Story by Eva Ellenburg
Addison Yarbrough had a picture in her mind of what the last month of her first pregnancy would look like.
She envisioned baby showers, long visits with family and the usual first-time mom jitters. She imagined her mother and sisters meeting her baby in the hospital recovery room. She planned on her parents staying with her for a week to help ease the stress of caring for a newborn.
She never thought it would involve self-isolation, conversations with family through screened doors and a deep anxiety that her husband Justin won’t be allowed in the delivery room.
She never pictured bringing her first child into a global pandemic.
Yarbrough, a 23-year-old teacher and Creedmoor resident, is due the fourth week of April. She’ll deliver her daughter, Mabel Louise, at WakeMed North Hospital in Raleigh. She’s one of the hundreds of thousands of Americans who gave birth during the coronavirus pandemic.
For expecting parents and families with newborns, the global health crisis adds stress and uncertainty to a situation that’s already challenging under normal circumstances.
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As coronavirus cases rose in late March, hospital systems across the state began prohibiting visitors with few exceptions.
Laboring and post-partum patients may now have only one healthy adult visitor. These visitors also cannot come and go – they won’t be allowed back in the hospital if they leave.
“I go on WakeMed’s website – I probably refresh it at least five times a day to make sure that exception for the laboring mother is still there,” Yarbrough said. “I think that’s my biggest fear – having to give birth without Justin there with me.”
The Centers for Disease Control and Prevention has said it’s unclear whether COVID-19 poses a greater risk to pregnant people. In general, pregnancy increases the risk of severe illness from respiratory infections like the flu.
Brian Brimmage, an OB/GYN at Raleigh OB/GYN Centre, said initial evidence didn’t indicate pregnancy was a risk factor for coronavirus, but recent small studies have called that into question.
Brimmage said some of his patients have asked about getting induced so they can deliver earlier in the pandemic, prior to hospitals’ peak capacities.
But he said it’s not that simple. Some patients could be exposed to asymptomatic people at the hospital that they might not have encountered had they waited longer.
“There’s really not a good recommendation,” he said.
Generally, Brimmage said obstetricians don’t induce women before 39 weeks of pregnancy without a good medical reason. That standard hasn’t changed.
High Point resident Teresa Hyde is expecting her fourth child on April 22 at High Point Medical Center.
Hyde has seen progressive changes at her weekly OB/GYN appointments in the Wake Forest Baptist Health system, which now prohibits visitors at outpatient clinics.
“One week, it felt relatively normal,” Hyde said. “The next week, they’re calling me beforehand saying only one visitor is allowed. The next week, nobody’s allowed, and everyone’s wearing masks.”
In early April, she learned that one coronavirus model projected the state’s peak to be on her due date.
Hyde started asking her doctor about inducing early, something she had never done with her previous three births. She ultimately decided against induction.
“We’re talking the difference of a week here, but that just feels like such a bigger time frame now with this virus,” she said.
Kim Payne, a 42-year-old Wake Forest resident, had already planned on being induced her 39th week of pregnancy in late March due to her age.
But as the virus spread, she talked to her healthcare provider about inducing even earlier. At the time, she thought N.C. hospitals would be at full capacity in late March.
“The baby’s lungs are the last thing that develops, so we definitely didn’t want her to come without being able to fully defend herself against (coronavirus), should she ever be exposed to it,” she said. “At the same time, we didn’t want to be in the middle of the hospital delivering a baby when we were at the peak of this outbreak.”
When she got induced at 38 weeks into pregnancy, she used a separate entrance for laboring patients at WakeMed North. Payne was comforted by learning that the hospital didn’t have an intensive care unit, so severely ill COVID-19 patients wouldn’t be treated there. She gave birth to a daughter, Mia, on March 28.
For Erin Arnold, induction ended up being the right option for her, too.
Her baby was already measuring a little large in the final weeks of her pregnancy. That, combined with concern over the novel virus, led the Arden resident to get induced a week early.
Mission Hospital in Asheville has a labor and delivery entrance, and by March 23, it had started its one-visitor restriction. These policies, along with the employees’ strict protocols of masks and sanitization, gave Arnold peace of mind.
When she ended up needing an emergency C-section, she began panicking that her husband, Tyler, wouldn’t be let in the operation room with her.
However, doctors allowed him in as the surgery progressed.
“That was definitely something that I thought that wasn’t going to be able to happen,” she said. “Having him there was a necessity for me, so I was relieved.”
Her son Bo was born on March 24, and she FaceTimed her mother and sister in the recovery room.
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Susanna Elliot, a doula in Wake Forest and founder of New Creation Birth Services, said some of her clients are considering changing their birth plans in light of the hospital visitor policies, which classify doulas as visitors and not part of the care team.
