WEBVTT - How do you have a baby during a pandemic? 0:00:00.120 --> 0:00:05.519 Hi everyone, I'm Katie Curic, and welcome to next question today, 0:00:05.720 --> 0:00:09.800 Giving birth and the time of coronavirus. When I walked 0:00:09.840 --> 0:00:14.440 into the hospital, the hallways are eerily quiet. One mother 0:00:14.640 --> 0:00:19.800 surreal experience of going it alone. You saw the doctors, 0:00:19.840 --> 0:00:23.479 you saw security guards, and you saw cleaning staff just 0:00:23.560 --> 0:00:26.560 really kind of giving you a nod of you got this, 0:00:26.880 --> 0:00:31.760 but in a really powerful, yet somber and scary way. Later, 0:00:31.840 --> 0:00:34.720 we'll check in with obstetricians in two different New York 0:00:34.760 --> 0:00:38.400 hospitals to understand some of the biggest challenges they face 0:00:38.800 --> 0:00:43.040 and keeping pregnant mothers safe amid COVID nineteen. When I 0:00:43.080 --> 0:00:45.960 tell a patient that her COVID nineteen tests came back positive, 0:00:46.400 --> 0:00:50.000 she's terrified and there's a lot of avoidance of wanting 0:00:50.040 --> 0:00:52.800 to know the answer to that. Um So, I think 0:00:52.840 --> 0:00:55.600 it's the biggest challenge we have is to let our 0:00:55.640 --> 0:00:58.920 patients know that it's okay to come seek care. But first, 0:00:59.000 --> 0:01:02.280 my next question, how do you have a baby during 0:01:02.320 --> 0:01:08.280 a pandemic? Alicia Biggs had already given birth once nearly 0:01:08.360 --> 0:01:11.920 two years ago, to a baby girl named Olivia, and 0:01:12.000 --> 0:01:14.920 beyond the excitement of planning for their second child, to 0:01:15.040 --> 0:01:18.479 take place at the same hospital and with the same doctor. 0:01:18.800 --> 0:01:21.959 Alicia and her husband Patrick were really looking forward to 0:01:22.040 --> 0:01:26.240 a few crucial things being different this time around. I 0:01:26.280 --> 0:01:28.920 really wanted my my mom in the room. She wasn't 0:01:28.920 --> 0:01:31.319 in the room for the first pregnancy, and you know, 0:01:31.360 --> 0:01:34.240 I really wanted her there for for this one. She's 0:01:34.280 --> 0:01:37.360 my best friend, and and just um thought the more 0:01:37.360 --> 0:01:40.680 of the merrier for this one. And then another thing 0:01:40.680 --> 0:01:42.720 that we thought would be really nice and special that 0:01:42.800 --> 0:01:46.360 was a little different was in my first pregnancy, in 0:01:46.400 --> 0:01:49.480 my delivery, I had a very healthy baby, but she 0:01:49.560 --> 0:01:51.680 needed to go to the nick you at first. So 0:01:52.320 --> 0:01:56.400 that initial time where you're you spend with your with 0:01:56.480 --> 0:01:58.720 your newborn, I'm kind of on your chest, and just 0:01:58.840 --> 0:02:01.480 with your husband and with your family and just really 0:02:01.520 --> 0:02:04.559 relishing in the moment of what just happened. We didn't 0:02:04.560 --> 0:02:07.680 really get because she was sent into the nick you 0:02:07.800 --> 0:02:10.760 so fast. So we were hoping and crossing our fingers 0:02:10.840 --> 0:02:14.280 for an easy and healthy delivery where we could have, 0:02:14.440 --> 0:02:17.040 you know, shared that moment that people talk about all 0:02:17.080 --> 0:02:21.320 the time. Because of the complications of Alicia's first birth 0:02:21.680 --> 0:02:25.240 and the already large size of her second baby, Alicia's 0:02:25.280 --> 0:02:28.960 doctor planned to have her induced on Marchy, one week 0:02:29.000 --> 0:02:33.040 before her due date, at New York Presbyterian Hospital in Manhattan. 0:02:33.600 --> 0:02:37.119 But as that date neared, cases of the coronavirus were 0:02:37.120 --> 0:02:40.640 growing at alarming rates across New York City, which was 0:02:40.760 --> 0:02:44.480 already the epicenter of the virus, and hospitals were being 0:02:44.520 --> 0:02:48.000 forced to make some very tough decisions to prevent the 0:02:48.120 --> 0:02:52.240 virus from spreading. The week before, we had heard looming 0:02:52.720 --> 0:02:56.320 messages from people saying, you know, the hospitals down to 0:02:56.520 --> 0:02:59.959 usually you can have two attendees with you, they moved 0:03:00.040 --> 0:03:02.720 it down to one. So that means the plans changed 0:03:02.760 --> 0:03:07.040 for my mother. But they, you know, everybody was really 0:03:07.080 --> 0:03:10.000 messaging me saying, oh, they'll never you know, not let 0:03:10.040 --> 0:03:12.600 your your spouse in or your they'll you always have 0:03:12.760 --> 0:03:15.320 one person. So I kind of put it out of 0:03:15.360 --> 0:03:18.040 my mind that was never going to happen to me. 0:03:18.840 --> 0:03:21.760 And the Sunday prior to the delivery, so about three 0:03:21.840 --> 0:03:25.960 days before I got a call from my doctor she said, 0:03:26.000 --> 0:03:28.600 I have good news and I have bad news. The 0:03:28.680 --> 0:03:32.639 good news is there's a full staff in labor and delivery, 0:03:32.919 --> 0:03:35.560 which which really just level sets you as to what 0:03:35.800 --> 0:03:38.320 is good news. Anymore. The bad news isn't going to 0:03:38.360 --> 0:03:39.920 have to break it to you that you can no 0:03:39.960 --> 0:03:43.160 longer have your husband in the room. Those are some 0:03:43.240 --> 0:03:45.200 of the most difficult phone calls I've had to make. 0:03:45.960 --> 0:03:50.040 Dr Alan of Brownstein is Alicia's obstetrician. When she found 0:03:50.040 --> 0:03:52.880 out the news that New York Presbyterian Hospital had to 0:03:52.960 --> 0:03:57.160 institute severe restrictions due to the coronavirus and was no 0:03:57.280 --> 0:04:01.840 longer allowing any partners, family member, or outside support into 0:04:01.840 --> 0:04:05.480 the hospital at all, much less the delivery rooms, she 0:04:05.600 --> 0:04:09.840 immediately called her patients. They were long phone calls. I 0:04:09.880 --> 0:04:12.640 would sit there with them. I I feel horribly that 0:04:12.720 --> 0:04:14.640 they were not able to have that person with them, 0:04:14.640 --> 0:04:18.800 and how upsetting disappointing that was, and they were obviously disappointed. 0:04:19.440 --> 0:04:22.560 Um and that was not an easy conversation to have, 0:04:22.800 --> 0:04:27.200 although I do feel like they did understand the reasons 0:04:27.240 --> 0:04:30.200 why it was being done and how severe things had 0:04:30.240 --> 0:04:32.359 become for the hospital to make that decision that they 0:04:32.400 --> 0:04:35.440 couldn't have somebody there. And I would say, I'm going 0:04:35.520 --> 0:04:38.160 to do everything I can to make this a great 0:04:38.200 --> 0:04:40.960 experience for you, despite the fact that your husband's not 0:04:40.960 --> 0:04:43.200 going to be there. I said, make sure you have 0:04:43.320 --> 0:04:47.400 your laptop, your phone fired up charged. Don't forget to 0:04:47.440 --> 0:04:49.440 bring your charge to the hospital so if it dies 0:04:49.520 --> 0:04:52.039 during the delivery, you can still you know, charge it 0:04:52.120 --> 0:04:53.880 up and have your husband there. You can have him 0:04:53.920 --> 0:04:57.240 on the laptop, on FaceTime, on Zoom, on any platform 0:04:57.279 --> 0:04:59.000 so that you can feel like he's with you as 0:04:59.080 --> 0:05:03.720 much as possible. For Alicia, the news was devastating. I 0:05:03.760 --> 0:05:06.640 just cried to her on the phone, Um, and she 0:05:06.839 --> 0:05:11.440 was just unwavering in her support, saying, you you can 0:05:11.480 --> 0:05:13.560 do this, and where you're going to do this together 0:05:13.800 --> 0:05:16.200 and you will not be alone because I Am going 0:05:16.240 --> 0:05:18.600 to be there the entire time and it's you know, 0:05:18.680 --> 0:05:21.839 it's you and me and we will figure out a 0:05:21.880 --> 0:05:24.000 way to get through this. And she said take a 0:05:24.080 --> 0:05:28.080 day to to just figure yourself out. Patrick, where you 0:05:28.160 --> 0:05:31.280 crushed when you heard the news, I was. I was 0:05:31.640 --> 0:05:36.039 totally heartbroken that Sunday and Monday. It was incredibly difficult, 0:05:36.440 --> 0:05:38.960 um and sad. But then there was a shift that 0:05:39.040 --> 0:05:42.160 happened on kind of Monday into Tuesday before she gave 0:05:42.160 --> 0:05:45.280 birth on Wednesday, where it was this, you know, this 0:05:45.360 --> 0:05:47.960 was our new reality and we will we'll get through 0:05:48.000 --> 0:05:50.599 this together as much as possible. I took a day 0:05:50.640 --> 0:05:54.440 to be very emotional to you know, really just understand 0:05:54.480 --> 0:05:57.720 what was going on, and then I, um, I was 0:05:57.760 --> 0:06:01.680 a swimmer by background, uh, and really just tried to 0:06:01.800 --> 0:06:05.040 use the tools that I had available to me, you know, mentally, 0:06:05.279 --> 0:06:08.440 and really then said, okay, here's a day where you 0:06:08.520 --> 0:06:11.920 get to decide how you're going to move forward, and 0:06:12.960 --> 0:06:17.279 then really treated it as a swimming um and a 0:06:17.320 --> 0:06:19.640 swim race, right, It's a you know, swimming is a 0:06:19.720 --> 0:06:24.200 very individual, an individual sport that's surrounded by teammates who 0:06:24.240 --> 0:06:30.000 support you. I met my husband while swimming, and