Access to medical care for women has been deeply affected by the coronavirus pandemic. Women have had to adapt to new treatment protocols for pregnancy, labor and delivery, hospitalization after sexual trauma, fertility treatments, and mental health conditions.
Labor & Delivery
Lital Kremer, a 34-year old mother from Kiryat Ono, expected to have her mother and husband present for the birth of her third child at Sheba Medical Center, just like she did with her previous pregnancies. However, as she neared her due date, she realized that wasn’t going to happen because of coronavirus protocols.
“It was a little nerve-racking knowing I was going to give birth amid the crisis… with concerns about what will happen, where to go, how it will be in the hospital itself — and the fear that someone will get infected,” Lital expressed in an interview with The Times of Israel.
Ultimately, her husband, Roi, was permitted to stay with her for the birth at Sheba, but both parents had to wear masks for their entire stay at the hospital.
“I had to be with the mask the entire time, including during labor itself, with contractions,” Lital said. “It was hard to breathe and it was hot. What was weird was that the nurses and the doctors were wearing masks, so you can’t really always understand what they’re saying and what their facial expressions are. It felt like a movie, everyone was walking around with masks and it’s all white and sterile.”
Immediately after birth, they had to say a temporary goodbye to their newborn daughter. She was taken to the nursery to be bathed and cared for – where parents are not allowed to enter for fear of infectious exposure. Fortunately, Lital’s labor and delivery went relatively smoothly despite the masks and temporary separation from her baby girl.
“You no longer think about the fact that the birth took place with masks and craziness,” said Lital. “At the end of the day, it’s behind us. After the birth, I left with a healthy baby, and everything is okay.”
Pregnancy Care for COVID-19 Positive Women
When pregnant women receive a positive diagnosis for COVID-19, difficult decisions must be made quickly. Should mothers and newborns be kept together in order to facilitate bonding, or should they be separated to prevent the spread of infection to the baby?
Israel’s first COVID-19 obstetrics and gynecology ward was established at Sheba Medical Center. Women who have coronavirus can come to receive any necessary medical treatments and to give birth at this specialized unit, isolated from the regular maternity rooms. Since it was opened, 10 pregnant women have been treated in the ward. Four of them gave birth, one of whom was in critical condition and transferred after birth to Sheba’s ICU for COVID-19 patients.
The ward comprises several delivery rooms, a newborn unit, a high-risk pregnancy clinic, and operating rooms for C-sections. All staff must don a protective suit and gear before entering, including full smocks, face masks, gloves, and shoe covers. Naturally, the staff must maintain minimal physical contact with each patient, using a range of technologies to conduct whatever can be done remotely from a customized control room.
“It’s both technically and physically difficult to operate with all of that equipment; you look like a little astronaut and it limits your ability to walk and your range of motion,” said Prof. Eldad Katorza, Senior OB-GYN at Sheba and head of the COVID-19 ward.
Despite these challenges, the medical team strives to provide each woman with as positive a stay as possible. “The interaction with the patients has been very good,” said Katorza.
Normally, the baby is given to the mother immediately after birth to create the first, important connection – empathy, body heat, the first feeding – between mother and newborn. But the pandemic has thrown this routine into question, especially in the dedicated COVID-19 maternity ward.
Based on experiences at Sheba, combined with data from around the world, Katorza assessed that most babies born to coronavirus-positive mothers test negative for the virus. Additionally, the virus is not transmitted through breast milk. However, this doesn’t mean babies are protected from infection after birth.
“In the beginning, it wasn’t clear what policy we should adopt: Should we request separation of the mother and newborn after birth, or can we maintain the connection between them under certain limitations,” Katorza explained. “In the end we decided to leave that decision to the parents.”
How long will the specialized maternity ward stay open? It will operate until the pandemic has fully passed and the Sheba team can be completely certain that no woman with COVID-19 will arrive and need medical assistance.
“We aren’t closing this unit and we are ready for any scenario, including a renewed outbreak in the near or far future,” stated Katorza.
Near the end of March, fertility treatments were stopped. This decision was made out of concern for the unknown effects of COVID-19 on the first trimester of pregnancy. Cousins of the virus, SARS1 and SARS2, did affect pregnancy, causing more miscarriages, small fetuses, premature births and other problems. On May 11, the Ministry of Health decided to approve fertility treatments for women of all ages. Guidelines for abortion services, which had also changed because of the pandemic, were also updated. Now, all hospitals are providing abortion services.
Coping with Postpartum Depression
Giving birth in the midst of a global pandemic, in unusual hospital circumstances and with hospital protocols in constant flux, can lead to long-term ramifications for both the parents and babies. The lack of an immediate postpartum connection can intensify the stress and anxiety experienced by many new mothers, dramatically increasing the risk for postpartum depression.
“What will happen to the [mothers’] relationship with their newborns and the emotional development?” questioned Katorza. “We’ll likely only discover the full ramifications of the pandemic on men and women’s health over the coming few months and years.”
In response, the Briya Fund, an organization dedicated to improving women’s healthcare in Israel, created an online questionnaire for women to check themselves to see if they’re okay or if they need assistance. The questionnaire provides an automated response about the severity of the women’s symptoms and lists contact information for available mental health clinics. In the first day the site went live, 300 women filled out the form, and the rates of postpartum depression were found to be very high.
Online services have been a fabulous instrumental tool for helping individuals and medical care providers to avoid unnecessary exposure. Telemedicine is particularly helpful for psychiatric treatments and therapies for women who are suffering from postpartum depression or sexual trauma. Currently, the mental health centers at both Sheba Medical Center and Hadassah-Ein Kerem Hospital in Jerusalem operate online. Bayit Chaim, which runs several other mental health clinics throughout the country, also launched a coronavirus hotline (in Hebrew, English, Arabic, Russian, and Yiddish) for callers in need of emotional support and guidance.
“There have been cases reported of people delaying [seeking treatment], even with very serious health events, such as heart attacks, strokes, urgent surgeries and more. People were scared to come to the hospital and as a result, they neglected their health and caused themselves damage. We want to avoid this as much as possible,” Katorza said.
The development of so many varied online treatments has added bonuses for the future, as many of these expert, convenient services may remain available even after the pandemic passes. The option of online care is helpful for many different individuals and conditions.