Early on Sunday, March 22nd, Lauren Pelz got a text from a friend who’d heard that the NewYork-Presbyterian (N.Y.P.) hospital network had decided to bar partners from accompanying women in labor, due to concerns about the spread of COVID-19. It was the day before Pelz was scheduled to be induced to deliver her second child at N.Y.P. Lower Manhattan Hospital. She searched the hospital’s Web site and Twitter feed for news about the change in policy, but found nothing. She tried calling her obstetrician but couldn’t reach her. Hours later, her husband, Matthew, got through to someone on the hospital hotline, who confirmed that he would not be allowed to attend the birth of his daughter.
Pelz, a corporate event planner, spent the rest of the day crying. She considered cancelling the induction, which her doctor had recommended because she is thirty-nine and had some complications with her pregnancy, but she was also mindful that local hospitals were about to be inundated with coronavirus patients. “We just wanted to have the baby as quickly as possible and get back home safely,” she said. So, at 8 p.m. on Monday night, her husband brought her as far as the hospital lobby, hugged her tight, and told her not to worry. “You’ve got this. You’ve done this before,” he said. He watched as a security guard led his sobbing wife to the maternity ward, where she immediately received a mask. Once Pelz was settled in her room, a nurse swabbed her nose to test for COVID-19.
Through the night, Pelz was aware that the ward was short-staffed—several nurses were out sick. She tried to limit how often she asked for water or made other requests; for several hours, the hospital halted her drip of Pitocin, the medication used to induce her labor, because no staff were available to track her progress. All the while, Matthew was visible via FaceTime on an iPad at her bedside. Pelz found it difficult to breathe through her contractions under her mask; by late morning, after her COVID-19 test came back negative, she was permitted to remove it. Her obstetrician and a physician assistant coached her through ninety minutes of pushing, and Pelz delivered her daughter just before 1 p.m. on Tuesday. When the doctor put the baby on her chest, Pelz began crying again, overwhelmed by the bittersweet experience of greeting her daughter, Skylar Lucille, alone.
Pelz was one of the first women in the city to labor without a partner after both the N.Y.P. hospital network and the Mount Sinai Health System—which together see more than twenty-five hundred deliveries a year—announced the banning of all visitors for obstetric patients last Monday. Now it looks as if she may have been among the last. In the chaotic days following the N.Y.P. and Mount Sinai announcements, many expectant mothers began leaving town, seeking home births, or showing up in active labor at city hospitals, where partners were still allowed. But, on Saturday, Governor Andrew Cuomo caught many hospital officials off guard by issuing an executive order mandating that all maternity units allow women to have one asymptomatic partner during labor and delivery. All labor-and-delivery (L. & D.) units will have to screen visitors for COVID-19 symptoms and conduct temperature checks every twelve hours. Hospitals are asked to provide partners with masks from their dwindling supply.
“I’m elated,” Georges Sylvestre, an obstetrician who specializes in high-risk pregnancies at N.Y.P.-Weill Cornell Medicine in Manhattan, told me after Cuomo’s decree. Forcing women to labor alone seemed “harsh,” Sylvestre said, and many medical staff were uncomfortable with the rule. But he also understood his hospital’s position. The virus is both unpredictable and extremely contagious, he said, and the presence of even one extra person on the unit increases the risk of transmission, particularly as there is so little personal protective equipment (P.P.E.) to go around. “You don’t want to have the partner who gives a healthy newborn COVID, never mind the staff,” Sylvestre said.
In New York, the national epicenter of the COVID-19 pandemic, Governor Cuomo has asked for all elective surgery to be cancelled. Oncologists are deferring and revising cancer treatments, and fertility specialists have halted in-vitro-fertilization cycles. As the state’s coronavirus cases double every four days, health officials are working to limit the spread of infection and reduce other demands on hospital beds. But childbirth is not easily postponed, and the delivery of maternal health care amid this crisis differs considerably from hospital to hospital, and sometimes from hour to hour. “I’m at ease for now,” Sylvestre said, “but no one really knows what will happen next week.”
The impact of COVID-19 on pregnant women and infants is not yet well known, which helps explain the conflict and confusion. The initial news had been reassuring: research from China showed that pregnant women who tested positive for the virus did not transmit it to their babies, and all had good outcomes. But the study included a mere nine women, all of whom had only mild symptoms. A more recent study, of forty-one pregnant women with COVID-19, found that they had a higher risk of miscarriage, preterm birth, and preëclampsia (along with a higher rate of C-section), particularly if they had been hospitalized for pneumonia. “I’ve never been so dependent on such shaky data to make what are fundamentally life-or-death decisions,” Neel Shah, an assistant obstetrics professor at Harvard, told me.
The messages new mothers are receiving are therefore jumbled. Hyein DeGannes, a thirty-six-year-old Mandarin teacher at a Brooklyn charter school, is another woman whose delivery date fell in the week between the private hospital ban on birth partners and Governor Cuomo’s reversal. She gave birth to her daughter, Keanu, on March 25th, at Mount Sinai West, while her husband, Randy, stayed at home with their older child. The next morning, the COVID-19 test DeGannes had taken when she was admitted came back positive, and she and her daughter were moved to a quarantine room with another sick mother, where visits from nurses were infrequent. She received contradictory instructions about how to care for Keanu, who tested negative. A doctor told her to pump and dump her breast milk for two weeks and give her daughter formula in the meantime. A doula friend said she should go ahead and breastfeed, but with a mask on.
N.Y.P.’s decision to ban partners was informed by two cases involving women who arrived at an N.Y.P. hospital with no coronavirus symptoms; after giving birth, both showed severe signs of COVID-19 and needed days in intensive-care units. What alarmed the hospital was not only the speed at which the women’s health deteriorated but also that they went untested until they developed symptoms. Before their diagnoses, they came into contact with an estimated total of at least thirty health-care workers, all of whom lacked P.P.E.
“Having partner support is essential for labor,” Jesse Pournaras, a doula who launched a Change.org petition protesting the ban on partners, said. (The petition received more than 613,000 signatures before she closed it on Saturday.) She pointed to studies showing that women who deliver without a companion are at greater risk of complications during and after birth. But not all obstetrics staff are delighted by the reversal of the policy. “We have too many health-care workers sick in hospitals, and quite a few on ventilators,” Sascha James-Conterelli, the president of the New York State Association of Licensed Midwives, said. Many providers are “scared to death,” she said, especially if they live with older or immunocompromised people; eight nurses and four obstetricians in the Mount Sinai system are infected, and one postpartum nurse recently died from COVID-19. James-Conterelli told me that she has been hearing too many stories of fathers lying about their symptoms so they can witness their child’s birth, and not every hospital has the staff to keep checking the temperatures of non-patients. One L. & D. nurse at Maimonides, a private hospital in Borough Park, recently posted on Facebook that some partners are still being sent away if couples arrive during the night shift, when hospitals tend to be particularly short-staffed. A compromise that some city hospitals are striking, James-Conterelli said, is to bar partners from labor—which is often long and unpredictable—but call them in for the birth itself.