he understands, 0:06:30.080 --> 0:06:33.200 you know, the nuances of how I am of of 0:06:33.400 --> 0:06:36.800 when I get into that mode. So we spent the 0:06:36.880 --> 0:06:41.919 next days just preparing and kind of getting into that zone. 0:06:42.960 --> 0:06:46.559 On Wednesday, March, in the darkness of the early dawn, 0:06:47.040 --> 0:06:51.280 Patrick drove Alicia to New York Presbyterian Hospital and watched 0:06:51.320 --> 0:06:55.240 from the car as she walked in alone. When I 0:06:55.440 --> 0:06:58.880 walked into the hospital, the hallways are are eerily quiet 0:06:59.040 --> 0:07:02.080 because no one needs, you know, should be walking hallways 0:07:02.520 --> 0:07:05.039 unless they really have to. So I had my bag 0:07:05.080 --> 0:07:07.559 and it was clear with my bump where I was going, 0:07:08.240 --> 0:07:12.000 um and you saw the doctors, you saw security guards, 0:07:12.200 --> 0:07:15.320 and you saw cleaning staff just really kind of giving 0:07:15.320 --> 0:07:18.200 you a nod of you got this, but in a 0:07:18.280 --> 0:07:23.480 really powerful yet somber and scary way. And when you 0:07:23.720 --> 0:07:27.600 when you go immediately to sit down to check in, 0:07:27.760 --> 0:07:31.240 they give you a mask and they need to treat 0:07:31.280 --> 0:07:35.080 you as though you have COVID, um as though you 0:07:35.120 --> 0:07:39.680 have the virus, and they test you immediately when you 0:07:39.720 --> 0:07:42.760 get into the room, and then you we I didn't 0:07:42.760 --> 0:07:46.880 know results for twelve hours after that. Um, So your 0:07:46.920 --> 0:07:50.360 tense because you're having a baby, but you're you're also 0:07:50.440 --> 0:07:52.600 just tense because you don't know if you have COVID. 0:07:52.920 --> 0:07:55.600 You don't know if the nurses around you might have, 0:07:55.880 --> 0:07:59.800 you know, gotten it. So you're everybody's you know, protecting 0:07:59.840 --> 0:08:05.040 themselves for the greater benefit of everybody, right, But it's 0:08:05.120 --> 0:08:08.200 just really scary. So I didn't find out until right 0:08:08.280 --> 0:08:12.280 before I pushed that I had tested negative, which I 0:08:12.320 --> 0:08:15.960 was just you know, very tense about and you know, 0:08:16.080 --> 0:08:19.600 continue to tell Pat what if I have I was 0:08:19.680 --> 0:08:22.200 I was getting more stressed about having COVID than I 0:08:22.280 --> 0:08:26.400 was about delivering the baby. Um At first, the whole 0:08:26.440 --> 0:08:31.240 thing sounds ridiculously stressful. Just hearing you talk about it, 0:08:31.240 --> 0:08:35.880 it's making me feel anxious. Yeah, no, it was. It 0:08:35.960 --> 0:08:38.560 was anxious. It was, it was. It was really anxious. 0:08:38.640 --> 0:08:42.440 I mean some of the you know, beautiful things that 0:08:42.520 --> 0:08:46.360 had come out of it was you know, um, just 0:08:46.520 --> 0:08:49.280 understanding what the nurses are and the doctors are putting 0:08:49.280 --> 0:08:53.240 them how they're putting themselves out there to make you 0:08:53.280 --> 0:08:55.720 feel comfortable. So they you know, I walked in and 0:08:55.760 --> 0:08:58.560 they said they gave me a letter, a handwritten letter 0:08:58.640 --> 0:09:02.920 signed by all the nurses saying you're not alone, and 0:09:03.000 --> 0:09:05.559 you're going to prove to yourself how strong we already 0:09:05.559 --> 0:09:08.840 know you are, and we're here for every step of 0:09:08.880 --> 0:09:11.880 the way. And you know, everything was just so powerful 0:09:11.960 --> 0:09:15.080 that you're you're emotional and you're crying, but because you're 0:09:15.400 --> 0:09:18.120 you know, partially sad, partially scared, but partially you know, 0:09:18.160 --> 0:09:21.080 you're empowered to to get through this, and you just 0:09:21.160 --> 0:09:22.800 have one choice and you have to just get to 0:09:22.840 --> 0:09:26.560 the other side and decide, you know, I can either 0:09:27.000 --> 0:09:30.320 I need to make this a positive experience. So I 0:09:30.559 --> 0:09:33.520 um and they did a great job for me too, 0:09:33.559 --> 0:09:35.680 because the way we had it set up was I 0:09:35.720 --> 0:09:38.360 had an iPad A. Alicia had an iPad and we 0:09:38.440 --> 0:09:42.640 basically space time uninterrupted for thirteen hours, and so she 0:09:42.720 --> 0:09:44.440 had it on a little table with her that could 0:09:44.480 --> 0:09:48.160 move UM, and the nurses and the doctors talked to 0:09:48.200 --> 0:09:51.520 me as if I was in the room the entire time. 0:09:51.559 --> 0:09:54.280 They're saying, Okay, we're gonna do this. We're doing this, um, 0:09:54.320 --> 0:09:56.400 you know, here going to take her medicine up to 0:09:56.440 --> 0:10:00.400 this level. So they did a very um amaze job 0:10:00.440 --> 0:10:03.000 of making me feel a part of the entire process, 0:10:03.040 --> 0:10:07.600 even though I was They're virtually on an iPad, Alicia, 0:10:07.600 --> 0:10:10.200 I wanted to go back and ask you about the delivery. 0:10:10.320 --> 0:10:13.120 Did the doctors and nurses look like they were dressed 0:10:13.160 --> 0:10:15.920 for some kind of chemical spill? I mean, was that 0:10:16.080 --> 0:10:21.319 a strange experience for you versus seeing their faces? Right? 0:10:21.480 --> 0:10:24.560 It was? You know, they're in there in full there 0:10:24.559 --> 0:10:28.040 in masks. They're also in a shield. Um, they're in 0:10:28.280 --> 0:10:31.200 full gloves. You know, you can it's it's hard to 0:10:31.200 --> 0:10:35.000 to necessarily get out their demeanor, you know, other than 0:10:35.160 --> 0:10:38.840 verbally and and really through their eyes. So you had 0:10:40.000 --> 0:10:42.440 it was that's what made it so scary until I 0:10:42.520 --> 0:10:45.520 knew that I had tested negative for COVID. It was. 0:10:45.920 --> 0:10:48.480 It was a really scary time, which I think helped 0:10:48.520 --> 0:10:52.400 with you know, the handwritten letter and just really trying 0:10:52.480 --> 0:10:57.280 to read people's eye contact. And but it was a 0:10:57.400 --> 0:11:01.200 unique experience, and luckily I had a doctor who had 0:11:01.280 --> 0:11:04.960 been my doctor this entire time through you know, my 0:11:05.000 --> 0:11:07.720 first birth and also all my appointments of my second birth, 0:11:08.280 --> 0:11:13.319 and her comfort. You know, at one point I got quite, 0:11:13.480 --> 0:11:17.320 you know, just I just lost, I got my my 0:11:17.400 --> 0:11:19.560 emotions got the better of me, and I you know, 0:11:19.600 --> 0:11:22.280 I just was crying because this was all just a lot, 0:11:22.679 --> 0:11:25.280 and you know, she came in and you know, gave 0:11:25.320 --> 0:11:27.400 me that look of we we had we're going to 0:11:27.559 --> 0:11:29.240 do this and we're going to get through this, and 0:11:29.400 --> 0:11:32.520 you know, you're you're tough, and you just we're going 0:11:32.600 --> 0:11:35.240 to be tough together. And so that was really nice. 0:11:35.280 --> 0:11:38.480 And so I tried to make it also, you know, 0:11:38.640 --> 0:11:42.400 a lighter experience in in terms of they also saw 0:11:42.480 --> 0:11:46.880 how petrified I was so trying to combat that. I 0:11:46.960 --> 0:11:52.200 brought in plastic wrapped COVID approved sweat bands so that 0:11:52.240 --> 0:11:55.640 they could undo them, um and so that you know, 0:11:55.679 --> 0:11:58.280 the nurses and the doctor when we were you know, 0:11:58.320 --> 0:12:01.320 going through labor could could see that I was this, 0:12:01.760 --> 0:12:03.560 you know, this can be fun and this is a 0:12:04.440 --> 0:12:05.920 you know, bring it back to that, this is an 0:12:05.920 --> 0:12:11.760 amazing experience. So we all did wear sweatbands during the delivery. 0:12:12.160 --> 0:12:16.040 Dr Brownstein, what was it like for you helping Alicia. 0:12:16.160 --> 0:12:20.280 Luckily it was her second child, so she wasn't you know, 0:12:20.320 --> 0:12:23.760 it wasn't her first rodeo, but it still must have 0:12:23.800 --> 0:12:28.439 been pretty stressful. Can you describe what that delivery was like? Right? Well, 0:12:28.800 --> 0:12:33.400 she had her husband on the laptop the entire time. 0:12:33.640 --> 0:12:36.920 I felt like he was there. I had regular conversations 0:12:37.000 --> 0:12:40.200 with her throughout the entire labor process, and I would 0:12:40.240 --> 0:12:43.360 just talk directly to him. Um. We tried to make 0:12:43.440 --> 0:12:46.600 him as included as possible and just feel like he 0:12:46.760 --> 0:12:49.800 was just another person in the in the room. She 0:12:50.000 --> 0:12:53.120 was very funny. She said, you know, usually, you know, 0:12:53.160 --> 0:12:55.920 Patrick is here with me, and last delivery we had 0:12:56.000 --> 0:12:58.520 him were the headband for it, and we were both 0:12:58.520 --> 0:13:01.760 wearing the headband together, and she whipped out these brand 0:13:01.760 --> 0:13:03.800 new headbands for me and the nurse and she said, 0:13:04.160 --> 0:13:06.720 would you be willing to please by or these headbands? 