Cat Garcia came down with flu-like symptoms right around the time she was supposed to have a baby shower for her twin boys. It was late March, Gov. Jared Polis announced the first Stay-at-Home order that same week.
She joked with her husband, who also had symptoms, that they might have “the Corona.”
Each day new symptoms popped up. She lost her sense of taste and smell, she was coughing and had a runny nose, and she was running a fever. Then she had an increasingly hard time breathing — that’s when she and her husband started to worry about the pregnancy.
Pregnant women have had to face two big fears during the coronavirus pandemic: birthing without their partner or families, and being separated from their newborn if they test positive for the virus. Those policies have changed over time, but doctors, birth rights advocates and new parents alike wonder what the impact separation may have on women and their newborns.
'My only support that I had was gone'
On March 27, Garcia drove herself to the hospital, her husband had a fever and they knew the hospital wouldn’t let him in. She had horrible back pain, but the baby monitors showed her twins, Kal and Bruce were doing well. The hospital sent her home. Her parents picked her up — later they each would come down with the virus, too.
The next day, she was back at the hospital. Her mom went with her because her husband couldn’t.
“They decided like, ‘We need to get these babies out because we don't want to have to put you on a ventilator. Now we're worrying about the babies because you can't breathe,’” she said. “And it was really a struggle because I knew that they were early, and I was worried that they were going to have some health issues with being born premature, but then also being worried about myself, like, OK, I don't want to be put on a ventilator. Is there any flexibility here? Like, what truly are my options and how far can I push it?”
They moved her to the operating room for an emergency cesarean section. For three days, her mom had been with her, and now she had to leave.
“I was upset and crying about that. And so now my only support that I had was gone,” she said. “But I just remember the doctor talking to me and like, OK, you just need to keep breathing. And then you're going to fall asleep. When I woke up, that’s when it really hit me, like I didn't get to see the delivery. My husband wasn't there for the delivery.”
From decades of championing skin-to-skin contact to separating newborns and moms
She knew they had taken her twins to the neonatal intensive care unit. They were born six-weeks and one day early.
At the start of the pandemic, the Centers for Disease Control and Prevention advised hospitals across the country to separate COVID-19 positive women from their newborns across the board. The recommendations were more cautious than advice from the World Health Organization which did not advise separation. Instead, the WHO advocates for close contact and breastfeeding, which “helps a baby to thrive.”
Garcia didn’t get to touch or hold her boys for 19 days after her delivery. She worries about the impact those days may have on her babies.
“I just think developmentally, like all these little things that are normal, that there's research done on how beneficial it is,” she said. “And now I am sitting here thinking like, what kind of negative impact is gonna come from this?”
Phoebe Montgomery, a midwife and nurse practitioner at Denver Health, was shocked when she first heard that her hospital would be abiding by the policy. For decades, doctors and researchers have been working to understand family-centered care that champions skin to skin contact, breastfeeding and bonding immediately after birth.
“It almost feels like a bomb has gone off in the way that we care for patients,” she said.
“Predominantly there was just a lot of fear because there's a newborn involved, and that's really hard for a lot of people to imagine, you know, a newborn getting the coronavirus,” Montgomery said. “That's even more terrifying than you or myself or someone else catching it.”
Symptomatic women are advised to temporarily separate from their newborns, in cases like Garcia for long stretches, in other cases just the length of their hospital stay. Experts say that these kinds of interventions can result in physical and emotional costs.
She wore a mask to deliver her baby and for her first two weeks of life
Gladis Ibarra was days away from her due date when she used hand sanitizer and realized she couldn’t smell it. Her husband had lost his sense of taste and smell, too. She grabbed Vicks Vaporub and put it on her nose. Her eyes watered, but she couldn’t smell the menthol gel.
She was worried about being separated from her baby after delivery. She called the hospital she would deliver at, North Suburban, to try and get tested. She and her husband were tested a few days prior to her delivery but didn't get their results until they were already in the delivery room.
At the hospital, she wore a mask to deliver her daughter, Ophelia. After the delivery, the nurses placed Ophelia on her chest.
“Of course the biggest question was like, 'What about my baby?' Right? What happens now? Am I able to bring her home with me?” she said. “After delivery, my sense of taste and smell were both relatively back. I didn't have any fever. I didn't have any cough. She was tested twice for COVID, both results were negative.”
During her hospital stay, she was asked to wear a mask and to wash her hands before holding or touching Ophelia who stayed in the room with her. She was able to take her newborn home but was advised to take the same precautions. She wore a mask for the first two-weeks of Ophelia’s life.
