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Scott Webb: Pregnancy at the time of COVID-19 understandably raises lots of questions and concerns. And joining me today to help answer these questions is Dr. Rachel Beck, a Practicing OB GYN at Salinas Valley Medical Clinic Healthcare for Women in Salinas. Dr. Beck is also Chief of Staff at Salinas Valley Memorial Hospital. This is Ask the Experts, the Podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Dr. Beck, so great having you on again. You know, when we last spoke in April, data was limited and trickling in from China. Now we know a little bit more about COVID-19 and pregnant women. Recently, the CDC announced that pregnant women have an increased risk of developing severe COVID-19 in comparison to non-pregnant women of childbearing age. The CDC also said that they're more likely to be hospitalized, at greater risk for ICU admission, and of being intubated. So this data was compiled in the US versus China. And this has been within the last few months. So can you shed some light on all this new information?

Dr. Beck: There definitely has been lots of new information coming out just in the last, you know, last month. And one of the problems with all this new information is that there's so much coming so fast and it's sometimes difficult to digest what is relevant, what's not relevant, what's real, what's not real. And so, this put this new information about pregnant women and being at increased risk for hospitalization and severe illness is something that we take very seriously. The good news is that the data does not show any increased risk in mortality. So that's a plus. And then one of the problems that I have with the data and with the study, is that they did not separate out women being admitted to the hospital for non COVID reasons. So we know that pregnant women are more likely to be admitted to the hospital just from pregnancy complications. And so unfortunately this study did not separate out COVID specific hospitalizations with obstetric related hospitalization. So that complicates the data a little bit, but what we have to assume the assume the worst and take it seriously and just continue to study the effects of COVID in pregnant women.

Host: Yeah, definitely. And we were talking off the air before we got started about how much we do know now that we didn't know a few months ago and how much we still don't know. And that is very interesting, you know, that they didn't separate them out. So that is a little confusing. And as you say, you know, you're just sort of defaulting to, well, let's assume the worst and kind of hope for the best, which is probably good advice for all of us. So who's more at risk Latino, black women?

Dr. Beck: We've seen just in COVID in general, that this virus seems to affect the black and Latino communities more. So it makes sense that black and Latina pregnant women would be more affected as well. So that, I mean, the data is consistent and that it is affecting those communities at a higher rate.

Host: Definitely. And I think we covered this one last time, but maybe some things have changed. Can a mother transmit the virus to their unborn baby?

Dr. Beck: In the last couple of weeks, there has been some data coming out suggesting that that is a possibility. So now we're saying, you know, it might be possible. Thankfully it is very, very rare. And we have not seen much of that. The data does show there have been many pregnant women with COVID and very few, if any infants dismissively infected with COVID from their mother.

Host: I wanted to ask you as well about transmitting the virus during birth or through breast milk.

Dr. Beck: We haven't seen any data suggesting transmission through breast milk, and we still feel like breastfeeding is very important and would be very protective as well for the infant. So we still are encouraging breastfeeding, even if mom is COVID positive. And then as far as transmission during the delivery, probably it wouldn't be so much just from during the delivery. If the baby would be infected, it would be during the pregnancy.

Host: So, what are the guidelines for expected moms at Salinas Valley Memorial Hospital? Do they need to be tested? How close to giving birth are they tested? Do they need to self isolate? Does everyone in their household also have to get tested?

Dr. Beck: What we are recommending for our pregnant patients is starting at around 37 weeks of gestation. So about three weeks before the due date, we are recommending that they self quarantine. And what that means is that they limit contact with anybody outside of their household. So they, they don't have any contact with anybody outside their household. They, you know don't go outside. They don't go to the store, they are quarantining. And then the members of their household we would like them to coordinate as much as is reasonable. So obviously if a spouse needs to go to work, the spouse continues to go to work, but they really limit any outside contact. We think that by self quarantining for the three weeks prior to the due date that should decrease their risk of contracting, COVID close to delivery. And at this time we do not have the capabilities to test every pregnant patient. So we are not testing all of our pregnant patients before they're admitted. But we do test patients who have a scheduled C-section since we know the day that they will be coming in for their surgery, we are testing all of our pre-op patients for the hospital. So they will be tested for COVID approximately four days before their scheduled.

Host: Interesting things to think about that I hadn't really processed before. So what if a patient came into the hospital to deliver is COVID-19 positive? What safety steps does the hospital take then? Will there be skin to skin contact with the mother and newborn? It's sort of a heartbreaking scenario that a mother wouldn't be able to hold her newborn, but that's possible. Right?

Dr. Beck: Good question. And one that everybody struggles with. So if we have a mom that's positive you know, we have a conversation before the baby's born. We have a conversation with the mom and with the family. So the CDC and American Academy of Pediatrics does recommend separating baby from mom after an informed decision conversation. But we've had moms who have decided to be separated from their babies. And we've had moms who have decided they do not want to be separated from their babies. And we respect their decisions and we have an informed consent. And if a mom and baby are not separated, then we take all of the appropriate precautions of hand-washing and masking the mom. And they can absolutely do skin to skin contact. And we're still recommending breastfeeding. So if the baby is separated from mom, the mom will pump her breast milk to feed to the baby. And if they're not separated, then we're doing skin to skin. And baby can nurse with mom as long as mom is masked and washing hands. And the one good thing about pregnant women and babies is that we've really been doing a lot of this hand-washing. We always washed our hands before we picked up our newborns before COVID. So we're just being even more diligent about that process.