0:13:06.720 --> 0:13:09.080 It makes me feel like Patrick is here and in 0:13:09.120 --> 0:13:12.240 the room, and we always like absolutely so the nurse 0:13:12.280 --> 0:13:15.240 and I were wearing our matching headbands along with Alicia 0:13:15.320 --> 0:13:17.520 and going through the whole process and pushing them. We 0:13:17.600 --> 0:13:19.959 got pictures of us all with our headbands on, and 0:13:20.000 --> 0:13:22.880 it just made it more fun and inclusive, and Patrick 0:13:22.920 --> 0:13:24.480 felt like he was there and we were just trying 0:13:24.520 --> 0:13:27.160 to be as importive and as there for her as 0:13:27.200 --> 0:13:31.320 you could possibly be. How long were you in labor, Alicia? 0:13:31.520 --> 0:13:36.960 So I was in labor for about thirteen hours. The 0:13:37.080 --> 0:13:40.960 labor and delivery part was went by really fast because 0:13:40.960 --> 0:13:44.079 you had all of the support of the of of everybody, 0:13:44.120 --> 0:13:46.400 and you know it's building up to this one moment 0:13:47.040 --> 0:13:50.679 and then you know the post. The post twenty four 0:13:50.679 --> 0:13:53.680 hours and forty eight hours after is I think the 0:13:53.760 --> 0:13:58.120 hardest part too, where you just feel loneliness and being 0:13:58.160 --> 0:14:00.960 scared because you're sitting with your you're sitting alone with 0:14:01.000 --> 0:14:05.520 your thoughts and um, you have a roommate, but everyone's 0:14:05.559 --> 0:14:10.640 really scared to to, you know, even talk to each other. Yeah, 0:14:10.920 --> 0:14:15.680 So it's just it's it's an interesting environment. What was 0:14:15.720 --> 0:14:19.960 it like for you, Pat to see your son on 0:14:20.120 --> 0:14:24.160 that iPad screen? It was surreal for sure. I mean 0:14:24.240 --> 0:14:29.200 it was, you know, again, not what you had anticipated. Um, so, 0:14:29.320 --> 0:14:31.200 you know, after he was born, they bring them over 0:14:31.240 --> 0:14:34.560 to the heating table to do measurements and all those things, 0:14:34.560 --> 0:14:36.680 and so they picked up the iPad and brought me 0:14:36.720 --> 0:14:39.280 over there. So they made me feel the entire time 0:14:39.320 --> 0:14:41.480 like I was part of the process. And then the 0:14:41.560 --> 0:14:43.160 picking up at the hospital the next day, it was 0:14:43.280 --> 0:14:46.320 very special to just you know, Alicia was on the 0:14:46.320 --> 0:14:49.720 wheelchair with Jack with a blanket over her, and so 0:14:49.840 --> 0:14:52.280 she had the blanket over him basically until she got 0:14:52.320 --> 0:14:55.000 to the car and then, um, you know, to see 0:14:55.040 --> 0:14:56.440 him for the first time and to hold him and 0:14:56.440 --> 0:14:58.320 to put him in the car seat. That would be 0:14:58.360 --> 0:15:01.000 a moment that will have kind of etched in my 0:15:01.040 --> 0:15:05.320 brain forever, that first time medium outside the hospital Alicia 0:15:05.320 --> 0:15:08.240 and patted. Just a few days after you had to 0:15:08.280 --> 0:15:12.360 go through this, Governor Cuomo announced an executive order that 0:15:12.480 --> 0:15:17.640 rescinded these restrictions so that hospitals in New York allowed 0:15:17.680 --> 0:15:22.480 women to have one support partner present during their births. 0:15:23.200 --> 0:15:28.880 So did you feel like, gosh, uh, why the heck 0:15:28.960 --> 0:15:32.400 did I end up in this window? I did think 0:15:32.440 --> 0:15:35.320 it was funny timing. I'm hoping I have, we have 0:15:35.400 --> 0:15:39.000 some delayed good karma hanging over us in the future. 0:15:40.160 --> 0:15:44.280 But I was, I was, you know, being a second 0:15:44.320 --> 0:15:48.680 time mother. I was happy that it was me who 0:15:48.840 --> 0:15:51.760 has had the benefit and you know, the fortune to 0:15:52.520 --> 0:15:55.680 have a delivery with my husband, and during times like this, 0:15:55.760 --> 0:15:58.280 it makes you realize just you know, what's important, and 0:15:58.840 --> 0:16:01.400 I was happy to take that place for someone other 0:16:01.440 --> 0:16:04.880 than a first time mom, because that's a really it's 0:16:04.880 --> 0:16:09.720 it's scary, it's lonely, and you know, doing it when 0:16:09.760 --> 0:16:12.440 you have no idea what's going on once you give 0:16:12.480 --> 0:16:17.240 birth is just frightening. So I'm I'm really glad that 0:16:18.160 --> 0:16:20.560 it happened to me versus some of my other close 0:16:20.640 --> 0:16:25.200 friends who were um first time mom's delivering very shortly 0:16:25.240 --> 0:16:30.160 after that, and luckily was the band was lifted. Congratulations 0:16:30.240 --> 0:16:33.560 to Alicia and Patrick Biggs, to big sister Olivia, and 0:16:33.640 --> 0:16:36.720 of course too little Jack Biggs, who will have one 0:16:36.800 --> 0:16:42.320 hell of a birth story to tell when we come back. 0:16:42.640 --> 0:16:46.480 Dr Alana Brownstein on what we know so far about 0:16:46.600 --> 0:16:58.040 pregnancy and COVID nineteen. One of the many things we 0:16:58.120 --> 0:17:00.920 don't yet know about COVID nineteen is how the virus 0:17:00.920 --> 0:17:04.320 affects pregnant women and their babies, So we wanted to 0:17:04.359 --> 0:17:07.719 talk to a few obstetricians about what they are seeing 0:17:08.119 --> 0:17:11.280 as well as how their hospitals and pregnant patients are 0:17:11.320 --> 0:17:15.439 experiencing all this. We started New York Presbyterian Hospital with 0:17:15.560 --> 0:17:18.800 Dr Alana Brownstein, the o B we heard from at 0:17:18.800 --> 0:17:21.480 the beginning of the episode. A few things to note 0:17:21.520 --> 0:17:25.920 about New York Presbyterian Hospital. It is massive, with multiple 0:17:26.000 --> 0:17:29.879 campuses across the New York metropolitan area. It's also one 0:17:29.920 --> 0:17:34.320 of the most prominent hospitals, ranked number five in the country. 0:17:34.640 --> 0:17:37.760 Dr Brownstein delivers out of the hospital's location on the 0:17:37.840 --> 0:17:42.240 Upper East Side of Manhattan, a community that's overwhelmingly white 0:17:42.320 --> 0:17:46.560 and ensured. Dr Brownstein answers a few medical questions first 0:17:46.880 --> 0:17:49.560 and then walks us through what labor and delivery looks 0:17:49.600 --> 0:17:56.879 like right now where she practices. What physiological changes and 0:17:56.960 --> 0:18:02.280 biological changes occurred during pregnants that could in fact make 0:18:02.359 --> 0:18:08.040 pregnant women more susceptible to certain viruses if not COVID nineteen, 0:18:08.160 --> 0:18:11.560 it's too soon to tell, but can you explain what 0:18:11.720 --> 0:18:14.880 happens to women that could put them at greater risks? 0:18:15.920 --> 0:18:18.960 So we know that pregnant women are at a relative 0:18:19.080 --> 0:18:23.879 immune suppressed state um in parts so that the the 0:18:24.000 --> 0:18:26.679 mother's body can accept to feed us in their body 0:18:26.720 --> 0:18:28.879 which is not their own cells. So we know that 0:18:28.920 --> 0:18:31.560 it is decreased in certain ways like that. We also 0:18:31.600 --> 0:18:33.800 know that certainly any bodies that they have can be 0:18:33.840 --> 0:18:37.440 in lower tighters just because of the plasma volume expansion 0:18:37.440 --> 0:18:43.000 that happens naturally in pregnancy. So it is theoretical possible 0:18:43.359 --> 0:18:46.960 that your immune systems decrease could make you more susceptible 0:18:47.000 --> 0:18:49.800 to certain viruses and make that disease much worse in 0:18:49.840 --> 0:18:52.399 pregnancy than not. We just need more time to know 0:18:52.440 --> 0:18:54.520 iff that's the case for COVID nineteen or not. But 0:18:54.640 --> 0:18:58.600 in Layman's terms, you're saying that the expansion of the 0:18:58.640 --> 0:19:03.520 baby can decrease lung capacity just because it's pushing up 0:19:03.520 --> 0:19:06.920 on the lungs right, So later in pregnancy, especially where 0:19:06.920 --> 0:19:09.919 there's a whole fetus in the in that cavity, it 0:19:10.040 --> 0:19:13.160 can make it difficult for the lungs or expand more, 0:19:13.440 --> 0:19:16.439 which also sometimes can make it more difficult to know 0:19:16.520 --> 0:19:18.480 who has it or not. Because when you talk about 0:19:18.560 --> 0:19:21.080 some of the symptoms of COVID nineteen and you talk 0:19:21.160 --> 0:19:24.800 about respiratory changes, well, feeling short of breath is a 0:19:24.920 --> 0:19:28.440 very common symptom of normal pregnancy, So that can make 0:19:28.440 --> 0:19:31.280 it a little bit more challenging to figure out what 0:19:31.320 --> 0:19:34.600 it is because your respiratory rate is faster, and certainly 0:19:35.119 --> 0:19:38.320 you feel more breathless. It's harder to um take a 0:19:38.320 --> 0:19:40.359 deep breath, and it's harder to feel like your lungs 0:19:40.359 --> 0:19:43.439 are fully expanding because of that fetus in that area. 0:19:44.160 --> 0:19:47.439 What happens when a pregnant woman comes in now to 0:19:47.560 --> 0:19:51.640 your hospital is she immediately tested for COVID nineteen. So 0:19:51.720 --> 0:19:55.040 any woman that is coming onto the unit gets a 0:19:55.119 --> 0:19:58.919 mask right away. Um. If the patient is admitted to 0:19:58.960 --> 0:20:02.439 the hospital, then she is immediately tested. If somebody comes 0:20:02.480 --> 0:20:06.280 in and is not admitted, then they are not tested 0:20:06.320 --> 0:20:08.480 for For example, if a woman thinks that her water 0:20:08.520 --> 0:20:10.679 broke and she's coming in and she's evaluated and it 0:20:10.680 --> 0:20:13.000 turns out that her water didn't break, she's sent out. 0:20:13.400 --> 0:20:16.359 We don't test that person for COVID. If the patient 0:20:16.480 --> 0:20:19.560 is admitted for whatever reason it is, whether it's labor, 0:20:19.840 --> 0:20:23.959 preternal labor, any other condition going on obstetrically, that patient 0:20:24.080 --> 0:20:26.840 is tested for COVID. It does take a few hours 0:20:26.840 --> 0:20:28.960 before we get the test back, So we essentially just 0:20:29.000 --> 0:20:33.720 treat everybody like they're positive UM, and then anything obstetrically 0:20:33.840 --> 0:20:36.000 is done as it normally would be. If she's in labor, 0:20:36.040 --> 0:20:38.600 we're managing her labor. She wants pay medicine, she gets 0:20:38.600 --> 0:20:41.879 pay medicine. That part doesn't change. It's really more of 0:20:42.720 --> 0:20:46.000 UM whether or not she is positive in what that 0:20:46.040 --> 0:20:48.480 means for her, the delivery and for the baby afterwards. 