The coronavirus pandemic has prompted many pregnant women to consider home births to avoid hospitals and other expectant moms ill with COVID-19 in the labor and delivery ward.
Indeed, a startling analysis of universal test results at two New York City hospitals last month found about 13% of women who showed up to have a baby were coronavirus positive, even though they felt well and had no symptoms.
But a new study, published Tuesday as a research letter in JAMA, found that prevalence to be much lower — less than 3% — when pregnant women who were ready to give birth were universally tested in medical centers in Connecticut.
The findings show that with the right precautions, hospitals can be safe places to give birth even during the COVID-19 pandemic, said Dr. Katherine Campbell, the lead author and assistant professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine in New Haven, Connecticut.
“The most important finding of our study is that labor and delivery units are incredibly safe,” Campbell told TODAY.
“During the month of our study, we found that no health care workers became infected while working in our unit, no women became infected with coronavirus while coming to our unit for delivery and we have no newborns leaving the hospital infected with COVID.”
The study involved 782 women admitted to give birth at three Yale New Haven Health hospitals in southern Connecticut from April 2 to April 29, 2020. All patients who were not previously diagnosed with COVID-19 were tested for the new coronavirus.
Of 756 women who had not been ill before and who had no symptoms, 22 tested positive for COVID-19 — or 2.9%.
Universal testing of pregnant women who come to a hospital to give birth is key in helping medical centers manage their obstetrical units during the pandemic, Campbell said. Testing allows health care workers to target the use of personal protective equipment and other limited resources depending on the diagnosis, she added.
“Connecticut is a state that was substantially impacted by coronavirus. Even though we didn’t have the same numbers as New York City, we had a considerable amount of coronavirus in our community,” Campbell noted. “So the universal testing really helped us to triage our patients, made sure we reduced risk of transmission between health care workers, patients and visitors.”
Several levels of precautions
At the three Connecticut hospitals involved in the study, the medical staff wears enhanced protective equipment for all of their initial interactions with expectant moms until their COVID-19 status is known. Most women test negative, allowing the doctors and nurses to switch to standard PPE.
Women who do test positive get full care in their own dedicated labor and delivery unit, where health care workers wear enhanced PPE, which includes extra gowns and an N95 respirator, Campbell said. That separate ward also includes an enhanced air filtration system to manage the virus that way.
The Centers for Disease Control and Prevention recommends temporarily separating a newborn from a mother with confirmed or suspected COVID-19.
In the hospitals that were part of the study, babies of women who accepted that guidance were taken to a room next-door where moms could interact with them through a video screen.
Some women chose against separation. In those cases, the hospitals used additional precautions to minimize risk of transmission such as keeping the baby at least 6 feet away from the mom in the room and using a healthy care giver to help feed baby, Campbell said.
She hoped the study findings would provide some clarity to other hospitals for managing their patients, especially those with a busy obstetrical service and limited resources.
Meanwhile, the American College of Obstetricians and Gynecologists reaffirmed hospitals and accredited birth centers remain the safest settings for birth, even during COVID-19.
“Patients concerned that delivering in a hospital or accredited birth center setting will increase their risk of exposure to COVID-19 should be assured that hospitals and accredited birth centers continue to be safe with strict infection control procedures,” the group noted.