Under the best of circumstances, pregnancy is fraught with uncertainty, hormonal peaks and valleys, and myriad physical challenges. Joy mingles with anxiety, which chatters with exhaustion, which whispers to excitement.
Teju Adegoke, an obstetrician-gynecologist at Boston Medical Center, the largest safety-net hospital in New England, cares for many women from underserved communities, including recent immigrants, refugees and asylum seekers, and lower income patients. She says these populations have always had a harder time accessing health care, and “these disparities are only exacerbated” by the pandemic including that many essential, low-paying work is done by people of color. Coronavirus is also disproportionately impacting the black community.
Adegoke says she is particularly concerned about social isolation, access to public transportation and patient reluctance to access care “because they are worried they will be targeted based on their immigration status.”
To combat these concerns, BMC conducts routine depression screenings, and looks for “social determinants of health, like food insecurity or housing insecurity at every visit.” They try to cut down on visits by scheduling blood work and ultrasounds on the same day, and “are actively reaching out” to assess patients’ needs for transportation or food assistance.
BMC allows one support person for labor and delivery, but many women are color are particularly concerned at the idea of not having enough people to advocate on their behalf, or to help prevent unnecessary, invasive interventions, given the high rate of maternal mortality for women of color.
Sabia C. Wade, a doula who trains others in the field, cites the recent death of 26-year-old Bronx resident Amber Isaac, who expressed concerns about her health and medical care before her emergency induction and subsequent Caesarean section. Black women are three to four times more likely to die during childbirth than white women, and Wade says covid-19 restrictions will only make the problem worse.
“For black birthing people, the reality of death is not only real but statistically way more likely to happen,” she says.
Many of Wade’s clients from marginalized communities were told by doctors, midwives, or friends to consider giving birth at home or in birth centers versus hospitals, both to mitigate risk of exposure to the coronavirus and also to enable more in-person birth support from partners, family or doulas. That can often be a costly option as many insurance companies won’t cover in-home births. Wade notes that doula care can be similarly cost-prohibitive, and “families of color are getting the short end of the stick. It all comes back down to marginalized communities needing equity in every way.”
Access to mental health support in an environment like today’s while dealing with a pregnancy can often be difficult to come by as well.
Casey Davidson lives in Quincy, Mass., and is seven months pregnant with her first child. She’s considered high risk due to the baby’s conception via in vitro fertilization, her age (41), and because she suffers from hypertension. Davidson experienced pregnancy loss last year and has coped with frequent anxiety during her current pregnancy. She worries about developing preeclampsia, a condition that can potentially be fatal for mothers, because of her high blood pressure. And although her doctors have been doing “their best,” via virtual appointments, and given her blood pressure cuffs to monitor at home, her mental health has “not even come up.”
An “IVF pregnancy, especially after experiencing a loss, it is most definitely riddled with anxiety,” she says.
Facing the possibility of giving birth without the support of her husband, who Davidson cites as a “calming influence,” is another stressor. “My husband and I went through a lot to have this baby, and this is supposed to be a happy time. Instead, we are dealing with living in constant fear, canceled baby showers, the inability to do hospital tours, being forced to take any birthing or parenting classes online, and worst of all — limited access to in-person prenatal care,” she says.
While Davidson misses the reassurance of in-person appointments, she knows many pregnant women are happy opt out of all but absolutely necessary office visits during this time. Ultimately, she just wishes she had more control of the situation.
Like Davidson, Katie Gutierrez has not been asked by her health-care team “even once” how she’s coping emotionally, which makes her worry about women experiencing severe mental health challenges. She hopes health care providers will consider allowing FaceTime calls during procedures like ultrasounds or other high-stress appointments where support partners are no longer allowed.
“Those things are stressful in the best of times, and these are not the best of times,” she says.
Gutierrez lives in Texas, a state that almost immediately saw a spike in confirmed covid-19 cases as soon as shops, restaurants and other public places began reopening. She had symphysis pubis dysfunction when she was pregnant with her now 2-year-old daughter, which caused acute pain that forced her to rely on crutches after the first 20 weeks of pregnancy. When she became pregnant with her second child, she immediately found a physical therapist who specializes in pelvic pain, since symphysis pubis dysfunction is likely to return during subsequent pregnancies.
But because of restrictions, Gutierrez was only able to see that therapist twice. “I worry constantly about what the reopening of businesses and low test availability will mean for hospitals — and the risk of contagion there — by the time the baby is due.”
