The state of obstetrics in the time of COVID-19

Authors: Adam Wolfberg, MD and Dani Bradley, MPH

How is COVID-19 impacting prenatal care and the delivery experience around the United States? What are women telling their doctors? What are women worried about? We asked thousands of women and this is what they told us.

These data come from a survey of 2,212 pregnant women in the United States conducted March 25-27, and from a digital tool to help women decide if symptoms they are experiencing are concerning – based on guidance from the Centers for Disease Control and Prevention (CDC). Over 112,000 women used our tool between March 20-27, 2020.

How has prenatal care changed?

• Nationwide, 21% of prenatal visits in the past two weeks were impacted, either canceled, rescheduled, or conducted remotely (phone or video). 26% of appointments scheduled in the next four weeks are similarly impacted.
• In New York, more visits were impacted (24%) in the past two weeks, and 33% of upcoming visits will be changed.

How are women thinking about their delivery?

• Before the COVID-19 pandemic, 1.3 percent of women nationwide were planning a home birth, with the remainder planning a hospital birth (94.8%)  or a delivery in a birth center (3.9%). At this time, 4.1% of women nationally are planning a home birth, and 5.3% are now planning a birth center birth in order to avoid a hospital delivery (90.6%).
• In New York, none of those surveyed were planning a home birth prior to the COVID-19 pandemic, and now 3% are considering that option.
• Even if they haven’t made plans, 28% of American pregnant women are thinking about delivering at home, and in New York, 34% are thinking about home birth.

What about visitors and delivery support people?

• Although American women still overwhelmingly expect to have their partner present at delivery, fewer women expect to be able to have a doula (Down from 9.2% to 5.7%) or other family members present at delivery (46.9% to 17%). In New York, only 11.9% expect to have family members present at delivery.

How are doctors doing when it comes to communicating with their patients?

• Not very well. Only 41% have received information about the impact of COVID-19 on their prenatal care, and in hardest-hit New York, only 36% report receiving this information from their healthcare provider. Nationally, only 26% report being very satisfied with the communication they are receiving from their healthcare provider.

What are women hearing from their healthcare providers?

• The most common policy change is that hospitals are prohibiting visitors other than the woman’s partner (87%). Nationally, few are being told they will have to labor alone (7.6%), although this is a more common practice in New York (35%).

What are the top concerns about the postpartum experience in this time of coronavirus?

1. Health and safety for baby – the top concern by far
2. Availability of childcare resources
3. Health and safety of family or support people
4. Being stuck inside with a new baby and siblings
5. Impact on breastfeeding
6. Impact on my postpartum visit

Ovia also launched a digital tool to help women decide if symptoms they are experiencing are concerning – based on guidance from the Centers for Disease Control and Prevention (CDC). 

The initial results are below, but a few findings stand out:

• Pregnant women frequently experience shortness of breath as a normal part of pregnancy, particularly in the third trimester, and many had difficulty distinguishing normal shortness of breath from the same symptom caused by COVID-19.
• A relatively large percentage of women had one or more symptoms that are common with COVID-19, however very few had a fever. We recommended that these women contact their healthcare provider to see if testing or further evaluation is appropriate.
• There is potential significant overlap between other symptoms of pregnancy and warning signs of COVID-19, including cough, gastrointestinal symptoms such as nausea, and vomiting, and resulting dehydration.
• In spite of enough concern among so many Ovia users that took the survey, fewer than 1% had been tested for COVID-19 (fortunately, most were negative).

Ovia Health is working to provide resources for the millions of women who look to our products for education and support, and we encourage OB/GYNs and midwives to reach out to their patients during this challenging time with information, specific education, and answers to the questions that are coming up every day.

Highlights from the first 112,000 responses:

• 64% of survey respondents are pregnant.
• 62% of respondents reported no symptoms indicative of COVID-19.
• 16% of respondents (13% of pregnant respondents) reported a combination of symptoms and health conditions suggesting they could be seriously ill with COVID-19 or another medical condition.
• Nearly 27% of respondents reported a cough, which can be a sign of COVID-19 or entirely normal.
• 2% reported a fever.
• 9% reported new onset shortness of breath.