0:20:48.520 --> 0:20:51.000 But everybody on the unit has a mask on. We're 0:20:51.000 --> 0:20:54.000 wearing gloves for everybody, and that's the same across the board. 0:20:54.520 --> 0:20:58.040 If we know if somebody who might be positive UM, 0:20:58.119 --> 0:21:00.439 we try to call ahead to the hot spook. I 0:21:00.440 --> 0:21:02.600 know I have a patient that's coming in that either 0:21:02.720 --> 0:21:05.960 I suspect as positive, I know is positive, or any 0:21:06.000 --> 0:21:09.159 inkling of that. We make sure we call ahead, We 0:21:09.200 --> 0:21:11.600 have a room waiting for them, and we make sure 0:21:11.600 --> 0:21:15.040 that they are isolated. What kinds of concerns are raised? 0:21:15.119 --> 0:21:20.720 Dr Brownstein if pregnant woman about to give birth test positive, 0:21:20.920 --> 0:21:25.920 other than protecting the staff members, is there any risk 0:21:26.000 --> 0:21:28.679 to her baby? Is their risk to her in terms 0:21:28.680 --> 0:21:32.960 of the delivery, etcetera. So for the delivery part, we 0:21:33.040 --> 0:21:35.920 deliver them as we would regardless of their COVID status, 0:21:35.920 --> 0:21:38.080 meaning if they are going to have a vaginal delivery, 0:21:38.119 --> 0:21:39.960 they can have a vaginal delivery. If they're going to 0:21:40.000 --> 0:21:42.359 have a c section, they can. For the baby, the 0:21:42.440 --> 0:21:44.960 concern is we want to make sure that it doesn't 0:21:44.960 --> 0:21:48.439 get transmitted to the baby. So currently it does not 0:21:48.640 --> 0:21:51.720 appear that there's vertical transmission, meaning that the baby would 0:21:51.800 --> 0:21:56.240 get the virus just from being inside the mom um. 0:21:56.400 --> 0:22:00.159 So it's thought that for the actual delivery process they 0:22:00.160 --> 0:22:02.639 can deliver as they normally would. It's more of a 0:22:02.720 --> 0:22:06.159 question for postpartum. The babies are not taken away from 0:22:06.200 --> 0:22:08.080 the moms, so that's the question. I get a lot, 0:22:08.119 --> 0:22:10.119 is my baby taken away from me? If I'm positive. 0:22:10.440 --> 0:22:12.760 We generally don't take the baby away from the mom. 0:22:12.840 --> 0:22:14.600 The mom the baby can still be with the mother, 0:22:15.000 --> 0:22:16.680 but we do try to make sure that the mom 0:22:16.720 --> 0:22:18.920 is wearing a mass mom's wearing gloves. We're not having 0:22:18.920 --> 0:22:21.680 that direct contact that that baby might get it from 0:22:21.720 --> 0:22:25.399 the mother. After the delivery, you're not concerned that the 0:22:25.480 --> 0:22:29.640 baby could become infected out of utera. So we are 0:22:29.840 --> 0:22:33.360 and not necessarily just during that delivery, but we're concerned 0:22:33.560 --> 0:22:36.720 with contact with the mom afterwards that even the mom 0:22:36.760 --> 0:22:38.520 just holding the baby. You know, the first thing you 0:22:38.560 --> 0:22:40.320 want to do is when you get your newborn is 0:22:40.560 --> 0:22:43.239 hold it tight, kiss at snugglet be very close to it. 0:22:43.480 --> 0:22:45.879 But all of those things, the baby could get COVID 0:22:45.960 --> 0:22:48.760 from that. So generally what they're trying to do is 0:22:48.840 --> 0:22:51.760 have the baby be with the mom, but still maintain 0:22:51.800 --> 0:22:55.200 that distancing, so being six freed away. If the mom 0:22:55.359 --> 0:23:00.159 chooses to breastfeed, then the mom can breastfeed. However, we 0:23:00.240 --> 0:23:02.399 try to wash the breast off. We try to make 0:23:02.400 --> 0:23:04.320 sure the mom has washed our hands. We want to 0:23:04.320 --> 0:23:06.480 make sure there's the mom is wearing a mass the 0:23:06.600 --> 0:23:09.600 entire time so she's not breathing directly on it or 0:23:09.640 --> 0:23:12.360 the other optionism mom can express breast milk and then 0:23:12.400 --> 0:23:14.520 somebody else can feed the baby the breast milk if 0:23:14.520 --> 0:23:16.600 they want to do it that way, because there is 0:23:16.640 --> 0:23:18.800 a concern that it could be transmitted to the baby, 0:23:19.200 --> 0:23:22.399 not in utero, but afterwards just having the contact with 0:23:22.440 --> 0:23:25.040 the mother, so we do try to limit that contact. 0:23:25.280 --> 0:23:27.199 But it's not like the mom can't be in the 0:23:27.240 --> 0:23:29.600 same room as the baby. I think that concern of 0:23:29.840 --> 0:23:33.119 having your baby physically taken away from you to another room. 0:23:33.200 --> 0:23:37.119 That is very concerning. What about having mothers give birth 0:23:37.520 --> 0:23:43.399 prematurely or early because of their COVID symptoms and concerns 0:23:43.440 --> 0:23:46.600 about their health and potentially the baby's health. So there 0:23:46.600 --> 0:23:49.399 are some situations or the mom just are so sick 0:23:49.720 --> 0:23:52.320 that they have to do that. We generally try to 0:23:52.680 --> 0:23:55.679 hold off on doing that if we could, just for 0:23:55.720 --> 0:23:58.639 the baby's health. UM, We'll try to get the baby 0:23:58.800 --> 0:24:01.160 at least to either like thirty two or thirty four 0:24:01.200 --> 0:24:03.760 weeks ges station if we have to do that, because 0:24:03.840 --> 0:24:07.359 there's such significant morbidity UM for the baby before that 0:24:07.440 --> 0:24:10.399 gestational age. But there are situations where moms are that 0:24:10.480 --> 0:24:13.040 sick that they do have to convert over and decide 0:24:13.080 --> 0:24:15.040 to deliver the baby early for the moms health. What 0:24:15.119 --> 0:24:18.440 about during pregnancy? I was getting a lot of questions, 0:24:18.440 --> 0:24:22.440 and I'm not a doctor with pregnant women very concerned 0:24:22.960 --> 0:24:27.320 if they got COVID ninety obviously for themselves, but very 0:24:27.359 --> 0:24:31.960 concerned about the health of their babies developmentally. What do 0:24:32.000 --> 0:24:35.879 we know about that? Great questions? So very little, only 0:24:35.960 --> 0:24:38.640 that again it's so early that we don't have patients 0:24:38.640 --> 0:24:40.760 that have had it very early in the pregnancy and 0:24:40.800 --> 0:24:43.440 then carried food a term. Yet, just because it hasn't 0:24:43.440 --> 0:24:46.119 been around that long so far, it seems that there 0:24:46.200 --> 0:24:49.560 might be a high risk for preterm delivery. UM, we 0:24:49.640 --> 0:24:51.880 are concerned about whether or not there could be an 0:24:51.880 --> 0:24:56.359 increased risk of either miscarriage or congenital adormalities. But we 0:24:56.440 --> 0:24:59.679 haven't seen that yet. UM, it's certainly a concern, and 0:24:59.760 --> 0:25:03.119 we're we're getting our huge registry of pregnant women to 0:25:03.160 --> 0:25:06.400 see something that we can follow out over time. It's 0:25:06.440 --> 0:25:08.800 just too early to know. We're also concerned about the 0:25:08.800 --> 0:25:10.840 growth of the baby, so we want to make sure 0:25:10.840 --> 0:25:13.760 if the mom is infected as the baby growing well, 0:25:14.040 --> 0:25:17.320 so they have to have ways to monitor that as well. 0:25:17.640 --> 0:25:20.800 We haven't seen it yet, but again only because those 0:25:20.800 --> 0:25:23.920 are things that take while to actually develop into see 0:25:24.000 --> 0:25:26.840 and it just hasn't been amount enough to see. I 0:25:26.880 --> 0:25:31.040 wanted to ask you about maternal mortality. We did two 0:25:31.080 --> 0:25:36.080 episodes on maternal mortality, which we're holding for later, but 0:25:36.160 --> 0:25:40.119 it's very concerning. There are something like seven hundred to 0:25:40.240 --> 0:25:45.640 nine women dying from pregnancy or childbirth every single year 0:25:45.640 --> 0:25:48.960 in this country. Not to mention the fifty thousand women 0:25:49.000 --> 0:25:53.119 every year who almost die. So how concerned are you 0:25:53.160 --> 0:25:58.520 about the impact of COVID nineteen on this skyrocketing maternal 0:25:58.600 --> 0:26:02.560 mortality rate. I think it goes back to we need 0:26:02.640 --> 0:26:05.360 to make sure that our patients have access, that they 0:26:05.400 --> 0:26:07.840 can be seen, that they can get to a hospital 0:26:07.880 --> 0:26:10.320 that can care for them, because that is going to 0:26:10.359 --> 0:26:13.040 make the difference of how they do and how their 0:26:13.080 --> 0:26:16.359 their babies do. And it's very concerning, and this is 0:26:16.400 --> 0:26:19.800 just one more, one more layer of things that can 0:26:19.840 --> 0:26:21.640 make it harder for those women to get the good 0:26:21.680 --> 0:26:25.119 care that they need. The doctors we spoke to for 0:26:25.240 --> 0:26:29.360 our maternal mortality Episodes also said it can be crucial 0:26:29.400 --> 0:26:32.240 to have support for the mother. There's not only before 0:26:32.240 --> 0:26:36.600 and during the pregnancy, but afterwards, since so many complications 0:26:36.640 --> 0:26:40.400 can happen after the baby is born and hospitals are 0:26:40.440 --> 0:26:43.600 so focused on the health of the baby. What are 0:26:43.600 --> 0:26:46.159 your thoughts there, But there's a lot of things that 0:26:46.200 --> 0:26:49.560 can happen postpartum um. It's not over once that baby 0:26:49.560 --> 0:26:54.080 comes out. You know, people can have um bleeding issues postpartum. 