OB/Gyn & COVID19
Updated: Apr 15, 2020
Essentially everyone is having a hard time right now. We all have unique circumstances and differing ways in which the COVID19 pandemic is affecting us. Discussing one set of struggles doesn't downplay another, and there's no competition of hardships. So as I detail the difficulties in reproductive health right now, that is not to detract from the issues faced in any other area.
I will also say that the degree to which reproductive health is impacted is very location-dependent. Some OB/Gyn offices are essentially shut down completely. Some areas are subject to different legislative decisions. Some hospitals need to exercise more extreme caution based on local prevalence of disease. The adverse effects we are seeing are not necessarily universal.
Here's a look at some of the ways this pandemic is changing reproductive healthcare:
Access to contraception is difficult. Some clinics won't start or renew prescriptions for the birth control pill, patch, or ring without an annual exam; Depo Provera requires an injection, most often administered in a medical office; and long-acting methods like the subdermal contraceptive implant and intrauterine devices require an office procedure. Some offices are not open for these types of visits, and some patients simply do not feel comfortable going to a medical office during this time. There is a threat of a condom shortage due to hoarding (as with many other goods) and reduced production due to factory closures and decreased staffing. Contraception is a vital public health tool, and hormonal birth control methods are used for the control of many health problems.
Pregnancy termination is in jeopardy. COVID19 is being used as a political tool in some locations to ban abortion services, attempting to use social distancing and PPE (personal protective equipment) conservation as a defense. Nearly half of all pregnancies in the United States are unintended. Obstructions to contraceptive access are not going to help that. Abortion *is* a time-sensitive medical procedure. Forced birth due to a pandemic that has unclear impact on pregnancy, is dramatically stressing most people's lives in countless ways including financially, and is putting many social services in jeopardy is more dangerous than ever.
Evaluation of concerning symptoms is challenging. Many medical visits are being converted to telehealth, and it's great that patients have that option. I can't perform a speculum exam, test for STIs, check an IUD, incise a cyst, appropriately assess pain, or take a biopsy - to name just a few examples - via telehealth, however. While a good discussion can help diagnose and make a management plan for some conditions, a physical exam and testing is very important for many others. Again, some offices are simply not open at all or not open to non-pregnant patients during this time, and many patients are opting to delay evaluation even when they are worried or suffering.
Fertility treatments are in limbo. The reason for this is two-fold. First of all, it's unclear at this time what COVID19 does to a pregnancy. There are not obvious risks right now, but similar viruses have had profound impacts. A majority of our anecdotal evidence on COVID19 and pregnancy is focused to those exposed in the third trimester given the time course of the pandemic, and we have much less information on what happens with earlier exposure. Does it increase miscarriage rates? Does it cause abnormal organ development? Does it restrict growth? We're not sure. It's difficult, then, to allow a person to make an informed decision on proceeding with assistance with conception as we simply do not have the information. Secondly, reducing non-emergent office visits and procedures aids in efforts for social distancing, a hugely important measure in handling this pandemic. It's hard to use the term "non-emergent" when it comes to fertility, because truly time is everything. Every day in waiting to grow one's family can feel like an eternity. Fertility is greatly impacted by age. Some people seeking fertility treatments have already been trying for pregnancy for years. To tell these people to put their dreams on hold is heartbreaking.
Non-urgent procedures and surgeries are being delayed. Non-urgent doesn't mean unnecessary, it simply means that it can reasonably be put off for a few months. Patients with severe pain, heavy bleeding, and even concerns for or known diagnoses of cancer are having to wait. When we are able to perform these types of surgeries again, many will have to wait even longer because our OR schedules will be jam-packed with months of surgeries that would have otherwise occurred.
Pregnant people are afraid. It's hard enough to grow a human in normal circumstances. Pregnancy in a pandemic is incredibly stressful. Almost all of my pregnant patients have cried to me about the fears they have related to the virus. They're worried about the pregnancy, the delivery experience, postpartum recovery, and their families. They're worried about going to the hospital even when they think they're in labor or when they have concerns about the baby. They're worried that when they do go in, the hospital will be over-run by COVID19 patients, and they'll be turned away. They're worried their partners won't be able to be there with them. They're worried their babies will get sick in the hospital. They're worried they won't be able to manage the postpartum period because they won't have the help that they need. I provide the reassurance that I can, but I don't have all the answers.
Formula and diapers can be hard to find. People are hoarding and not considering the needs of others. A formula-fed baby doesn't have other options. Manufactured diapers have alternatives at least, although they're not practical for everyone.
Reproductive healthcare workers are having to work without appropriate PPE. In some cases this is due to legitimate shortages. In others, it is based on misguided policies. This can result in more workers taken out of the workforce due to illness or (completely justified) unwillingness to work in unsafe conditions.
With all of these setbacks and uncertainties, I think it's important to maintain some healthy optimism and and look for solutions. Some thoughts:
If your healthcare provider's office won't refill your birth control prescription or see you in-person for contraceptive services (make sure to call to check!), *find one that will* or use an online prescription service.
Buy condoms online.
Donate to and work with ACLU and abortion advocacy groups to ensure people can access termination of pregnancy.
Vote and advocate for people and policies that support funding to help healthcare clinics and hospitals remain open, appropriately staffed, and safely stocked with PPE!
Utilize telehealth if you can.
Adhere to social distancing guidelines, wash your hands, keep hand sanitizer with you, don't wear gloves everywhere you go (if you're not disposing them and putting on new gloves between activities, they're doing you and everyone else harm rather than good), and stay away from sick people so that if you do need to head into a medical office or hospital, everyone can be as safe as possible.
Talk to your healthcare provider about ways to manage conditions safely until surgery can be pursued.
Provide support to anyone you know who is struggling with fertility; if you're one of those people struggling, consider joining a support group or seeing a counselor who specializes in fertility issues and don't give up hope!
For people who do conceive and want to be pregnant, you still get to be excited about it - this pandemic does not get to rob you of your joy!
If you're pregnant, know that your prenatal care provider will do everything to care for you in the best and safest way possible, and you will get through this. Hospitals are still safe locations for giving birth, and policies are constantly adapting to ensure the best experience possible.
Look into services that can be pursued for postpartum assistance even in a pandemic - grocery delivery, laundry drop-off, a neighbor kid who can mow your lawn, online parenting groups, virtual postpartum exercise classes, telehealth for physical or mental health concerns, etc.
Order infant formula direct from the manufacturer.
Order diapers online or make or buy cloth diapers.