Host: Let's talk about babies testing positive, as troublesome as that is. And you mentioned about when and how, and the scenarios for moms and babies to be separated, but if mom is suspected of having COVID-19 or is positive and gives birth, there is the baby automatically tested. How is the baby tested? Is that same test done on the moms?

Dr. Beck: Recommendations from CDC and American Academy of Pediatrics is to test babies at 24 and 48 hours after birth. But it's, again, it's an informed decisions. So we have a conversation and they give consent or not. And then the baby is tested just the nasal pharyngeal swab, just like we do to the mom. And that's usually done at about 24 hours of after birth.

Host: So, Dr. Beck, when we last spoke in April, SVMH had modified its visitor policy, allowing one support person only to be with the expecting moms during labor and delivery. Has that changed? And could that change in the future? Especially since we're seeing an increase in cases in Monterey County, specifically in Salinas and South Monterey County.

Dr. Beck: So, we have not changed our visitor policy. We still allow one visitor to be with mom during the labor and immediate postpartum. I don't see that changing. We think that that's really important that these women have a support person with them during labor. And even though we're seeing an increase in numbers, we screen our patients for any symptoms and we will screen their support person for any symptoms. And obviously if somebody has symptoms of COVID, they would not be allowed in the hospital as a support person, but then that mom could have another support person with her.

Host: That's good to know, you know, you and I were speaking before we got started here today and we're both parents and you know, having a baby, it's just such a joyous time for the entire family. You know, unfortunately having visitors at home means added risk. So what do you want families out there to know about sort of living their lives and people kind of pushing out and branching out after the quarantine period, for those having people into their home? What do they need to know?

Dr. Beck: I think what we need to know is that we have to change how we interact to large family gatherings are probably not a good idea. We probably shouldn't be having large family gatherings inside the house. If we want to have a few family members over, trying to do it outside, trying to be distanced somewhat outside is the safer way to interact and see people. And I know when you have a newborn and everybody wants to come by and see the new baby. And nowadays I think that the new norm should be, you know, limiting who comes over to see your baby and trying to be outside as much as possible to limit the spread of COVID.

Host: So, let's switch gears here a little bit. You see patients at Salinas Valley Medical Clinic, Healthcare for Women. So what safety guidelines are in place. There are visitors allowed in with expected moms at routine and ultrasound appointments? Are you still doing video appointments?

Dr. Beck: So, we are still offering video appointments. We are not allowing visitors to come in with patients except under special circumstances. If we have, again, maybe an elderly person who needs extra help in the, in the exam room or, you know, a child in the exam room. But otherwise we are not allowing guests with our patients. And then we have a screening process before patients come into the office. They are screened, they are asked questions about fever and cough, and you know, if any symptoms. And if they have any symptoms, then we are rescheduling their appointments to keep our office and our staff safe as well. And then all patients are wearing masks. All staff are wearing masks at all times.

Host: Good to know, and good to know that you still have enough PPE despite the increased demand, if you will. So do pregnant women have to wait in their cars before seeing their physicians, instead of waiting in the waiting room, are they having their temperatures taken when they arrive?

Dr. Beck: They are having their temperatures taken. And it really depends. We're staggering, our visits, and we do have some spots in the waiting room. Sometimes they might wait in their car and sometimes they'll wait in the waiting room. It just sort of depends on how busy the day is and how many people are there, but we're trying to stagger and trying to make it as convenient as we can for everybody.

Host: So, if a patient says to you that they'd like to give birth at home, what's your response to that, Dr. Beck?

Dr. Beck: I still say the safest place to give birth is in the hospital. We have lots of protocols and processes in place to keep the patients safe, both from COVID-19, but then also from all the obstetric concerns and complications that can arise. And so hands down the safest place to have your baby is in the hospital.

Host: Yeah. Agreed. And as we wrap up here today, Rebecca, thanks so much for your time during this stressful, confusing, and still exciting time, you know, for moms and dads to be do you have any advice for pregnant women, their partners, their families, anything else you'd like to add?

Dr. Beck: No, I think it's the same advice for pregnant women as for everyone else is to you know, continue to use the public health strategies that we know work. So social distancing, wearing masks, washing your hands, avoiding large gatherings and parties. And I know that a lot of people are growing tired of the shelter in place and the lockdown, and they want to go back to life as it was. And I understand that, but we are in a different time right now and we just need to stay the course we're in for the long haul and we need to just rethink how we interact, and just stay smart and don't get complacent. So we just need to really stay vigilant.

Host: That is great advice. And you're so right, I think we're all just a bit fatigued by this. Fatigued, by the news, by lockdowns, by, you know, having things open and then being restricted again. But the bottom line is COVID-19 is serious. We know a lot about it that we didn't know a few months ago, but there's still so much that we don't know. And as you say, we need to be vigilant, stay the course, and for all of us, including you, Dr. Beck, thanks for your time today and really stay well. For more information on the Coronavirus, please visit svmh.com/coronavirus. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.