0:26:54.160 --> 0:26:56.920 You can get pre aclamps to a blood pressure issues 0:26:57.240 --> 0:27:00.199 postpartum um. There's a lot of things that if you 0:27:00.240 --> 0:27:03.200 don't have somebody who one knows about it you can 0:27:03.200 --> 0:27:05.480 help take care of you. And three recognizing and get 0:27:05.520 --> 0:27:09.280 you to your hospital can be major issues. UM and 0:27:09.320 --> 0:27:11.560 I think that is a huge problem having that support. 0:27:11.760 --> 0:27:14.120 It doesn't end once that baby comes out. It really 0:27:14.160 --> 0:27:17.120 goes into the whole hours partum care period as well. 0:27:17.320 --> 0:27:21.320 Can tell a medicine be helpful in that regard for 0:27:21.440 --> 0:27:24.199 women who have given birth but may not have as 0:27:24.280 --> 0:27:29.120 much access to top medical care. I think that we're 0:27:29.160 --> 0:27:31.560 seeing the role that telemedicine can play. I think it's 0:27:31.640 --> 0:27:35.159 really been shot into the spotlight with everything going on 0:27:35.200 --> 0:27:37.639 here where we're trying to keep people at home. UM, 0:27:37.720 --> 0:27:39.680 there are a lot of things that you can assess 0:27:39.800 --> 0:27:43.320 over the telemedicine visits. You can't do everything, but you 0:27:43.359 --> 0:27:46.119 can see the patient, you know. I'll have visits with 0:27:46.160 --> 0:27:48.520 my patients who all have them show me their own decision, 0:27:48.720 --> 0:27:50.919 you know, have you know, show me what that bleeding 0:27:51.040 --> 0:27:53.919 is looking like. I have patients get blood pressure monitors 0:27:53.960 --> 0:27:56.920 at home. I have them take their bloo pressure at home, 0:27:57.240 --> 0:27:59.240 show me what it shows like, show me what that 0:27:59.320 --> 0:28:02.040 number is, and then I can try to do an 0:28:02.080 --> 0:28:04.600 assessment whether that's somebody who needs to come in, or 0:28:04.600 --> 0:28:06.720 whether that's something I can just speak to them at home. 0:28:06.840 --> 0:28:09.840 So it certainly can help, especially in this day and 0:28:09.880 --> 0:28:12.560 age or trying to not have people come in. I 0:28:12.600 --> 0:28:14.280 think there is a lot of information you can get 0:28:14.280 --> 0:28:19.040 with a telemedicine visit. What's your advice, Dr Brownstein for 0:28:19.960 --> 0:28:23.760 pregnant women right now, with no end in sight, what 0:28:23.920 --> 0:28:27.800 would you tell your patients that might help pregnant women everywhere? 0:28:28.320 --> 0:28:30.600 I think the most important thing is what we're telling 0:28:30.760 --> 0:28:34.200 all people right now, which is make sure that you're 0:28:34.280 --> 0:28:38.360 practicing the social distancing, make sure you're performing hand hygiene 0:28:38.800 --> 0:28:41.600 where we're a mask, we're a protective gear. If you're 0:28:41.600 --> 0:28:45.240 going out, try to distance yourself from everybody. Um, those 0:28:45.240 --> 0:28:48.600 are the things that seem to be working. And I 0:28:48.640 --> 0:28:52.360 feel like for the pregnant patients, especially where there's already 0:28:52.480 --> 0:28:55.360 a high anxiety and a concern about this pregnancy, to 0:28:55.440 --> 0:28:57.320 try to protect themselves as much as they can, This 0:28:57.400 --> 0:28:59.960 is a great time to kind of stay inside corn 0:29:00.000 --> 0:29:02.120 teen and keep your distance from people as much as 0:29:02.120 --> 0:29:04.400 you can for your own protection and for that of 0:29:04.480 --> 0:29:12.560 your baby as well. Just across the East River from 0:29:12.680 --> 0:29:17.160 Dr Brownstein is the Elmhurst Hospital Center in Queens, a 0:29:17.280 --> 0:29:21.000 public hospital that has about five hundred and forty beds 0:29:21.400 --> 0:29:27.880 to New York Presbyterians hundred plus. It's located in Jackson Heights, Queens, 0:29:27.920 --> 0:29:31.479 which is the most ethnically diverse neighborhood in the country. 0:29:32.120 --> 0:29:35.120 It's a very underserved community and the community right now 0:29:35.480 --> 0:29:37.520 is being hit very, very hard by the COVID epidemic. 0:29:37.960 --> 0:29:42.160 Dr Tracy bone Hemmerdinger is the chief of Obstetrics at Elmhurst. 0:29:42.440 --> 0:29:45.920 The population that we generally see at Elmhurst is mixed 0:29:45.920 --> 0:29:51.760 community of new immigrants. UM. We see all different ethnic backgrounds. UM. 0:29:51.880 --> 0:29:55.440 The number one language spoken is Spanish, followed I think 0:29:55.520 --> 0:29:59.320 very closely by Bengali UM. And I think that a 0:29:59.320 --> 0:30:01.200 lot of the patient is that we see fall into 0:30:01.240 --> 0:30:05.360 the category of people who can't social distance because they 0:30:05.400 --> 0:30:08.000 live with large numbers of people in their homes, people 0:30:08.000 --> 0:30:10.320 who are responsible for caring for not only many children, 0:30:10.360 --> 0:30:13.560 but also their parents and their extended family UH. And and 0:30:13.320 --> 0:30:17.800 and people whose jobs are either domestic workers or you know, 0:30:18.000 --> 0:30:20.800 people whose jobs and livelihood may be cut off completely 0:30:20.840 --> 0:30:24.800 and not have any access to their regular daily needs. 0:30:25.040 --> 0:30:26.960 And so I think that that puts them at significant 0:30:27.040 --> 0:30:29.720 risk for any illness. Elm Hurst has been called the 0:30:29.760 --> 0:30:34.320 epicenter of the epicenter of coronavirus cases, the ground zero 0:30:34.440 --> 0:30:37.720 of the epidemic. The fact is Elmer's was one of 0:30:37.720 --> 0:30:41.520 the first hospitals hit by corona and it was hit hard. 0:30:42.000 --> 0:30:44.600 Elmhurst runs at capacity, so I believe it was running 0:30:45.880 --> 0:30:49.560 capacity before the epidemic, and so that's why it became 0:30:49.600 --> 0:30:51.720 so difficult, because we needed to figure out ways to 0:30:51.760 --> 0:30:54.040 structurally change our hospital to be able to take care 0:30:54.080 --> 0:30:56.760 of all of our patients. The very beginning of this, 0:30:56.840 --> 0:30:59.200 nobody really knew what was going on and what was happening. 0:30:59.720 --> 0:31:02.080 We got at a lot of patients presented and they 0:31:02.120 --> 0:31:04.280 didn't know what they were supposed to say or do. 0:31:04.400 --> 0:31:06.040 We didn't know what we're supposed to say or do. 0:31:06.600 --> 0:31:09.560 The recommendations from the CDC and from the New York 0:31:09.640 --> 0:31:12.880 City officials and the New York State officials were changing 0:31:12.920 --> 0:31:14.880 every couple of hours, and I would come up with 0:31:14.960 --> 0:31:16.560 some kind of a protocol and then it would have 0:31:16.600 --> 0:31:19.960 to be changed. And it was very frustrating and difficult 0:31:20.160 --> 0:31:22.480 on both sides. On the patient side, and not even 0:31:22.480 --> 0:31:24.520 just the patient side. The family members of the patients, 0:31:24.600 --> 0:31:27.880 especially for pregnant women, which is what I deal with UM. 0:31:28.000 --> 0:31:29.920 And now I would say we're a few weeks into it. 0:31:30.000 --> 0:31:32.480 We really got this down and we know how to 0:31:32.480 --> 0:31:34.600 manage it. And I think that a lot of our 0:31:34.600 --> 0:31:37.200 patients initially were very afraid to come to the hospital, 0:31:37.560 --> 0:31:40.040 especially because of all the news the elm Hurst Hospital 0:31:40.080 --> 0:31:42.160 has been on the news because we've gotten hit so hard. 0:31:42.480 --> 0:31:45.320 And now, UM, I think they feel more comfortable. Are 0:31:45.320 --> 0:31:47.080 our senses is starting to come up. Our patients are 0:31:47.080 --> 0:31:49.760 more comfortable coming in, and our outcomes are very good. 0:31:50.080 --> 0:31:53.440 Dr Bones says half the battle was working out the logistics. 