Dr. Hannah Reimen isn’t feeling great.
"I just started with a sore throat and a cough a few days ago,” she said. “I'm like, 'Oh God, please let this not be anything.’"
Reimen is a geriatrician. She works with five nursing homes across the Twin Cities. The last few weeks have been a blur of caring for patients, who are among the most vulnerable to COVID-19; devising contingency plans, as nursing homes restrict visitors and change their operations; and stocking scarce medical supplies like masks.
Adding to that stress: Reimen is 37 weeks pregnant.
“My biggest fear is that I'll have coronavirus when I deliver,” she said. “And right now, the recommendations are that you be quarantined away from your baby. That's a very scary scenario."
She hasn't been tested for COVID-19, Reiman said, but she is working from home under her own self-quarantine.
As the number of COVID-19 cases mounts in Minnesota, pregnant women like Reimen — and their medical teams — are scrambling to adjust their plans for prenatal care, labor and delivery and postpartum follow-up.
The changes come with their own share of stress and uncertainty.
Since the virus was detected in Minnesota about two weeks ago, Reiman has been weighing a host of considerations about her baby's impending birth, including: Should she induce early? Or wait out her sore throat and cough as long as possible?
Rieman is not alone. Women across the state are grappling with the uncertainty of being pregnant in the midst of a pandemic.
Meanwhile, hospitals are changing their protocols. Many have limited the number of visitors allowed in labor and delivery rooms to one or two people. Others are moving prenatal care online or over the phone.
Dr. Regan Theiler, Mayo Clinic’s obstetrics chair, said there's still a lot of uncertainty around how pregnant women and infants fare if they're infected with COVID-19. The limited data, so far, suggests neither group is at a higher risk for severe disease resulting from the virus.
But in the uncertainty, Mayo is making big changes to protect pregnant women and infants from contracting the virus. None of the options the hospital has come up with, Theiler said, are perfect — especially for families who have been working out the details of their babies’ births for months.
"These are uncertain times, and women's birth plans do not accommodate this pandemic,” Theiler said. “We're making changes left and right and trying to balance safety of the patients and making some sort of good patient experience at birth. And it's tough. It's really tough."
Those changes include doing more visits with low-risk patients online and over the phone. For high-risk patients, she said, Mayo doctors are making individual decisions about which in-person visits are absolutely necessary.
But the changes also include limiting who a mother can have in the room during labor and delivery: For now, that’s two people, Theiler said — and it’s a rule that could become more restrictive if the pandemic gets worse.
Those decisions are tough enough. But some of the most difficult conversations Theiler has been having with her staff revolve around how they will handle mothers who have COVID-19 during birth.
Right now, they're considering giving the mother the option of keeping her baby in the recover room with her, assuming she practices good hygiene, which is standard practice at Mayo.
Because of the limited data, medical staff can’t tell a mother how high the risk of infecting her baby might be if they stay in a room together. The only other option, Theiler said, would be to take the baby out of the mother’s room, and take care of the baby in the hospital’s nursery.
“And that's a hard conversation and a hard decision,” she said.
Changes outside the hospital setting
Linnea Mohn, who is due at the end of March, made a last-minute decision to have her baby at Minneapolis’ Roots Community Birth Center, an out-of-hospital birth center instead of at the St. Paul hospital where she'd been planning to deliver — to try to avoid infection.
“We just switched last Saturday,” she said, “mostly because the entrance to the maternity ward was through the ER. For our safety and also with respect to the hospital being overwhelmed in another two weeks, was what we were thinking — that if we could [find] a more private setting, we would choose that.”
Roots owner Rebecca Polston said that, among other precautions, like screening clients for signs of COVID-19, the clinic is prohibiting children from being in the facility, and is staggering visits between clients to encourage social distancing.
Amy Johnson-Grass owns Health Foundations Birth Center in St. Paul, where she said her staff is taking similar precautions.
Since COVID-19 cases were first confirmed in Minnesota this month, Johnson-Grass said the center’s phones have been ringing nonstop, with calls from pregnant women who want to give birth there.
"They're scared to be in the hospital,” she said. “They don't want to go to the place where sick people are going."
Johnson-Grass, who is also a licensed midwife, said women are also worried that hospitals will further restrict who can be in the room while they give birth.
“What we're hearing, is, 'Oh my goodness. Is it going to change even more and I will be by myself?’” she said.
Beyond the logistics of birth itself, Hannah Reimen has something else on her mind: the possibilities of postpartum depression in a world reframed by social distancing.
"You really rely on social support to get you through what you're dealing with,” she said. “Now, you can't see anyone, you can barely go outside, maybe for a walk."
The idea of bringing a baby home in an isolated world, she said, is overwhelming.
COVID-19 resources for pregnant women
Several agencies, nonprofits and other organizations have emerging resources for women as they navigate pregnancy in the time of coronavirus. Here are a few:
Pregnancy and Postpartum Support Minnesota: Website, helpline and mental health resources for pregnant women and new moms
Minnesota Department of Health: Resources on prenatal or postpartum depression and anxiety
Centers for Disease Control and Prevention: Pregnancy and breastfeeding information on COVID-19
COVID-19 in Minnesota
Health officials for weeks have been increasingly raising the alarm over the spread of the novel coronavirus in the United States. The disease is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.
Government and medical leaders are urging people to wash their hands frequently and well, refrain from touching their faces, cover their coughs, disinfect surfaces and avoid large crowds, all in an effort to curb the virus’ rapid spread.
The state of Minnesota has temporarily closed schools, while administrators work to determine next steps, and is requiring a temporary closure of all in-person dining at restaurants, bars and coffee shops, as well as theaters, gyms, yoga studios and other spaces in which people congregate in close proximity.