The message during the COVID-19 pandemic has been clear: Practice physical distancing, wear a mask, and stay home as much as possible. Ob/Gyn offices around the U.S. transitioned to telehealth for many services, asking patients to come to the clinic only when necessary.
Unfortunately, some patients stopped visiting their doctor's offices altogether – even the emergency room. A May 2020 poll found that nearly half of Americans skipped or delayed medical care because of the pandemic, and 11% said their condition got worse as a result.
Emergency departments around the world, including here at UT Southwestern, have reported major drops in heart attack and stroke-related visits. So, it's no surprise that patients getting prenatal or postpartum care might also be concerned about coming to the clinic.
The Centers for Disease Control and Prevention guidelines state that pregnant women should not skip prenatal or postpartum appointments – and no one should delay care for health emergencies.
Quick adaption to telehealth has allowed many of our patients to continue their care from the comfort of home. Here in the Ob/Gyn department, we've been planning for the switch to telemedicine since 2018.
Now, our patients are asked to come to the clinic only when a physical exam is needed, including lab work and ultrasounds. When you do come in, we’re taking extra precautions to keep you and your baby safe.
Let's discuss why it's important not to skip certain types of visits and what to consider if you're questioning coming to the clinic.
Since 2016, the World Health Organization has recommended that eight total appointments is sufficient for positive outcomes in patients with low-risk pregnancies. Here in the U.S., women may be used to having many more visits because of how we've traditionally provided prenatal care.
But prenatal care looks a little different during this pandemic, and likely will for a long time after. With low-risk pregnancy care, we may change approximately four in-person appointments to telehealth visits. For example, we may combine a new Ob/Gyn visit with the pregnancy confirmation ultrasound appointment rather than scheduling them separately.
Related reading: Pregnancy without ultrasound? Pros and cons
Patients have reported that they enjoy the option of telehealth to see and visit with their providers between exams. However, there are symptoms that can occur between prenatal appointments that might require more immediate, in-person care.
If you notice any of these symptoms, or if something doesn't feel right, call your prenatal care provider right away to determine next steps, or go to the emergency room:
- Blurred vision
- Decreased fetal movement
- Elevated blood pressure
- Increased swelling in the arms, legs, or face
- Severe abdominal pain
- Severe headache
- Vaginal bleeding
- COVID-19 symptoms, such as a fever, cough, shortness of breath, chills, severe fatigue, loss of taste or smell, and sore throat
Related reading: COVID-19 and pregnancy: Answers to 10 key patient questions
Take a Virtual Tour of Our Labor & Delivery Suites
As part of our COVID-19 emergency response, tours of the labor and delivery and postpartum areas at William P. Clements Jr. University Hospital have been temporarily suspended. This video provides of preview of the accommodations for new moms and their families.
Postpartum care is important for women’s long-term health. In fact, we think of the weeks after your baby arrives as the "fourth trimester of pregnancy."
In these visits, we assess your physical health and discuss your emotional wellness. We also talk through future health considerations, such as:
- Care for ongoing conditions, such as high blood pressure or diabetes
- Connecting with a primary care doctor
- Family planning, such as birth control and how long to wait between pregnancies
- Infant care, including feeding and how the patient is adjusting to motherhood
- Mental health in the weeks and months after delivery
- Sexuality and relationships at home
- Vaccinations for you and the baby
We might conduct some postpartum appointments as virtual visits during the pandemic. However, we will ask you to come in for lab work and certain physical exams such as checking cesarean section incisions or healing after vaginal delivery. If you had preeclampsia during or after pregnancy, we'll likely recommend an in-person visit to check your kidney function.
While it may be safe for you to delay your postpartum visit by a week or so, don't skip it altogether. Talk with your provider about your concerns before changing your appointment. You should also check how long your insurance policy covers pregnancy-related services. You'll want to complete your postpartum visit in that time frame to be fully covered.
Related reading: 6 FAQs about COVID-19, pregnancy, and adjusting at home
Your annual well-woman exam is essential to maintaining good health throughout your lifetime. This appointment can be delayed a few weeks but plan to reschedule.
Usually, a well-woman visit includes a pelvic exam, a breast health checkup, and a comprehensive conversation with your provider. This is a good time to discuss your general physical and emotional health, ask about age-related changes, and get personalized recommendations for your health through the next year.
Checking in at least annually with your provider helps you stay well with the most recent women's health recommendations. For example, we used to recommend an annual Pap smear to screen for cervical cancer once a woman becomes sexually active. Today's guidelines recommend that women ages 21 to 29 with low-risk and no previous abnormal Pap tests should be screened every three years. Women ages 30 to 65 can space them out to every five years.
In recent years, recommendations and technology have also been updated for women's heart health, colonoscopy,[MO5] and breast health screenings. Talk with your doctor about when you should schedule your next well-woman visit and whether it should be an in-person or telehealth visit.
Ask the Experts About COVID-19 and pregnancy
UT Southwestern's Dr. Shivani Patel and Dr. Robyn Horsager-Boehrer answer some of the most frequently asked questions about pregnancy and the novel coronavirus during a recent Facebook interview.
Mental health care
Stress related to COVID-19 has affected the mental health of nearly 40% of Americans. And research shows that women are more likely than men to say the virus has had a negative impact on their mental health.
Some pregnancy-related stress is to be expected, but the pandemic can certainly increase it. You might try our tips to manage “pandemic pregnancy” stress, which include practicing mindfulness, eating a healthy diet, and staying in touch with loved ones through technology.
It's also important to understand you are not alone if you are feeling overwhelmed, sad, or stressed. Help is available from your provider and through community resources. For example, you can speak with a trained crisis counselor through the Crisis Text Line. Simply text “HOME” to 741741, and a professional will be there to listen and help.
Feelings of hopelessness, despair, or suicidal thoughts should not be ignored. Depression and suicide are more common in pregnancy than many people think. If you or a loved one experience these symptoms, seek help immediately.
The National Suicide Prevention Lifeline is available 24/7 at 800-273-8255. Counselors can provide anonymous support for people who are anxious, depressed, or feeling overwhelmed, or those who have thoughts of self-harm.
Pediatric care, including vaccinations
In general, parents should follow the same health care schedule for their children during the pandemic as they would have before – including vaccinations.
Even so, it is very concerning that the CDC reported a notable decrease in recommended non-influenza childhood vaccines in the two months after shelter-in-place or stay-at-home orders were issued around the country.
We know that delaying or skipping such immunizations contributes to a rise in vaccine-preventable illnesses. As social distancing requirements are relaxed, children and their communities may face more outbreaks of diseases such as measles or whooping cough due to these postponements of vaccinations.
Your doctor will talk with you about what appointments and vaccinations your baby needs, including whether some visits can be in person or via telehealth.
When it comes to your health, don’t “tough out" symptoms or delay seeking care due to the pandemic. Call your provider if you're unsure about coming to the clinic. We're happy to talk through your options. As always, our goal is to help you have a healthy, happy pregnancy – especially during the pandemic.