Giving Birth During Covid19: Protocols and Possible Interventions :

By Let Mommy Sleep. April 23, 2020

As covid19 (coronavirus) continues to be a threat to the American public, giving birth in a hospital or a healthcare setting has many expecting parents feeling more anxious than usual. To help parents feel more confident and in control, common labor and delivery interventions are detailed below including coronavirus protocols. Interventions such as administration of pitocin may or may not happen but if they do, birthing moms and their support person will know exactly what is happening and why during their journey to baby's arrival. Knowing the facts help us make informed decisions.

We will continue to update this blog as more information becomes available. 



Whether a mother opts for a natural birth or an epidural, it can be helpful to understand the basics of medicines that may be administered during labor. Knowing the terms doctors and nurses may be using, and understanding the effects of potential interventions can help parents can feel comfortable with what may happen during labor and confident when making decisions, especially if there are unexpected changes.

Below is an overview of medications, protocols and interventions that may be used during labor and birth.

Social Distancing and Safety Protocols

As coronavirus continues, many hospitals are now implementing stricter rules on their maternity floors. Each hospital is different so it's important to understand your hospital or birthing center's specific procedures but we do know that in almost every hospital, mothers-to-be and support people should be prepared to wear masks even while mother is laboring.

Many hospitals are also implementing either a no-visitor rule or 1 visitor rule, meaning that birth moms can have 1 designated person supporting them through labor and delivery. The support person cannot change through mother's entire stay in hospital; if it is your sister who brought you to the hospital, it must be your sister who stays as your "plus 1" drung all of labor and delivery. The support person can come and go, but cannot change.  Generally, no children under 18 are allowed to visit at all during this time.

One thing to remember is that maternity wards are typically in a completely different, secured section of the hospital to minimize exposure risk of coronavirus and other illnesses to families and newborns. Coronavirus protocols are in place to protect families in a place that is considered safe to begin with. It is also important to note that, the virus has not been detectedin amniotic fluid, breastmilk, or other maternal samples. (source: CDC). It is still receommended to breastfeed your newborn.

Epidurals, Anesthesia and Spinal Blocks

An epidural is the local anesthesia administered just outside the membrane that surrounds your spinal cord and spinal fluid. Epidurals are the most common pain relief for laboring mothers and while there are differing opinions on the effect epidurals have on baby, they are overwhelmingly considered safe for baby’s health. There are reports of babies born to moms who have had epidurals taking longer to get into position for birth, since the epidural also travels to the baby through the umbilical cord.

Temporary side effects of epidurals are heavy shivering, a ringing of the ears, backache, nausea or difficulty urinating. These are also considered harmless to mom and baby. Because they are used to dull the intense sensations of labor, an epidural may also slow contractions.

Spinal Block– A spinal block is regional anesthesia, meaning that mother is numb from the belly down. This is the intervention used for c-section birth since it means that mother cannot move, or feel any sensation .

General Anesthesia– Use of general anesthesia is extremely rare, but we’re including the term so parents will know the difference between general and regional anesthesia. General anesthesia means mother is completely asleep instead of just numb in one area. An example of when this intervention would be appropriate is if mother was in an accident and birth needs to be induced. (Again, very rare).

Because mother will be numb from the belly down with any of these anesthesia, a Foley catheter will be inserted into the bladder to drain urine.

Oxygen

Oxygen, administered through an oxygen mask to laboring moms helps mother deliver oxygen to baby. The oxygen mask might be given if baby’s heart rate is dropping due to fetal distress during labor and this can be scary. The good news is that giving oxygen is common and It has not been shown to have adverse effects on baby or mother.

Pitocin

Pitocin is a synthetic version a natural hormone called Oxytocin. It’s a stimulant commonly given to induce or strengthen contractions. It may be given after an epidural because the epidural has slowed labor. It may also be given after birth to ensure mother does not hemorrhage to help the uterus contract back to its non-laboring state. Pitocin is generally considered safe for mother and baby but there is concern by the American College of Obstetricians and Gynecologists (ACOG) that it is overused, potentially causing unnecessary problems during labor and early breastfeeding.

Common side effects of Pitocin may include nausea, stomach pain and runny nose or sinus pain. Rare side effects may include confusion, slurred speech and headache. The doctor must be notified immediately if any of these are present.

When Pitocin is administered, Labor & Delivery nurses watch to be sure that contractions are not occurring too severely or too frequently. Contractions that are too strong or occurring too quickly can cause uterine rupture, meaning that the uterus tears creating a danger to both mother and baby. There is typically a 1:1 nurse to mom ratio when Pitocin is administered to ensure the laboring mom and baby are safe and monitored correctly.

Pain Management

Percocet is the most common medication given to help mothers with pain management after delivery. It is an opioid. Most opioids are not advised for nursing newborns, so when possible, sticking to NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil or Motrin) for pain relief is preferred.

For moms who have undergone a cesarean or who have had a difficult vaginal birth, Percocet is appropriate to help with this level of pain.

For mom’s whose goal is to nurse right away, the best thing to do is to nurse before Percocet is administered. If mom and her doctor decide that nursing on demand is okay on Percocet, the main thing to do is to watch baby for marked drowsiness. For a full term, healthy baby there will be side effects like sleepiness, but no lasting effects.

A nursing mother may also choose to pump while Percocet is in her system and save the milk for baby’s use when baby is 6 months or older. Once baby is past the newborn phase, the effects of opioids decrease.

It’s important to note here that if parents choose early formula supplementation so that opiods do not travel to baby, many, many motherswho want to, go on to have exclusive breastfeeding relationships.

Blood Pressure Control and Gestational Hypertension

Preeclampsia, also sometimes called toxemia, is high-blood pressure in pregnant women. It can become very dangerous if left untreated, and is treated using Magnesium Sulphate, also called “Mag.” Mag keeps Preeclampsia from advancing to Eclampsia, which manifests as seizures. When a mom is given magnesium sulphate it’s perfectly normal that she may be feeling too sick to nurse right away.

Hypertension meds like Procardia or Labetalol are beta-blockers that mom will take after birth and discharge for however long the doctor prescribes to keep blood pressure down. These do not affect nursing or the healthy full- term newborn.

***

Our hope is that this list helps parents-to-be become familiar with the terminology and basics of common interventions and medications given during birth so they can feel confident, in control and prepared should the unexpected arise and they hear doctors and nurses using these terms. This blog was written under the direction of present and former Let Mommy Sleep Labor & Delivery and NICU Registered Nurses but as always mother's primary care physician is the authority on her care.