In April, the CDC adjusted its recommendations to advise hospitals to “strongly consider” separation on a case by case basis.
The evidence to date suggests that the risk of a newborn getting COVID-19 during at the hospital is low when precautions are taken to protect the infant from a parent with the virus, according to The American Academy of Pediatrics.
As doctors and researchers learn more about the disease, recommendations and policies have changed. Separation after birth from COVID-19 positive mothers is no longer the standard across the board, but hospitals have to make decisions about symptomatic and asymptomatic patients.
At Centura hospitals, women who are asymptomatic can have their newborns in the room but are asked to take precautions like wearing a mask and washing their hands before touching the baby. Symptomatic women are advised to separate.
“It really comes from what little we know about this illness,” said Candace Garko, director of Children's and Women's Services at Centura Penrose-St. Francis Health Services in Colorado Springs. “From the CDC, it is appearing that people who are symptomatic shed a higher viral load, they are more contagious. So while we don't know truly how contagious asymptomatic, positive people are, we know symptomatic, positive people are significantly more contagious.”
On a ventilator and pregnant
Halfway through Veronica Markley’s pregnancy, she contracted COVID-19. She’s not sure where she got it, but as a teacher and a mother to a two-year-old, she says she was cautious. She drove herself to the hospital in Greeley where she lives with her husband and son. Once she got there, she was transferred to a hospital in Denver.
“I thought, Oh, I'll just be in the hospital for a little bit getting oxygen and then I'll be home,” she said. “Then all of a sudden, I remember the doctor coming in and saying, we need you to sign these papers in case things get, you know, worst-case scenario type stuff. And I was kinda worried, and she was so professional and calm, but I could see the concern in her face, like when she was like giving me paper after paper, after paper to sign.”
Markley could barely hold the pen to sign the paperwork. Soon after she was put on a ventilator for a week. When she woke up, she remembers seeing tubes connected to her arms, but her baby bump was still there. She was relieved to still be pregnant.
After another week in the intensive care unit at the hospital, she was finally able to go home. What she didn’t expect was that weeks later when she was due to deliver her daughter, Luna. She would test positive for COVID-19 — again.
“I was pretty vulnerable, just with everything we've been through and the recovery that I've gone through. And I just couldn't believe, I just didn't feel like it was fair,” she said.
The hospital staff gave Markley two choices: go home and come back a few days later to be retested, or deliver then and be separated from the baby after birth.
“I definitely didn't want that,” she said. She wanted to go home and come back for a second test, but since she was scheduled for an induction and the process began before her test results came back positive, she was already too far along to go back.
Ultimately, a doctor decided that she would be able to take Luna home. That doctor told Markley that the test was probably incorrect and that it was unlikely she had contracted the virus a second time. She wore gloves and a mask for her delivery and throughout her hospital stay when she interacted with the baby.
“It was not the birth that I would have wanted for myself and my little daughter. They put her on my chest for a little while, like just for a very short amount of time,” she said. “With my son, I was able to like have that golden hour with him. He was able to latch on by himself just have those sweet bonding moments together. And I didn't get that with our little girl, and that was really hard. It was really hard, but I also understood it was for her safety, if for whatever reason I was contagious, I wouldn't want to pass that to her.”
What we know about COVID-19 and pregnancy risks has changed
In late June, the CDC revised its position on risk to pregnant women after a report found that they are 5.4 times more likely to be hospitalized with COVID-19, 1.5 times more likely to be admitted to the intensive care unit, and 1.7 times more likely to need mechanical ventilation. Latinx and Black pregnant women were found to be disproportionately affected.
The lack of data on how COVID-19 affects pregnancy and birth led to policies that were made out of an abundance of caution.
“There was no research, there was no information on how this was affecting people that gave birth and their newborns,” said Karla Gonzales Garcia, policy director for the Colorado Organization for Latina Opportunity and Reproductive Rights. “So everything was just reactionary.”
Today, Colorado hospitals focus on a shared decision-making model, where the doctor and mother discuss the options and make a decision together.
“Certainly if we're in the situation where mom is quite ill, we want to take that into consideration as well,” said Dr. Allison Gilliland, nursery director at Good Samaritan Medical Center. “And again, talk to her about what are her goals, what are her values, what is important to her? What is she feeling that she's able to do and not able to do? And truly wanting to give the parents a voice.”
Garcia said she would have done whatever was necessary to keep her boys safe, but she’s frustrated that her experience was so different from some other mothers who’ve given birth during the pandemic.
“I understand the hospital has policies and yes, they were trying their best to help us out,” she said. “But it's like, it came to a certain point where it was like, I feel like they could have done more for us and they didn't.”