0:31:53.760 --> 0:31:55.960 There was a lot the hospital had to figure out 0:31:56.120 --> 0:31:59.800 and figure out fast when it came to managing incoming 0:32:00.040 --> 0:32:05.360 COVID or suspected COVID cases. With exceptions like labor delivery 0:32:05.400 --> 0:32:11.000 and postpartum. Elmhurst is now almost entirely devoted to COVID care. 0:32:11.640 --> 0:32:13.440 The physical space was something we had to figure out 0:32:13.480 --> 0:32:15.280 how to use and our staff as well. So we 0:32:15.360 --> 0:32:18.480 have a triage area that has seven beds for triage, 0:32:18.480 --> 0:32:20.160 and we had to put up a wall so that 0:32:20.200 --> 0:32:22.680 we could have COVID patients on one side. And non 0:32:22.680 --> 0:32:24.240 COOVID patients on another side. And then we had to 0:32:24.280 --> 0:32:26.240 do the same thing in our post anesthesia care unit 0:32:26.280 --> 0:32:27.880 after c sections, we had to put up a wall 0:32:28.200 --> 0:32:30.440 to separate an area where we could put COVID patients 0:32:30.520 --> 0:32:34.560 or suspected COVID patients and non COVID patients, um, you know, 0:32:34.600 --> 0:32:36.800 and then who could go into those rooms versus who 0:32:36.800 --> 0:32:38.640 can who has to go into an isolation room someone 0:32:38.720 --> 0:32:41.120 actively coughing with a high fever, whether or not we 0:32:41.160 --> 0:32:44.480 have a positive test that patients probably should be isolated, UM, 0:32:44.520 --> 0:32:46.680 and so figuring out where we can put those people 0:32:46.720 --> 0:32:50.080 and not overrun our our service. And obviously staff has 0:32:50.080 --> 0:32:54.160 been affected. UH, nurses and doctors and resident doctors have 0:32:54.360 --> 0:32:58.360 all been hit, and we've had many many providers get 0:32:58.360 --> 0:33:02.360 sick and be out for sometime, and so that puts 0:33:02.400 --> 0:33:07.080 a strain on everything, UM. And so streamlining the system 0:33:07.160 --> 0:33:10.560 has to deal with figuring out which staff you have 0:33:10.640 --> 0:33:12.800 when and making sure that you have enough staff at 0:33:12.800 --> 0:33:15.000 all times. Obviously, many of us would love to go 0:33:15.080 --> 0:33:17.240 help our colleagues in the emergency department or in the 0:33:17.360 --> 0:33:19.240 medicine I see you, but you have to make sure 0:33:19.240 --> 0:33:22.520 you're able to cover everything. And you know, since we're 0:33:22.560 --> 0:33:24.800 pretty much the only service in the hospital left that's 0:33:24.840 --> 0:33:26.680 non COVID, we want to make sure we're covering our 0:33:26.680 --> 0:33:29.760 patients well with experienced physicians and nurses who know how 0:33:29.840 --> 0:33:32.440 to handle will be When it comes to how this 0:33:32.600 --> 0:33:36.320 virus effects pregnant women, Dr Bones says, there are still 0:33:36.360 --> 0:33:39.920 a lot of unknowns, but also a few key and 0:33:40.160 --> 0:33:44.640 positive takeaways. The course and pregnant women seems to be 0:33:44.800 --> 0:33:47.000 not any worse than it would be for non pregnant women, 0:33:47.000 --> 0:33:48.760 which is a very good thing and for and for men. 0:33:49.320 --> 0:33:51.880 Women tend to be doing a lot better with the 0:33:51.880 --> 0:33:54.960 disease than men. Um so that's a positive thing for 0:33:55.000 --> 0:33:58.920 women as well. Uh, we are noticing that are the 0:33:58.960 --> 0:34:02.680 transmission from from pregnant woman to her fetus seems to 0:34:02.680 --> 0:34:05.640 be almost zero. It's not a d zero, but it's 0:34:05.680 --> 0:34:08.080 it's almost zero. So that's a very very good thing 0:34:08.080 --> 0:34:11.759 as well. Um And the one thing we've learned, I 0:34:11.760 --> 0:34:13.279 think that a lot of people in this hospital and 0:34:13.280 --> 0:34:15.560 in the country have learned, is a lot of people 0:34:15.560 --> 0:34:18.520 are infected with CODE. We learned that by testing, So 0:34:18.560 --> 0:34:20.880 we're testing every single patient now that gets admitted to 0:34:20.880 --> 0:34:24.520 the hospital on our floor, and we've noted many, many 0:34:24.560 --> 0:34:28.640 patients who are positive and completely asymptomatic, and some of 0:34:28.680 --> 0:34:30.920 them become symptomatical later, and some of them never do. 0:34:31.680 --> 0:34:34.279 The other thing Dr Bone has learned is you don't 0:34:34.280 --> 0:34:37.480 know what to expect when it comes to this new virus, 0:34:37.560 --> 0:34:40.680 which makes her job all the more difficult. You've got 0:34:40.680 --> 0:34:43.440 to be really cautious because I've seen and again this 0:34:43.480 --> 0:34:45.839 is anecdotal, but I've seen it go both ways. I mean, 0:34:45.880 --> 0:34:48.799 we had one super sick pregnant woman who ended up 0:34:48.800 --> 0:34:51.080 going into the I See You and was very close 0:34:51.080 --> 0:34:54.000 to being intubated, and then we as a group interdisciplinary 0:34:54.120 --> 0:34:58.440 between high risk obstetrics and I See You and pediatrics, 0:34:58.440 --> 0:35:00.520 decided that it would probably be better for her health 0:35:00.760 --> 0:35:04.160 to deliver, and we delivered her her baby by C section, 0:35:04.239 --> 0:35:08.440 and she miraculously got better after she was delivered, and 0:35:08.480 --> 0:35:10.720 she didn't require intubation, and I actually had the privilege 0:35:10.760 --> 0:35:13.880 of sending her home on Sunday. Uh flip side, I 0:35:13.920 --> 0:35:16.480 had another patient last week who came in for an 0:35:16.600 --> 0:35:21.040 uncomplicated scheduled C section and did wonderful, no problems at all, 0:35:21.080 --> 0:35:24.000 totally healthy. As I mentioned earlier, we swabbed everybody when 0:35:24.000 --> 0:35:26.239 they first come into the hospital, and it was taking 0:35:26.239 --> 0:35:28.360 about twenty four or four hours to get the results 0:35:28.360 --> 0:35:30.560 back at that point, so we didn't have her results. 0:35:30.920 --> 0:35:33.520 And then on post operative day one, about a day 0:35:33.520 --> 0:35:35.279 after she had her surgery, all of a sudden, she 0:35:35.360 --> 0:35:38.719 decompensated and got very very ill, also requiring oxygen and 0:35:38.840 --> 0:35:40.920 I see you care. And then her test came back 0:35:40.960 --> 0:35:44.719 positive from days before when she was asymptomatic. So it's 0:35:44.880 --> 0:35:47.759 very hard, I think, to to figure out who's gonna 0:35:47.800 --> 0:35:50.279 go which way and when, and that's what makes it 0:35:50.320 --> 0:35:53.960 so difficult to care for the patient. Before COVID hit, 0:35:54.080 --> 0:35:58.799 Elmhurst was very involved with the maternal mortality crisis, particularly 0:35:58.840 --> 0:36:02.200 the racial despaired these that see so many more black 0:36:02.239 --> 0:36:06.560 and brown women dying due to pregnancy or childbirth, and 0:36:06.719 --> 0:36:11.840 Dr Bone notes that COVID nineteen is underscoring that same disparity. 0:36:12.120 --> 0:36:15.880 I think that black women, and I think that UM 0:36:16.000 --> 0:36:19.080 underserved women in general are being hit harder and men 0:36:19.160 --> 0:36:22.560 are being hit harder by this UM. Whether that's because 0:36:22.560 --> 0:36:27.920 they have underlying illness or just there there decreased access 0:36:27.960 --> 0:36:30.720 to care, I think it's probably a combination of both. 0:36:30.719 --> 0:36:34.000 And I don't think that COVID nineteen is going to 0:36:34.040 --> 0:36:37.799 be different than anything else. Uh, COVID nineteen doesn't discriminate, 0:36:37.840 --> 0:36:40.640 meaning anybody is eligible forgetting it. But I do think 0:36:40.760 --> 0:36:42.920 that we're going to see more of this in the 0:36:42.960 --> 0:36:45.520 same populations that we see more of other illnesses because 0:36:45.560 --> 0:36:48.800 of access to care, and because of limited resources and 0:36:48.800 --> 0:36:50.880 and all of the other problems that go along without 0:36:51.600 --> 0:36:55.000 As for right now, the biggest obstacle Dr Bone and 0:36:55.040 --> 0:36:59.360 her team at Elmhurst face is misinformation. Their fear around 0:36:59.360 --> 0:37:02.720 COVID and the fear of contracting it has kept many 0:37:02.760 --> 0:37:06.160 pregnant women from coming in to get the care they 0:37:06.200 --> 0:37:08.839 may desperately need. We want to take care of our 0:37:08.880 --> 0:37:11.560 our patients as we always do, and they're so afraid, 0:37:11.960 --> 0:37:13.720 and they're just so afraid to come into the hospital. 0:37:13.760 --> 0:37:15.440 They're so afraid of what's going to happen to them 0:37:15.440 --> 0:37:18.000 where they're babies. They're afraid of infecting other family members 0:37:18.560 --> 0:37:22.120 um and they're afraid, like everybody else is, of of 0:37:22.239 --> 0:37:24.600 having it. You know, when I tell a patient that 0:37:24.640 --> 0:37:28.680 her COVID nineteen tests came back positive, she's terrified. And 0:37:29.320 --> 0:37:31.000 there's a lot of avoidance of wanting to know the 0:37:31.000 --> 0:37:34.520 answer to that. UM, So, I think it's the biggest 0:37:34.840 --> 0:37:37.000 challenge we have is to let our patients know that 0:37:37.080 --> 0:37:39.480 it's okay to come seek care. It's more important for 0:37:39.520 --> 0:37:41.319 you and your your health and your baby's health to 0:37:41.360 --> 0:37:43.080 come seek care, and that we know what we're doing 0:37:43.360 --> 0:37:44.960 and we're going to take care of you and this 0:37:45.040 --> 0:37:47.120 is all gonna be okay. And I think our patients 0:37:47.160 --> 0:37:49.279 are grateful for that and they're starting to come round. 