A Survey of Labor and Delivery Practices in New York City during the COVID-19 Pandemic

Abstract

Recently, a novel coronavirus, precisely severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), that causes the disease novel coronavirus disease 2019 (COVID-19) has been declared a worldwide pandemic. Over a million cases have been confirmed in the United States. As of May 5, 2020, New York State has had over 300,000 cases and 24,000 deaths with more than half of the cases and deaths occurring in New York City (NYC). Little is known, however, of how this virus impacts pregnancy. Given this lack of data and the risk for severe disease in this relatively immunocompromised population, further understanding of the obstetrical management of COVID-19, as well as hospital level preparation for its control, is crucial. Guidance has come from expert opinion, professional societies and public health agencies, but to date, there is no report on how obstetrical practices have adapted these recommendations to their local situations. We therefore developed an internet-based survey to elucidate the practices put into place to guide the care of obstetrical patients during the COVID-19 pandemic. We surveyed obstetrical leaders in four academic medical centers in NYC who were implementing and testing protocols at the height of the pandemic. We found that all sites made changes to their practices, and that there appeared to be agreement with screening and testing for COVID-19, as well as labor and delivery protocols, for SARS-CoV-2-positive patients. We found less consensus with respect to inpatient antepartum fetal surveillance. We hope that this experience is useful to other centers as they formulate their plans to face this pandemic. Key Points

Where the System Failed: The COVID-19 Pandemic’s Impact on Pregnancy and Birth Care

“…The SARS-CoV-19 (COVID-19) viral pandemic created a massive shift in how health care systems interact with patients, staff, and the public. The maternity care system, which encompasses prenatal care, labor and birth care, and postpartum care, has experienced vast changes in structure and interpersonal interactions as an attempt to curb exposure for both patients and staff, specifically with visitor policy changes, COVID testing for patients, and reduced or clustered care ( Capanna et al, 2020 ; Fryer et al, 2020 ; Peña et al, 2020 ). These changes have profoundly affected the experiences of patients interacting with the health care system, as well as the nurses who are caring for them.…”

Decision-making on the labour ward during the COVID-19 pandemic

“…2 We speculate that obstetricians might have been more likely to expedite delivery particularly because at the time, it was not clear how labour might impact the course of COVID-19. Evidence of changes to obstetric decision-making and early delivery has been highlighted in a survey by Peña et al 3 …”

Framework for obstetrics and gynecology department change management in response to COVID-19 pandemic

“…Understanding obstetric management of COVID-19, as well as hospital-level preparedness for its control, was crucial for patient safety. [ 7 ] Guidance for patient management has come from expert opinions, case series, and systematic reviews of observational studies. [ 7 8 ] Saudi as well as international perinatal societies have produced fairly consistent guidelines for the management of these patients based on available data.…”

“…[ 7 ] Guidance for patient management has come from expert opinions, case series, and systematic reviews of observational studies. [ 7 8 ] Saudi as well as international perinatal societies have produced fairly consistent guidelines for the management of these patients based on available data. [ 9 10 ]…”