At the height of the coronavirus pandemic, many non-essential medical procedures — annual check-ups, elective surgeries, in some cases, even IVF — were postponed. But, of course, one thing that couldn’t be canceled by COVID-19 was labor. Giving birth may look different during a pandemic, but it’s still happening. Heather Bartos, MD, knows this well.
She owns a women’s health clinic in Cross Roads, Texas, and has helped almost 80 patients welcome their bundles of joy to the world since the coronavirus hit the US hard in March. Dr Bartos worked even when elective procedures were put on hold and the labor and delivery wing of her hospital was a ghost town. She assisted parents whose stress levels were at an all-time high, and who were constantly fretting over misinformation they read about the virus on social media.
We caught up with Dr Bartos this April, and again this June. "In the last 48 hours, Texas has noticed another big increase in [COVID-19] cases, so we're preparing for another wave," she told us on Wednesday 24th June. On top of that, new research says that pregnant women may be at increased risk for becoming severely ill with COVID-19 compared with women who aren't expecting. "It is indeed distressing," she says. "We relentlessly urge our pregnant women to protect themselves and their unborn children first because we don’t know everything about the behaviour of this virus." That means wearing a mask, and socially distancing.
We asked Dr Bartos about what it was like to deliver babies during coronavirus, the impact to her business, and whether she thinks there will really be a post-quarantine baby boom.
Refinery29: At a time when so many jobs and even medical procedures have been put on hold, what has it been like to work in a field that’s indisputably essential right now?
Dr Heather Bartos: “You know, I actually delivered a baby on Saturday night. Babies come whenever they come. We try to plan, but the one this weekend came early. The mom was planning a C-section, but there was an issue with blood pressure.
“The ‘OB’ side of my job — delivering babies — is still running as normal. We were lucky. We didn't have a problem like New York did. We never said, "Okay, no one can come with you to the birth" — and of course, they quickly reversed that policy too. Different hospitals allow different things. I had one that said just the partner could be in the delivery room, but another allows the spouse and the doula.
“In my clinic, we’re maintaining a no visitor policy. Spouses of patients can come watch the OB ultrasound, but then they have to leave. No kids, no grandparents.
“In total, I delivered 23 babies in April, specifically. Springtime is often busy. People get married and have sex in June after their weddings. There are spikes like that. When Fifty Shades [of Grey] came out, we had babies nine months later, in early December. It’s like futures in the finance market.”
We’re hearing a lot about how different being pregnant and delivering babies is right now, but mostly from the perspective of the parents. How are things different on your side of things?
"Usually, I like to deliver freestyle, as I call it. I don't typically wear a mask during vaginal delivery, so people can see my face. Now we have to be fully gowned up like we're in an operating room. It’s boots, sealed gloves, the whole works. N95 and eye shields and hair covers. So the whole room looks very sterile, which is not my vibe. I, of course, get why we do it. I think it's probably weird for the patient, because it looks like we think she's diseased, you know? It's so impersonal for a very personal moment. And I look like Dustin Hoffman in Outbreak.
"After working with patients, when I get home, I strip in the garage, which is usually a fun sight for my husband. I'll walk from the garage to my bathroom in my bra and underwear. And I'll get directly into the shower. And the clothes, they'll go directly in the wash. I even wash my shoes."
Do you think everything going on right now makes parents more anxious about delivering?
"Possibly. They were very anxious in the beginning — there was so much misinformation out there. Pregnant people are often in these Facebook groups and communities, and so if one person had a bad piece of information, it was spreading like wildfire — or like the virus. That's why I started making videos for social media every week to explain things. I think having a doctor out there saying, ‘Okay, this is what we know today,’ ‘Okay, we're finding this out an hour before you do’ is helpful.
"But I also tell mums: 'We aren’t out of the woods,' and especially now with more children affected. We are of course worried about our pregnant mamas and their babies."
You mentioned you’ve seen patients with Zika. How did that outbreak compare to coronavirus?
"I mean, there were very clear signs when people were sick with Zika — with this, it’s so slippery and the tests aren’t always accurate.
"I also worked with swine flu patients when I was an gynaecologist in the military. It seemed like we had more information about that too, and like we knew it hit pregnant women harder at the time.
The biggest refrain I hear from all the doctors right now is that we just don't know. We're getting a new story every day. [The American College of Obstetricians and Gynaecologists] is our governing body, but they were fairly silent at the beginning of all this. We’re just trying to just communicate what we know to the people that need to hear the information." [Editor's note: In a late-May conversation, Dr Bartos clarified that ACOG has been coming out with more papers and issuing more guidance to OB/GYNs than they had been early on.]
"Why is there so much conflicting information out there about how this virus really impacts pregnant women?
"We can't do many varieties of studies on pregnant women. We can’t have a control group where one pregnant woman’s getting hydroxychloroquine and one's getting placebo. It’s considered unethical to mess with an unborn child.