0:37:52.360 --> 0:37:56.400 I have learned that people tend to come together in 0:37:56.400 --> 0:38:01.200 a crisis, and that's a very good thing. Um. I 0:38:01.280 --> 0:38:04.319 run the department, and at times running a department like 0:38:04.360 --> 0:38:08.640 this is difficult. And when this hit, I didn't have 0:38:08.719 --> 0:38:11.600 to ask anything more than once. And I haven't heard 0:38:11.600 --> 0:38:14.839 a know at all. Everybody has stepped up. We've had 0:38:15.080 --> 0:38:19.120 co workers outsick, everybody checks on them every day. UM. 0:38:19.160 --> 0:38:22.200 It's just people do come together. And I think it's important, 0:38:22.280 --> 0:38:25.360 especially in the climate in this country now, to recognize 0:38:25.400 --> 0:38:28.640 that that at in a crisis, America is going to 0:38:28.719 --> 0:38:36.480 come together. Dr Tracy bone Hemmerdinger, the chief of Obstetrics 0:38:36.520 --> 0:38:42.960 at Elmer's Hospital in Queens, New York. Up next for 0:38:43.080 --> 0:38:46.160 all those pregnant women out there and their partners some 0:38:46.239 --> 0:38:49.640 tips on how to feel safe and empowered during these 0:38:49.719 --> 0:39:06.480 uncertain times. Giving birth during a pandemic is no doubt 0:39:06.680 --> 0:39:10.480 a very stressful event, so for those pregnant women and 0:39:10.560 --> 0:39:13.400 their family or partners, we wanted to leave you with 0:39:13.480 --> 0:39:16.879 some tips for how to reduce anxiety and feel not 0:39:17.000 --> 0:39:20.920 only safe but empowered. So the role of the doula 0:39:21.160 --> 0:39:26.000 is to offer continuous support. Chantal Troub, who is originally 0:39:26.080 --> 0:39:28.839 from Cape Town, South Africa, if you couldn't tell by 0:39:28.840 --> 0:39:32.160 her accent, has been an active birth duela in New 0:39:32.239 --> 0:39:35.400 York City for nearly twenty years, which means she has 0:39:35.440 --> 0:39:39.239 supported a lot of women through some very intimate and 0:39:39.480 --> 0:39:44.040 often difficult life changing moments. That's around seven hundred eight 0:39:44.080 --> 0:39:48.680 hundred plus births. Now Dulas are commonly thought of as 0:39:48.760 --> 0:39:53.759 birth coaches, someone who provides emotional and informational support, but 0:39:53.880 --> 0:39:58.160 also and often crucially, a lot of physical support, things 0:39:58.200 --> 0:40:03.600 like massage or counter pressure to alleviate back pain during contractions, 0:40:03.719 --> 0:40:07.320 or even moving mothers into a more comfortable birthing position. 0:40:08.120 --> 0:40:11.480 But with physical support out of the question and severe 0:40:11.480 --> 0:40:14.480 restrictions on the number of people who can accompany women 0:40:14.520 --> 0:40:18.040 through labor. Seantalas had to figure out how to do 0:40:18.080 --> 0:40:21.480 it all virtually. This is not the same as being 0:40:21.520 --> 0:40:24.719 in the room with someone. But the one aspect that 0:40:24.760 --> 0:40:28.520 I've had to adjust is how do I support my 0:40:28.600 --> 0:40:32.439 client without using my hands. Everything else is the same. 0:40:32.800 --> 0:40:36.279 Once they're in labor, I set up my computer or 0:40:36.280 --> 0:40:39.239 my laptop or my phone, and I in the day, 0:40:39.320 --> 0:40:43.760 I'm here in my living room on FaceTime, face to face, 0:40:44.719 --> 0:40:50.839 using my voice and my gestures to help them and 0:40:50.880 --> 0:40:55.680 to be able to give them cues of connection and safety. 0:40:56.280 --> 0:40:59.200 When it became like the nighttime or things got much 0:40:59.239 --> 0:41:01.920 more intent, I would hold up in my bedroom with 0:41:02.000 --> 0:41:05.680 my phone and my I pad, keeping the room dark. 0:41:05.719 --> 0:41:08.080 If their room was dark, I would only turn up 0:41:08.120 --> 0:41:10.440 my lights on if their lights were on, so that 0:41:10.520 --> 0:41:13.440 I could keep the same ambiance in my home as 0:41:13.480 --> 0:41:16.600 in theirs. And again I would give them solid support 0:41:17.239 --> 0:41:22.239 face to face and using my voice and using my gestures. 0:41:22.360 --> 0:41:27.000 And so far it has worked really well. I was 0:41:27.200 --> 0:41:30.719 actually for someone who was not technical savvy at all. 0:41:31.800 --> 0:41:35.200 I have been so pleasantly surprised how well this has 0:41:35.239 --> 0:41:39.520 worked under these circumstances. First, Chantal share some advice for 0:41:39.520 --> 0:41:44.320 those supporting their pregnant partners. So a woman in labor 0:41:45.160 --> 0:41:50.800 really needs to feel safe and protected to be able 0:41:50.880 --> 0:41:54.799 to let go and open up, to be able to 0:41:54.920 --> 0:42:01.080 let her baby out. So feeling safe and feeling supported 0:42:01.440 --> 0:42:12.360 and feeling protected is essential. So for the partner to understand, 0:42:12.800 --> 0:42:18.759 how can we adjust in this time to create safety 0:42:20.040 --> 0:42:24.080 at the times where clearly we are feeling a lot 0:42:24.120 --> 0:42:30.720 of fear and anxiety about this disease and about feeling 0:42:30.800 --> 0:42:34.080 supported in the ways that we think we may have needed. 0:42:34.880 --> 0:42:41.760 So we want to relate on and almost primitive level. 0:42:42.000 --> 0:42:46.400 We want to be able to communicate cues of safety 0:42:46.719 --> 0:42:53.200 using face to face facial expressions, using our voice, our 0:42:53.400 --> 0:42:58.799 tone of our voice, and then our gestures and our postures. 0:42:58.880 --> 0:43:04.600 So whether we're supporting virtually or in person. Now this 0:43:04.960 --> 0:43:09.600 may change place to place because changes are happening daily. 0:43:10.160 --> 0:43:13.239 But as of now, our partners are required to wear 0:43:13.280 --> 0:43:16.600 a mask the whole time while they are in the 0:43:16.680 --> 0:43:20.440 laboring room until they leave. And so when your mouth 0:43:20.600 --> 0:43:24.600 is covered by a mask, you have to learn to 0:43:24.719 --> 0:43:28.680 communicate with your eyes. And so you want to learn 0:43:28.719 --> 0:43:33.560 to smile, for example, so big that your eyes smile. 0:43:34.960 --> 0:43:37.600 You want to be able to use the tone of 0:43:37.680 --> 0:43:41.319 your voice and the gesture of your hands. So if 0:43:41.320 --> 0:43:47.880 you're able to be in person, then touch is key. 0:43:47.960 --> 0:43:50.520 You want to touch the mother, You want to hold 0:43:50.680 --> 0:43:55.200 the mother, You want to massage the mother, give counter pressure, 0:43:57.000 --> 0:43:59.480 you want to stay close. And this is a lot 0:43:59.520 --> 0:44:03.719 of RuSHA on the support person, especially if you weren't 0:44:03.719 --> 0:44:06.719 planning to be the main support person. It takes a 0:44:06.760 --> 0:44:14.479 lot of focus and stamina to be present and pay 0:44:14.520 --> 0:44:18.840 attention for a long period of time. We want to 0:44:19.680 --> 0:44:23.640 one communicate face to face. We also want to really 0:44:24.640 --> 0:44:28.360 tune in and learn how to listen. We want to 0:44:29.239 --> 0:44:34.000 listen to what the mom is saying, hear how she's sounding, 0:44:35.440 --> 0:44:39.920 understand her concerns, and to be able to support that. 0:44:40.080 --> 0:44:43.680 So that takes a lot of focus and emotional presence, 0:44:44.160 --> 0:44:48.400 and we want to prepare for that. So here's a 0:44:48.480 --> 0:44:51.640 tip that I've suggested to some of my clients is 0:44:52.040 --> 0:44:55.360 on the mask, you can either maybe draw a smile 0:44:55.719 --> 0:45:00.000 on your mask, or maybe take a photograph of yourself 0:45:00.360 --> 0:45:04.840 smiling and pun that onto your shirt, or even take 0:45:04.960 --> 0:45:11.480 pictures of your honeymoon or a happy time together, or 0:45:11.960 --> 0:45:16.239 your pet or your puppy or your favorite beach location, 0:45:16.480 --> 0:45:20.040 print them out and then take them onto the walls 0:45:20.600 --> 0:45:26.040 so you can surround yourself with moments of feeling safe 0:45:26.280 --> 0:45:29.960 and at peace and joyful and happy. As for the 0:45:30.040 --> 0:45:33.799 moms out there, Chantal's first tip is to understand the 0:45:33.880 --> 0:45:37.799 new ambiance of the hospital. She says, it's important to 0:45:37.960 --> 0:45:42.800 mentally prepare for what labor and delivery look like right now. 0:45:43.560 --> 0:45:45.600 What you have to get used to seeing it is 0:45:45.640 --> 0:45:50.000 pretty much like a hazmatted vibe. Everybody is wearing overalls 0:45:50.120 --> 0:45:53.680 or gowns. Everybody, all the medical staff or even the 0:45:53.719 --> 0:45:58.680 housekeeping are wearing a mask. Their head is covered and 0:45:58.760 --> 0:46:04.080 they either wearing goals or a shield. So it's pretty 0:46:04.120 --> 0:46:09.520 surreal and something to adjust mentally for. The Other thing 0:46:09.560 --> 0:46:12.000 that I would really like you to prepare for is 0:46:12.040 --> 0:46:15.000 that at some point during your hospital will stay, you 0:46:15.160 --> 0:46:18.239 will be wearing a mask, whether that may only be 0:46:18.520 --> 0:46:24.839 entriage or if you happen to test COVID positive, And 0:46:24.960 --> 0:46:28.239 that's another adjustment to get used to just laboring with 0:46:28.320 --> 0:46:31.400 a mask. So I encourage you to just try a 0:46:31.520 --> 0:46:35.600 mask and use that communicating with someone. What does that 0:46:36.080 --> 0:46:40.279 I feel like to communicate? How does that change? And 