Protecting themselves and their unborn children from a deadly virus in a global pandemic is only one of the many burdens pregnant women have had to bear over the last year.
As the country has crossed the grim milestone of more than half a million lives lost to COVID-19, mothers across the nation are dealing with a crisis uniquely their own: bringing new life into a world devastated by disease.
"I don't want him to associate his coming into the world with anything that caused his parents trauma or was traumatic," said Naajaya Leak Wilson, while holding her 2-month-old son, Brooks.
Leak Wilson spent much of the last year inside her Raleigh home after she and her husband learned they were expecting a baby just as the nation was learning a novel coronavirus that had started to spread.
"It just seemed like everything was shutting down and the world was just, like, shutting down," she said.
Beginning in March of 2020, Dr. Jasmine Johnson, a maternal fetal medicine fellow at UNC Health watched as her patients navigated the same responsibilities and challenges that accompanied motherhood pre-pandemic, along with shifting, far less intimate prenatal care restructures to avoid unnecessary exposure to COVID-19.
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"In addition to taking care of themselves and their pregnancy, they may have other children in the home, they may be working a full-time job, managing taking care of their parents, living in multi-generational homes," said Johnson. "When the pandemic hit, I didn't see those things change for our patients."
Aside from expectant mothers' heightened risk of severe illness from COVID-19, healthcare providers are naming intangible factors as perhaps the most pervasive among mothers: fear, anxiety, and isolation.
"The isolation that pregnant women, families, have had, in addition to everybody else, but I think they are particularly vulnerable, is a crisis that honestly I don't know that we're gonna fully know the total adverse effects because we've just not quite had enough time," said Cassandra Elder, CNM, City of Oaks Midwifery in Raleigh.
Elder said her office saw a spike in new patients during the early months of the pandemic; many of the women fearful that local hospitals would follow the lead of New York City hospital systems and ban support people in labor and delivery rooms.
"I cannot tell you the fear that that put into women," Elder said. "We were working really hard to provide reassurance that they would not be alone."
Bans on support people in labor and delivery rooms were never put in place locally, but providers said the regularly shifting guidance and restrictions continued to cultivate instability for expectant mothers as well as themselves, the ones patients turn to for reassurance.
"The unknown created a lot of fear in our patients and a lot of our providers too," said Johnson. "There was definitely a higher sense of anxiety across the board within the hospital community."
Where, pre-pandemic, entire families could accompany mom to her prenatal appointments, visitors were soon limited or restricted altogether.
At Elder's clinic, visitors are still banned during prenatal checkups where things don't always go as planned. In February, Elder had to accompany a patient to the hospital where it was confirmed she'd suffered a miscarriage.
"That's really, really scary for women, coming into ultrasounds by themselves," said Elder. "Because that's typically when a pregnancy loss, obviously, is diagnosed. And you go in, you're holding your breath anyway, wanting everything to be normal and most of the time it is, but when it's not, it's just so sad. It's just so sad."
Leak Wilson's husband, Shaun, was only allowed to accompany her to one prenatal appointment: a scheduled anatomy scan halfway through her pregnancy.
"Pregnancy is just a risky thing for the baby," said Leak Wilson. "It's risky for the mom and every appointment you want to get good news, but what if you don't, and you have those thoughts and that's not anything that you want to experience alone."
A BABY IS BORN
Fortunately, Leak Wilson, a nurse, was able to have her husband and mother with her, and was not alone when the big day arrived.
But even after all she'd done to stay safe, Leak Wilson found out as she was going into labor, that she'd recently cared for a patient who ended up testing positive for COVID-19.
"When I got to the hospital, I had to tell everybody I've had this COVID exposure," she said. "It was just exhausting and then you don't know what to expect. You don't want people to deliver your baby in hazmat suits. That's not what you envision."
The laboring mother had to undergo a COVID test swab in the midst of contractions, not knowing whether she would get to hold her baby when he was born.
"I reached the peak of my stress right before I had him that by the time I gave birth to him, I was literally relieved," she said.
TRACKING THE EFFECTS OF A PANDEMIC
As the country marks one year since the start of the pandemic, healthcare providers are waiting for conclusive data to provide a full picture of the effects COVID-19 has had on pregnancy outcomes.
What we do know is that going into the pandemic, racial disparities had already made a mark on North Carolina's infant mortality rate.
In their 2021 NC Child Health Report Card, NC Child and the North Carolina Institute of Medicine gave the state a failing grade in birth outcomes, with African American babies twice as likely as white babies to die before their first birthday.
"We are seeing what the rest of the country is seeing- so communities of color being more devastated, people of lower socio-economic status who are dependent on frontline jobs and aren't able to socially distance in a safer way," said Johnson.
Johnson said at UNC, researchers are looking at the effects revamping prenatal care during the pandemic has had on patients, particularly the shift to a telehealth model.
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"In order to have a telehealth visit you have to have a smart phone or cell phone with reliable cell service; you have to have access to the internet and that's not the case for everybody," said Johnson. "We just want to make sure we're not having blind spots and missing people with this new innovation in prenatal care."
JOY IN THE MIDST OF CHAOS
For all of the hardship the pandemic has wrought for pregnant and postpartum mothers, it has also provided room for some positive and welcomed change.
"Despite the pandemic, people are growing their families," said Johnson. "They're finding joy in the midst of all this suffering and chaos."
For many mothers, Johnson said telehealth visits have been more convenient than traveling to appointments, especially while caring for other children at home.
Before the pandemic, Elder said there would oftentimes be something like a wall between a mom and her partner while in the recovery room after their baby was born, as they constantly welcomed a barrage of visitors eager to meet their new baby.
"When that barrier was just gone- you got to see these families, these couples come together in a much more intimate way," she said.
Elder said she's seen her patients learn how to advocate for themselves and speak up when they're scared.
"Women are brave and they're amazing," said Elder. "And for a woman to birth: brave; in spite of it all, in spite of the fear, in spite of the loneliness."