got, and it was really lonely to go through the longer appointments and test without him.”
Stefani said some of the rotating providers at their OB-GYN practice did not explain things thoroughly and relieved worrying symptoms such as high blood pressure and severe leg swelling. During her 34-week appointment, a doctor sent Stefani straight to the hospital after checking her chart and symptoms. She was diagnosed with severe preeclampsia and induced that day; her husband was present when she delivered one twin and the other by caesarean section. Her family is now safely together at home, but Stefani said she still mourns the delivery and recovery she thought she would have – surrounded by family and support.
“During my pregnancy, I emphasized how I would survive with twins,” she said. “When the pandemic took every opportunity my family members came to help, I cried almost every day.”
“I worry about my patients all the time”
Moving personal appointments to telehealth visits affects the communication between patients and doctors. “I worry all the time about my patients,” said Dr. Carol Major, an OB-GYN and mother-fetal medicine expert in Orange, California. Major specializes in high-risk pregnancies, monitoring mothers with health conditions such as hypertension, diabetes, and mental illness.
Major asks patients at home to do what they can, such as testing their sugar levels or blood pressure. “But it’s not the same as actually seeing them in person, because sometimes there’s just a feeling about a person when you make them known,” she said. “Sometimes I think, ‘they don’t look good.’ And I’m worried I might not appreciate that over the phone. “
For families who do not have access to telehealth services, fear of COVID-19 may add up to a precaution that they seek utmost care. Dr. Charlene Collier, an OB-GYN in Jackson, Mississippi, said this is likely to affect rural families who live hours away from their nearest provider. “We do not know how many are not coming in, or who are missing appointments because of this,” she said. She knows that patients worry about ever-changing hospital policies, just as mothers only have to give birth or separate mothers from their infants. “Women fear that they are asymptomatic with COVID, and that they will be separated from their baby,” she said.
The fear and apprehension about feeding at COVID also affects the mental health of families. “Customers feel increased stress, isolation, and grief over the delivery they anticipate,” Saleemah McNeil, a reproductive psychotherapist and birth doula at the Oshun Family Center in Philadelphia, told CBS News. Plus, parents feel disconnected from their broader support networks. McNeil said her practice has received so many questions about supporting postpartum mood disorder during the pandemic that they have hired additional therapists to meet needs in the community.
“I was not there”
Because of the pandemic, some mothers had to be born without their partner as a support person. Jawanza Keita and his fiancée, Amelia, welcomed their third child on April 5th. Amelia, an educator in Philadelphia who asked to be identified only by her first name, told CBS News that OB appointments felt “a little impersonal,” noting that it was difficult to really connect with masked providers. “With an obvious concern for health and safety, the appointments were immediate and businesslike in nature, and did not take longer than the time required to complete all questions, examinations and procedures,” she said.
Hospital guidelines allowed for one support person to be with Amelia, but if Keita was with her, someone else would have to look after her 5- and 3-year-old children – and potentially expose them to COVID. They made the difficult decision for Keita to stay with her children while Amelia delivered alone. The two communicated via video. “All I could see on the camera screen were the white walls and the ceiling of the room,” he said. He heard the baby’s first cry over the phone.
After delivery, Amelia experienced severe postpartum hemorrhage – “passing blood clots larger than the palms of the nurse’s hand.” At the other end of the line, Keita felt helpless while medical staff manually hovered her uterus and solved the problem. “I was sitting in a haze of uncertainty,” he said. “Under normal circumstances, I feel that people who are ill or being treated should have a lawyer. A lawyer can help ensure clear communication, compassion and good decision-making. But I was not there. I could not protect them yet advance. “
“We try to answer many questions”
Doctors still do not know for sure how COVID-19 will affect the number of mothers and babies who die. However, they know that the pandemic birth and repayment has made a tight, lonely place for so many families. COVID-19 disproportionately affects people of color, and it can also affect Black motherhood rates.
“We try to answer a lot of questions,” Collier said. “Maybe we can, hopefully, a year from now if everything is behind us. But it’s all still missing.”
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