OB-GYNs have practice rolling with the punches. We’re used to our schedules changing when a patient is in labor and we need to drop everything to attend a birth. But the effects of COVID-19 on OB-GYNs are introducing new challenges, and we must rely on our ability to quickly adapt to ever-changing information and management of patients.
Our challenge in obstetrics is that we care for two patients at once, and sometimes we need to choose the needs of one over the other.
We have a lot of experience doing this with pre-eclampsia, gestational diabetes and premature rupture of membranes. But COVID-19 is a big unknown in terms of how it presents in pregnancy, how it affects the fetus and how it affects the mom. There hasn’t been enough time to determine all the ramifications.
And so when my 36-week patient with polyhydramnios is crying while having a nonstress test — “I’m so scared. What if I get infected? What will happen?” — I’m left with taking her hand and saying, “You will be OK. Your baby looks great and I’m here for you,” hoping beyond hope that I’m right.
Patients fantasize about and plan their labor and delivery experience. They go to classes, hire doulas, ask family members to be present, plan on a natural birth but need their coach with them or plan for an epidural as soon as they hit the door. This is one of the most important days of their lives, and they want it to be perfect.
As obstetricians, most of us try to temper patients’ expectations since we know anything can happen in labor. But with COVID-19, we must prepare our patients for a birthing experience far from their plans. They may be alone if their partner doesn’t pass the assessment for low risk of COVID-19. They may have to forgo the epidural if the anesthesiologist is busy intubating a COVID-19 patient. They may have to be separated from their baby if they test positive for COVID-19. Even more devasting, they may need intubation to breathe, and we have to consider delivering their baby to optimize the mom’s survival even if their baby is premature.
In gynecology, the effects of COVID-19 are a little different. In our office, we have been triaging our patients to see whom we can manage with a phone call or a telemedicine appointment. But some patients with postmenopausal bleeding, cervical dysplasia, an ovarian cyst or a breast lump need to be seen. Normally, we would get these patients in right away and manage them expeditiously with whatever testing is needed so as not to miss cancer or a precancerous lesion that needs treatment.
What will happen to these patients now? We still see them in the office, but we can’t schedule them for surgery or a mammogram. How will waiting two, three or possibly more months affect their chances of a cure or survival? My patient who had been scheduled for a LEEP with high-grade dysplasia or my 62-year-old patient with postmenopausal bleeding and 2 cm endometrial thickening on ultrasound, whom I’m pretty sure has endometrial cancer — how do I quell their fears of waiting?
There are some silver linings to the effects of COVID-19 on OB-GYNs. For once, because we’re seeing fewer patients in the office and spacing them out so our waiting room is virtually empty, I have the luxury of time to answer all my patients’ questions and concerns in a relaxed manner. I even have time to ask about their family members, their work and their fears.
In labor and delivery, for the most part, our environment is filled with new life and new beginnings. As obstetricians, we’re fortunate to be able to share and participate in this intimate moment with our patients. And because only one support person is allowed with the patient, we play an even bigger role in supporting and assisting our patients in the birth experience. This has all brought a greater depth to my relationship with patients.
COVID-19 has stressed our healthcare system and each specialty in different ways. Healthcare providers have stepped up to the challenge despite risks to themselves. Medicine has always been a calling, not just a job, a fact COVID-19 has done much to highlight. In OB-GYN specifically, our challenges force us to quickly adapt to the changing landscape of practicing in the face of COVID-19 — a baby waits for no one, not even a virus.