"Sadly, much of what we know about OB is actually from the Nazis when they did all their experimentation. But right now, we mostly have to extrapolate what we know about adults to pregnancy."
Do you do coronavirus tests on your patients before they come in? Do you just swab their nose as part of pre-op?
"Yes, they’ve been requiring that. For C-sections, we have them come in 40 hours head of the procedure to take a test. If a woman comes to us in labor, we swab her on admission, and she’s in a room isolated from other patients until the results come back.
"We also do a pulse [oximetre] check and take the temperature of everybody. The pulse ox can tell us a lot about the health of the lungs.
"With actual coronavirus testing, I only had five tests the first big week that they shut everything down. For everybody! I go, "That's not enough.’ The lab person said, 'Well, in seven days you can order some more. We might be able to get you 10.'
"We now get them more regularly, but at the beginning it was bad. I had to hold back two for employees, in case I had an employee that was starting to have symptoms because I couldn't have them here and infecting everybody else. And then we saved three for our patients.
"But I have not yet had a pregnant patient who had COVID-19."
What about personal protective equipment? Has your clinic had the same access issues as hospitals around the country?
"I have not seen a shortcoming for us. We're in a relatively low hit area in North Texas. I'm in a network of doctor moms for the area and people are sharing what they have. So they're like, ‘Hey, my office has these extra N95s, I want to give them to a doctor who’s going to need them for the hospital.’ There's kind of a community of people that are sharing their supplies, which is great.
"The doctors are really kind of rallying around each other right now, which is nice and a little different than how it's been."
Has coronavirus changed other procedures you perform, besides delivering babies? Can you do elective procedures?
“On 22nd April, we were allowed to start doing elective cases again, but you had to meet certain parameters. Things like making sure the procedures aren’t expected to take up a bunch of resources and PPE, and that the hospital has saved 25% of its beds for COVID patients.
“We can also do in-office procedures. So if you're having a miscarriage, normally we would have to go to a hospital and do a D&C. If the person doesn’t want to go to the hospital, I can do it in the office. That way, patients don't have to be exposed to other people.
I know many medical professionals are using teleconferencing to keep up with their patients. Is that something your practice does? What’s the reaction been?
“We're doing probably 50% telemedicine at this point. We started really early. We modified our in-office hours, but we’re trying to really keep the feel of, ‘We're here for you,’ for our patients, and telemedicine is a way to do that.
“We offer it to our OB patients if they want. We might say ‘If you want to stay home this weekend, we can talk to you on the web. If you want to come in and hear the baby's heartbeat, that’s fine.’ For some visits, moms can check the fetal heartbeat via a doppler. Or if they have a blood pressure cuff at home, they can use that.
“People still wanted to come in for their sonograms and some like to come in and talk to our midwife or one of the doctors about what's going on. They're scared. But people want information and we make sure to get it to them.
"We’re actually building a second clinic and I was thinking, ‘Do I need to put a drive-thru window in this new clinic? Is that the way of the future?’ So we'd be able to do drive-thru testing — or drive-thru anything? Or do we need to build a smaller clinic that’s more web-based? These are the things that we don't know."
You’re the owner of your practice as well as being an gynaecologist. How has the pandemic affected you as a business owner?
"Everyone’s taken a big tank in the business side of things due to the coronavirus. I'm not getting paid right now. I furloughed myself so that my staff could get paid, and I haven't gotten a pay cheque the last six weeks. I have six providers that work under me — three NPs, two doctors, and a midwife — and I wanted to keep their salaries, as well as my nurses’.
'With fewer patients coming in at the beginning of this, though, there was lot of busywork. I'd assign someone to go over all the electronic medical records templates and make sure those were up to date, or to make sure that our handouts that we give patients were up to date. But at least the providers are still getting paid.
"Lots of doctor's offices, including mine, applied for that PPP, [the pay cheque protection program, a loan program that’s helping small businesses during the pandemic] and then there were some catastrophes with that. [Editor's note: Bartos's business was approved for PPP in May. She’s been furloughed now for 14 weeks.]
“To be honest, I’m hoping there’s going to be a baby boom after this pandemic! I think we‘re all secretly hoping for a boom.”
We hear so much about about how COVID is affecting restaurants and non-essential businesses. But many people would never think the belt-tightening would hit doctors, too.
"With doctors, there's always this perception that we're all on the golf course after lunch, eating truffles and champagne. Most small doctor offices — your community ones, not the ones that are employed by big hospitals — it’s just like a normal small business. And just like the restaurant that's putting out food to go, we have to do the same thing.
"Ultimately, my main hope is that a lot of people are having sex and getting pregnant. [laughs]"
This interview has been condensed for clarity and length.
The World Health Organization has declared COVID-19 a global pandemic. It says you can protect yourself by washing your hands, covering your mouth when sneezing or coughing (ideally with a tissue), avoid touching your eyes, nose and mouth and don't get too close to people who are coughing, sneezing or with a fever.