A View from the White Coat

A View from the White Coat

(with Mask, Gown, Gloves, Etc.)

Dr. Payal Shah
Dr. Payal Shah

Nearly a year into the coronavirus pandemic, Dr. Payal Shah, the director of Obstetrics and Gynecology at Holy Name Medical Center in Teaneck, said she is grateful that some of the anxiety and fear that clouded the early days of covid has subsided because doctors and medical staff today have more knowledge and experience, and because meticulous guidelines and algorithms for managing pregnant patients are in place.

These guidelines have meant a shift in several areas, such as visitor policy, PPE (personal protective equipment), the room’s air quality control, among other things.

But the “new normal” at The BirthPlace, Holy Name’s site for labor and delivery patients, has ensured a safe and good experience for pregnant women who have been delivering their babies during this fraught time, said Dr. Shah, who shared some of her thoughts with Our Children.

Our Children: The challenges of pregnancy and childbirth have no doubt been amplified by covid. Can you share what you and the hospital staff at Holy Name Medical Center are doing to make the birth experience the safest and still most rewarding experience?

Dr. Shah: As far as safety, we follow all CDC (Centers for Disease Control) and the Department of Health guidelines. At Holy Name, we are a locked unit, and that has always been so. We are carefully monitoring who comes in and out of the unit. That has always been our standard, but obviously in the time of covid this has proven to be even more helpful and useful because you cannot walk in and out of Labor and Delivery. We allow only the father or whoever the mom chooses as her support person to come and stay with her. But they are not allowed to go home and come back. They must remain with the patient if they choose the entire time the mom is in the hospital. I think we are one of the few hospitals that very quickly allowed moms to have their husband with them. That was an issue with several hospitals when covid was at its peak. Moms, especially covid-positive moms had to deliver by themselves and that was an emotional nightmare for them. So many women were making decisions to either deliver at home or other unsafe decisions about delivery of their child. We very quickly realized that for the mom having their support person was key, so we allowed that since the get-go of covid and continued to allow that visitation policy.

We have a separate covid and non-covid units, so covid-positive moms are still on Labor and Delivery, but they are in separate, private rooms, which are special for covid-positive patients. These are negative pressure rooms. They’ve been built so that the air is pulled out of the room, so it is safe for everyone in the room, including the providers, the nurses, the patient, the visitor, everyone.

The covid-positive visitor is not allowed to leave the room and must wear a mask the whole time. The providers going in the room are in full PPE, including N-95 masks, isolation gown, etc. Once a baby is born to a covid-positive mother, the baby stays with the mother. Very early on in covid, they were isolating the baby from the mother, however, this very quickly was proven that for the emotional health of both the mother and baby, it was important that the baby stays.

Our Children: How have the last months of covid impacted or changed the way in which you practice?

Dr. Shah: Everyone was scared in the beginning. Everybody was so terrified of covid, including the patients, especially pregnant patients. To be pregnant, especially during the peak of covid, when patients were coming in, they were so anxious and so frightened, and we didn’t have much information. These patients required so much emotional support. That’s who we were as physicians and the nurses. We were their support, and we were there to provide them some sort of normal birth experience from their prenatal care outside of the hospital to the delivery inside the hospital. We were trying to make their pregnancy as best and as normal and as happy an experience for them. Therefore, on an emotional level we provided so much more for the patient. They needed so much more. More time. More encouragement. More to help them feel relaxed.

During covid, we may be the only people that they are seeing. We had so many breakdowns in the office. It was scary. You had to go above and beyond providing support. You provided not only their medical care for their pregnancy, but it was kind of like you were their doctor, their therapist, their best friend, their mother or father, you were everybody to them because for a while, you were the only one they were seeing. And it was hard for us as well. When I would finish an office session it was so emotional. It was so heavy on me as well because to imagine what these women have to go through. Not only before delivery but after delivery because we are telling them not to see anyone. Normally, everyone would come to see you and celebrate your baby, but you can’t do that anymore. You have to protect yourself and protect your baby and make sure that you’re not getting covid.

As far as the practice, delivering a baby is still the same, however we need to be prepared. For example, if I have an emergency, I can’t just rush into the room. Now, you need a few extra minutes to get your PPE on. You have to think a little bit more and be a little bit more prepared in these situations.

Our Children: This has been some year. But are there any “silver lining” takeaways from this experience?

Dr. Shah: I think definitely that having a baby in and of itself is something that brings joy to everyone. For so many people 2020 was such a terrible year. But to have a baby and bring joy to anyone’s life is a silver lining in and of itself. Many people really did feel like there was no happiness in 2020.  These covid-positive moms who came in scared to death, not knowing what was going to happen, to go home with a healthy baby, I don’t think they could have asked for anything else. When the moms got home, they were able stay home and bond with their families. Being home also allowed moms to breastfeed longer. These were some of the good things. Above all, any time, anyone can go home with a healthy baby, that is something to smile about.

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