Her Virus Test Came Back Positive. 3 Hours Later, She Had a Baby. - The New York Times

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Rebecca Arian, a few hours into labor at a Brooklyn hospital, was balancing on her hands and knees, trying to ease a biting contraction in her lower abdomen with no painkillers.

Then her midwife walked into the room and delivered upsetting news: Ms. Arian, 32, had tested positive for the coronavirus. While Ms. Arian tried to process this, the staff asked her to put on a surgical mask.

Wearing the mask during childbirth made it feel like she was gasping for air while her body was splitting in half, she said. In that moment, the diagnosis of Covid-19, the illness caused by the virus, was the last thing on her mind.

“I was dealing with the idea of getting the baby out of me,” said Ms. Arian, whose son was born in May.

Each year, over 100,000 infants are born in New York City, where the pandemic has now reshaped the experience of childbirth. The virus has added more tension into what is an already uncertain process, as women are entering hospitals that have been overrun by a disease that has killed nearly 22,000 in the city and more than 120,000 nationwide.

Most women, like Ms. Arian, are immediately tested for Covid-19 when they enter maternity wards; then they may spend hours waiting for the result. In many cases, they go through labor in a mask. Some pregnant women with the virus have reported feeling shunned by staff members who they believe are fearful of contracting the illness.

Jesse Pournaras, a New York City-based doula, has tracked hospital policies in the city during the crisis and says they have been difficult to determine and “extraordinarily variable,” and have contributed to New Yorkers’ anxiety.

“People are confused and they’re upset, and they’re going into the labor and delivery units in a state of fight or flight,” Ms. Pournaras said.

During the pandemic, Gov. Andrew M. Cuomo has tried to shape guidelines for childbirth at hospitals, but his executive orders on the subject created confusion because facilities interpreted them differently. Critics have also said it felt like New York slid back to a time when pregnant women had less input over their care.

New York City’s Department of Health said that to protect health workers and patients, it was providing guidance to hospitals from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists. But the C.D.C. advises each facility to adopt policies based on rates of community transmission, as well as on space and staffing needs.

In late March, after public outcry, Mr. Cuomo reversed a new rule banning partners from labor and delivery wards. In April, under another order, he clarified that hospitals are required to allow partners and doulas to stay with most patients through labor, delivery and postpartum care.

His office convened a Covid-19 Maternity Task Force that released recommendations in April for birthing facilities, which included universal testing for patients and partners, after a study in New York City found that nearly 14 percent of pregnant women who tested positive for the virus were asymptomatic.

Dr. Dena Goffman, the chief of obstetrics at NewYork-Presbyterian Hospital/Columbia University Medical Center and an author of that study, said that she recognized the stress of the circumstances, and that her team was “working around the clock” to create rules that would keep everyone safe.

“I think the hospital is still the safest place to have a baby,” Dr. Goffman said.

Infectious diseases experts said there had been little evidence of maternity patients acquiring the virus in the hospital.

“We have not seen a significant number of hospital-acquired infections in labor and delivery,” Dr. Jeanne Sheffield, director of the Division of Maternal-Fetal Medicine at Johns Hopkins.

However, Dr. Sheffield said, labor and delivery staff members have reported getting sick after being exposed to virus-positive patients.

“We certainly do know of cases that came in positive and ended up transmitting to nurses and physicians,” she said. “Those reports were more abundant earlier on in the outbreak and have become less as we’ve learned to screen better and do better testing.”

On the whole, maternity care has morphed in the wake of the virus. In-person prenatal appointments are being canceled or conducted remotely, especially if someone has symptoms of Covid-19. Hospitals have suspended maternity ward tours and obstetric classes.

Doulas and one healthy support person are now allowed in the delivery room in most hospitals in New York City. But typically no one can leave the room once they arrive.

“I’m teaching my patients to go in like they’re camping,” said Denise Bolds, a doula who works in the city. “I’m telling my families they have to pack food, hydration and clothing.”

Denise Bolds, a doula in New York City, tells couples to pack for a hospital childbirth trip “like they’re camping.”Credit...Alice Proujansky for The New York Times

Hannah Mermelstein, 40, said she sat with her partner, Gretchen Virkler, 36, for three days as she labored at Maimonides Medical Center in Brooklyn. Then their medical team called for a cesarean section. The hospital’s policy — which has since changed — meant Ms. Mermelstein was not allowed in the room.