0:46:40.320 --> 0:46:43.800 then how does that change when you're needing to breathe 0:46:43.880 --> 0:46:48.680 and maybe breathing quite hard. So try you know, exercising 0:46:48.719 --> 0:46:52.160 with a mask. Try marching in one spot with a 0:46:52.239 --> 0:46:55.440 mask and notice, you know, how does that feel. It 0:46:55.480 --> 0:46:58.120 takes some getting used to and I want you to 0:46:58.320 --> 0:47:00.840 already know what that feels like before you go in, 0:47:01.680 --> 0:47:05.240 once you have some expectation of what your birth experience. Maybe, 0:47:05.360 --> 0:47:08.520 like Shantal says, the next step is to learn the 0:47:08.600 --> 0:47:13.680 coping mechanisms now for calming the nervous system at any time. 0:47:14.480 --> 0:47:17.400 One of the ways to regulate our nervous system is 0:47:17.480 --> 0:47:22.120 to start developing a breathing practice. The breath is the 0:47:22.239 --> 0:47:26.040 way into common our nervous system. The breath is the 0:47:26.120 --> 0:47:31.160 way to manage in contractions. So developing a breathing practice 0:47:31.320 --> 0:47:36.000 now is so helpful for now, for labor, for when 0:47:36.040 --> 0:47:41.279 the baby cries postpartum. One breathing practice that is incredibly 0:47:41.320 --> 0:47:45.279 helpful is a simple belly breath. You can place your 0:47:45.280 --> 0:47:48.560 hands on your belly and take a deep breath in 0:47:49.200 --> 0:47:55.640 full your belly and take a slow breath out, deep 0:47:56.120 --> 0:48:05.480 full belly breaths, long slow exhales, so in hell, breathe 0:48:05.480 --> 0:48:16.120 into your belly into your baby. Excel in calms the 0:48:16.200 --> 0:48:20.200 nervous system. So when we take an inhale, we bring 0:48:20.200 --> 0:48:24.279 an oxygen to our baby, to all our organs, even 0:48:24.320 --> 0:48:29.560 the public floor, And when we excel it allows us 0:48:29.600 --> 0:48:36.080 to feel safe, to feel open, to feel calm. Chantal 0:48:36.200 --> 0:48:39.600 also suggests when those feelings of fear or anxiety do 0:48:39.719 --> 0:48:43.319 bubble up, to not push them aside, but actually experience 0:48:43.400 --> 0:48:46.800 them and then move on. We don't want to feel 0:48:46.800 --> 0:48:50.200 those feelings. Were very good about squashing them down or 0:48:50.239 --> 0:48:55.319 pushing them away, or scrolling on Facebook or going and 0:48:55.360 --> 0:49:00.319 doing something. But to be able to manage those feel ends, 0:49:01.160 --> 0:49:03.919 we want to be able to allow them to be there. 0:49:05.120 --> 0:49:07.880 If we allow them to be there and con sit 0:49:08.040 --> 0:49:12.240 with them, they usually only lost just a few minutes. 0:49:13.120 --> 0:49:18.320 So allow yourself to be with the feeling, feel the feeling, 0:49:19.800 --> 0:49:22.840 and let it pass. Now it may come up again 0:49:22.920 --> 0:49:26.200 soon after, So we want to develop a practice of 0:49:26.280 --> 0:49:31.439 being able to stay with the feelings, acknowledge them, name them, 0:49:31.480 --> 0:49:34.440 and feeling scared. Right now, I'm really anxious about the 0:49:34.440 --> 0:49:37.680 way this may go. That's okay. We can feel them, 0:49:38.080 --> 0:49:42.960 don't push them away. It's important to be able to 0:49:43.000 --> 0:49:47.200 sit with them and breathe through them. We have a 0:49:47.280 --> 0:49:50.120 moment in this time to actually recognize them for what 0:49:50.200 --> 0:49:55.000 they are and transform them and move ourselves more to 0:49:55.560 --> 0:49:59.040 how can we feel safe? What makes me feel safe 0:49:59.120 --> 0:50:02.680 right now? Does being in a quiet room make me 0:50:02.760 --> 0:50:06.720 feel safe? Does having someone look at me and smile 0:50:06.760 --> 0:50:11.200 at me make me feel safe? Does have just me 0:50:11.600 --> 0:50:15.200 hugging my puppy right now make me feel safe? What 0:50:15.360 --> 0:50:18.400 makes us feel safe? Let's explore that so that we 0:50:18.440 --> 0:50:23.200 can find ways to use that and support us in labor. 0:50:23.360 --> 0:50:26.279 So the more that we learn about what makes us 0:50:26.440 --> 0:50:29.640 feel safe, then we can ask for what we need 0:50:29.800 --> 0:50:32.120 or set that up for the time that we have 0:50:32.200 --> 0:50:35.239 to go to the hospital when all else fails, when 0:50:35.239 --> 0:50:39.120 the breathing exercises don't do the trick, or you've acknowledged 0:50:39.160 --> 0:50:42.440 all those feelings to no avail, She says, take a 0:50:42.480 --> 0:50:45.200 moment to connect with what's behind all of this in 0:50:45.239 --> 0:50:52.040 the first place. And lastly, don't forget you're having a baby. 0:50:52.200 --> 0:50:55.960 It's a very important time to connect to your baby. 0:50:56.080 --> 0:50:58.920 Take the time to talk to your baby, Take the 0:50:58.960 --> 0:51:01.880 time to sing to your baby. I have some of 0:51:01.920 --> 0:51:05.920 my clients uh either singing lullabys to their babies or 0:51:06.080 --> 0:51:08.440 making up a lullaby. If you don't know, this is 0:51:08.480 --> 0:51:10.760 something that you can do on your own to your baby, 0:51:11.280 --> 0:51:14.080 or spouse or partner can join in where you both 0:51:14.160 --> 0:51:16.759 talk to the baby or sing to the baby. But 0:51:17.000 --> 0:51:19.759 talk to your baby right now and be honest with 0:51:19.800 --> 0:51:22.800 your baby. You can tell your baby, I'm feeling really 0:51:22.840 --> 0:51:26.920 scared right now. I'm worried about how it's gonna be 0:51:27.160 --> 0:51:30.239 bringing you into the world. Right now. Your baby can 0:51:30.400 --> 0:51:34.200 sense your anxiety, so it's okay to communicate to your 0:51:34.200 --> 0:51:37.120 baby how you're feeling and how you're going to be 0:51:37.239 --> 0:51:40.040 protecting your baby. How are you going to do everything 0:51:40.080 --> 0:51:42.520 you can to bring the baby into a safe world. 0:51:42.800 --> 0:51:45.320 To talk to your baby now, talk to your baby 0:51:45.560 --> 0:51:49.960 during labor, and talk to your baby postpardon. And if 0:51:50.080 --> 0:51:53.680 your baby needs to be separated from you for any reason, 0:51:54.280 --> 0:51:58.239 then keep talking to your baby, whether it's energetically or 0:51:58.280 --> 0:52:01.239 when you are reunited with baby. You can say I'm 0:52:01.360 --> 0:52:03.920 so sorry that we had to be separated. I was 0:52:04.320 --> 0:52:07.600 so sad to be separated, but I'm so happy to 0:52:07.680 --> 0:52:11.799 be reunited with you now and express that to your baby, 0:52:11.800 --> 0:52:14.760 because your baby does sense the way that you're feeling. 0:52:21.239 --> 0:52:25.560 That was Shantal Trout Adula assisting moms and families in 0:52:25.560 --> 0:52:28.680 the New York region. Shantala is put together a guide 0:52:28.680 --> 0:52:32.360 exclusively for Next Question listeners that goes over some of 0:52:32.400 --> 0:52:35.840 these tips for preparing moms and their partners for giving 0:52:35.880 --> 0:52:40.160 birth during the coronavirus pandemic. You can download that at 0:52:40.200 --> 0:52:44.320 Shantal Trout that's c H A and T A L 0:52:44.840 --> 0:52:48.799 t R a UB dot com. And while you're there, 0:52:48.880 --> 0:52:52.880 you can also check out her virtual workshops, including Birthing Strong, 0:52:53.239 --> 0:52:57.000 which she designed specifically for helping women who are due 0:52:57.120 --> 0:53:05.120 during this pandemic. And that does it for this episode 0:53:05.120 --> 0:53:08.399 of Next Question. Stay tuned for next week's show, when 0:53:08.400 --> 0:53:11.960 we'll be releasing our special two part series on America's 0:53:12.239 --> 0:53:18.400 maternal mortality crisis that's coming up April. And for the 0:53:18.440 --> 0:53:21.799 most up to date information on the coronavirus, make sure 0:53:21.840 --> 0:53:25.680 to check out the CDC and the World Health Organization websites. 0:53:26.200 --> 0:53:29.239 You can also subscribe to my morning newsletter wake Up Call, 0:53:29.560 --> 0:53:33.400 where we're diligently compiling the day's most pressing news. You 0:53:33.440 --> 0:53:36.760 can do that by going to Katie Correct dot com. 0:53:36.880 --> 0:53:39.720 Until next time and my Next Question, I'm Katie Couric, 0:53:40.000 --> 0:53:42.760 thank you all so much for listening, and stay safe 0:53:42.840 --> 0:53:52.960 and healthy out there. Next Question with Katie Couric is 0:53:53.000 --> 0:53:55.600 a production of I Heart Radio and Katie Curreic Media. 0:53:56.160 --> 0:53:59.680 The executive producers are Katie Kurk, Courtney Litz, and Tyler Klang. 0:54:00.000 --> 0:54:03.719 The supervising producer is Lauren Hansen. Our show producer is 0:54:03.800 --> 0:54:08.800 Bethan Macaluso. The associate producers are Emily Pinto and Derek Clements. 0:54:09.440 --> 0:54:14.040 Editing by Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing 0:54:14.120 --> 0:54:18.759 by Dylan Fagin. Our researcher is Gabriel Loser. For more 0:54:18.800 --> 0:54:21.919 information on today's episode, go to Katie Curik dot com 0:54:22.080 --> 0:54:25.000 and follow us on Twitter and Instagram at Katie Currich. 0:54:28.719 --> 0:54:31.040 For more podcasts for My Heart Radio, visit the I 0:54:31.160 --> 0:54:34.200 Heart Radio app, Apple podcast, or wherever you listen to 0:54:34.239 --> 0:54:35.080 your favorite shows.