Her impending births in April haven’t been affected – those clients had already planned on delivering at birth centers or at home. Birth centers still allow doulas and may have looser visitor policies.
But two of her clients due in June are considering home births so that both Elliot and their spouses can be there. However, if they have to be transported to the hospital, they must choose between the two.
“People are having to make hard decisions that they don’t want to make,” Elliot said.
She plans on going to clients’ homes when labor begins, riding with them in the car to the hospital and supporting them through video chat, phone calls or text messages for the rest of the hospital birth.
“It’s obviously not as good as being in person, but it works out,” she said.
But planning a home birth or delivery at a birth center means hiring midwives, who are currently in high demand.
Michelle Rhude, a certified nurse midwife and owner of Bella Donna Midwifery in Jacksonville, offers services for home births and at La Vita Bella Birth Center. She said out-of-hospital births can be an option for women with low-risk pregnancies.
Before the pandemic, she said she received five to six daily calls from potential clients. Now, her business is receiving up to 20 per day.
“Going to the hospital where there are sick people is one of the big fears,” she said. “The other fear is them having limitations as far as having support people with them when they’re in labor. That’s affecting potentially their care – that they don’t have an advocate there.”
Rhude said she’s planning on expanding her staff to meet the increased demand.
Like many hospitals and outpatient clinics, Rhude says the birth center is screening people for symptoms. They’ve developed stricter standards on distancing, wearing masks, limiting visitors, sanitizing between clients and changing clothes for both the birth center and home births.
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Candice Burchill, a Brevard resident who gave birth on March 21, said the tight visitor restrictions at Mission Hospital were difficult for her. She lost a baby boy in 2018 and was already nervous during this pregnancy.
In the third week of March, Burchill developed preeclampsia – a severe pregnancy complication characterized by high blood pressure – and had an emergency C-section.
Her mother and sister-in-law, both registered nurses, had planned on supporting her in the delivery room.
But her mother ended up waiting in her car for more than 24 hours in the parking lot while Burchill’s husband, Charlie, texted her updates.
“I was pretty heartbroken,” Burchill said. “You have sort of a picture of what you want your birth to look like. My mom and sister-in-law were definitely part of that picture.”
Her daughter, Everly, stayed in the NICU at Mission Hospital for 10 days. Initially, both parents – but no one else – could visit the NICU.
On the fifth day, they left for lunch. When they returned, the security guard stopped them and said only one parent at a time was allowed to visit.
“They had made a decision 10 minutes before,” she said. “Charlie said, well you go, and he had to go back to his car, and I cried all the way down the hallway, all the way up the elevator.”
They quarantined for two weeks at home after Everly was discharged and never developed coronavirus symptoms.
Burchill said she shares a Google Photo album with loved ones and updates it daily with pictures. Her dad and siblings have yet to meet Everly.
She has a scale at home to provide virtual updates to her doctor about Everly’s weight gain. She took her daughter to her first couple of pediatric appointments in person, but the next appointment will be over video chat.
Hospitals, doulas and midwifery businesses now offer many resources virtually, like childbirth education classes, lactation services and postpartum appointments.
Burchill’s pediatrician in Brevard – like most across the state – prioritize in-person appointments for patients like newborns. Usually only one parent is allowed to accompany them.
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Before she gave birth in March, Payne watched videos on how to go through labor alone.
She had read about hospitals in New York implementing no-visitor policies for laboring moms that month, which were quickly revoked, but she wanted to be prepared for the worst.
Hyde said she became worried after she saw what happened in New York, but she now thinks it’s unlikely N.C. hospitals will do that. She has shifted her attitude and feels less anxious than she did before.
“I was kind of coming up with worst-case scenarios, like if my husband can’t come to the hospital, but I realized no, worst-case scenario is that I have an unhealthy child,” she said. “The good part of all of this is it helps focus on what really is important – it’s not who comes to see your baby at the hospital. At the end of the day, we’re going to be a family for the rest of our life.”
Mabel Yarbrough was born on April 23, but Addie Yarbrough isn’t sure if her parents can stay with her to help — and she doesn’t know when Justin’s parents or her sisters will meet Mabel. She said it depends on her doctor’s advice.
“At first, I was crushed, thinking that my mom won’t get to come into the delivery room and see me become a mom,” Yarbrough said in an interview before her daughter was born. “We’re thankful that we have technology – we can FaceTime them when she’s born.”
There have been bright spots – people she barely knows have reached out, sending her encouraging messages.
“It’s just been a lot of figuring out how to healthily deal with it and say, it’s OK for me to be afraid and understand this is a pandemic and this is a really sad, scary thing,” she said. “But it’s also OK for me to feel really joyful, and remember this is our first baby.”