As Ms. Virkler prepared to go to the operating room, tears fell down their faces and they sang to each other in Hebrew.

“I wanted to be there for the birth of my child and I wanted to be there for Gretchen,” Ms. Mermelstein said.

A spokeswoman for Maimonides said that at the time, it would have been impossible to social distance in the operating room. So instead, Ms. Mermelstein called a midwife on FaceTime so that she could watch her daughter come into the world.

Rachel Beider, 36, was so scared to enter the hospital in late March that she left a note to her husband, in case anything went wrong. “I just had a really bad feeling,” she said. “I was just telling him how much I love him.”

When the couple checked into a room at Metropolitan Hospital Center in Manhattan, Ms. Beider said she immediately wiped the room down with hand sanitizer. She wished that she could distance herself from the staff members in masks who kept coming in.

Ms. Beider and her baby, Noah, are healthy. But in retrospect, she said, she would have left the city for the birth.

“It was genuinely scary,” she said.

In some cases, hospitals have separated women who test positive for Covid-19 from their newborns to protect the infants.

The Coronavirus Outbreak

• Frequently Asked Questions and Advice

  Updated June 22, 2020

  • Is it harder to exercise while wearing a mask?

    A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

  • I’ve heard about a treatment called dexamethasone. Does it work?

    The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

  • What is pandemic paid leave?

    The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

  • Does asymptomatic transmission of Covid-19 happen?

    So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

  • What’s the risk of catching coronavirus from a surface?

    Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

  • How does blood type influence coronavirus?

    A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

  • How many people have lost their jobs due to coronavirus in the U.S.?

    The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

  • My state is reopening. Is it safe to go out?

    States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

  • What are the symptoms of coronavirus?

    Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

  • How can I protect myself while flying?

    If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

  • What should I do if I feel sick?

    If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

  • How do I get tested?

    If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

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Cristal Brown, 36, of Brooklyn, checked into NewYork-Presbyterian/Lower Manhattan Hospital to give birth in late March. She was tested for the coronavirus when she arrived.

The next morning, Ms. Brown learned her result was positive. Her boyfriend, Jose Bueno, was asked to leave immediately. “I felt shocked and helpless,” she said.

When the baby was born, a hospital worker held up the child — named Jose after his father — so that Ms. Brown could see him. Then the staff quickly took him away.

“I never held him, put him on my chest,” she said.

Cristal Brown gave birth to her son, Jose, named after his father, Jose Bueno, after testing positive for the coronavirus. Credit...Alice Proujansky for The New York Times

Ms. Brown did not see her son again for nearly two days, and said that she had to ask multiple times for updates.

“I felt super guilty,” she said. “I felt like I couldn’t protect him, or help him, or explain to him what was going on.”

Some hospitals that were heavily hit by the pandemic had fewer nurses on the maternity floors to care for patients.

Sara Capitani, 49, a maternity nurse at the Brooklyn Hospital Center, remembered driving past temporary morgues when she arrived at work each morning.

Walking onto the labor and delivery unit, many of the rooms were occupied by women who had the coronavirus or who were suspecting of having it. Nurses were also calling out sick, which made it harder for Ms. Capitani to do her job.

She said she brought her own Tyvek suits and N95 masks into work to reduce her chances of getting sick.

“It’s not so much a fear of the patient,” she said. “It was this invisible beast. And just by caring for this person, am I at risk? I felt ashamed.”

Three hours after Ms. Arian learned she had the virus, she gave birth to her son, Geva Eliyah, named for her grandfather, at NewYork Presbyterian/Brooklyn Methodist Hospital.

Health care workers put the baby in an Isolette, an enclosed plastic box that is used for premature infants. They told Ms. Arian to wear a mask and only pick him up if she was breastfeeding.

She said that she barely slept and felt like she had to repeatedly ask for help. She asked for ice packs to soothe sore spots and mittens to stop Geva from scratching his face. A nurse who brought the ice left it by the door to avoid entering the room.

“It felt like I was in Puritan New England, and I had a scarlet letter on my chest,” Ms. Arian said.

But she understood the staff was also worried. “I could definitely feel this heightened level of anxiety,” she said.

In the weeks since giving birth, Ms. Arian has had two negative tests and has not developed any virus symptoms.

“Even though I feel very sad that I did not get to have the experience of becoming a parent that I wanted,” she said, “I’m also really glad that Geva is able to brighten people’s day in the middle of a really dark time.”

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