What to Expect for Prenatal Care During COVID-19

There are a lot of questions about what prenatal care will look like in the coming weeks and months and which visits can be safely adapted to virtual care or spaced out. We'll break them down for you here.

 By Annie Gabillet, Cleo

If you or your partner is pregnant or planning to be, COVID-19 will change the map of prenatal care. There are a lot of questions about what prenatal care will look like in the coming weeks and months and which visits can be safely adapted to virtual care or spaced out. The reality is that doctors and midwives can effectively deliver many aspects of prenatal education and screenings through telemedicine, while other aspects really can only be conducted in person.  

If your pregnancy is low-risk, here is a summary of what you can likely expect your prenatal care to look like. Remember that this plan is always made in collaboration with your doctor or midwife, and you can request shifts and changes to help you feel as safe and reassured as possible during this very strange time.  

These prenatal care events are likely to remain in-person:

• Early ultrasound: This establishes that there is a pregnancy implanted in the correct location and growing as we would expect. Depending on the gestational age, you will see the beginnings of a heart beat and confirm your due date. While not all institutions are continuing with this, if your provider is, it may be done in their office or at another facility.  
• OB labs: These check for blood type, infections, diabetes, anemia, and more. These labs are done on every person when they start prenatal care and can be ordered remotely and done at a blood draw laboratory. Grouping these labs by trimester is a good practice so you only go to the lab a few times in the course of a pregnancy. For diabetes screening in the third trimester, we’re seeing many OB providers ordering shorter versions of the test to limit time people have to spend at the lab. 
• Genetic screening: Most practices are shifting to remote consultations with genetic counselors and high risk obstetricians, rather than face-to-face meetings. There is also a trend to do more of the first trimester blood-draw screening (NIPT) and less of the nuchal translucency (NT) ultrasound, but in certain situations an NT is important. It is okay to ask what combination of genetic screening options makes sense for you based on how much information you need or want. When confirmatory testing is either recommended or is something you desire, the two options are chorionic villus sampling or amniocentesis, and these are procedures that would take place in person. 
• Anatomy ultrasound: This scan is typically done at 18-20 weeks and looks at all the parts of the fetus’ body and the position of the placenta. In the US, it is considered one of the most important in-person visits, and there really isn’t a substitute for it.  
• Vaccines and other shots: The vaccines that are recommended in pregnancy include the flu vaccine (influenza) in the first trimester, and the TDaP vaccine (pertussis) in the third trimester. The flu vaccine in particular is more important as ever, as it is known that influenza hits pregnant people really hard and weakens the immune system. If your blood type is Rh negative, it is still important to get a RhoGAM shot around 28 weeks and any time vaginal bleeding occurs. 
• Group B strep test: The Group B Strep test must be done in person and will be included as part of a routine visit around 36 weeks.  
• Antenatal non-stress testing (NSTs): Weekly or twice weekly listening of the fetus’ heartbeat is an important screening for pregnant folks with high risk conditions. Expect to be at your clinic or hospital for about an hour, which includes 20-30 minutes of fetal monitoring and an ultrasound to check the amniotic fluid level.  
• Regular prenatal visits for high-risk pregnancies: We’re seeing a lot of variability here, but it is recommended that folks with the highest risk pregnancies continue to be seen in-person, particularly for folks with issues related to blood pressure or diabetes.

These prenatal care events may be canceled, converted to virtual, or rescheduled:

• Low-risk prenatal visits: There’s a huge range of how these schedules are getting spaced out or switched to virtual. Some places are doing visits every six weeks instead of every four, while others are continuing the regular schedule, but offering video or phone only.  
• Group visits: Unfortunately, group prenatal care doesn't make sense in the current climate. We have heard of some folks getting to continue these groups online, and finding it incredibly helpful to stay connected to other expectant parents.
• Hospital tours and in-person prenatal classes: These have been canceled across the board. We’re also seeing most amazing birth prep groups offering virtual “community” classes. This is a great idea, as it is more important than ever to feel prepared for a birth in a changing landscape.

How you can adapt to virtual prenatal care: 

• Monitoring blood pressure and weight: If your practice ends up administering some of your prenatal care virtually, it may be wise to order an at-home blood pressure cuff and body weight scale to check your blood pressure and weight, respectively, before each visit. Ask your doctor or midwife how often you should be checking these measurements as part of your care and when they would want to hear from you in case your numbers are abnormal. As always, follow your instincts if you have any unexpected symptoms or concerns.
• Listening to your baby: More and more people are asking about buying “dopplers,” which are ultrasonic devices used to listen to a fetus’ heartbeat. While this can be reassuring for some, the dopplers you can buy online are not really medical grade, and without training in how to locate a fetal heartbeat, it can be hard to hear correctly. That can lead to a lot of unnecessary anxiety for expectant parents. The reality is that the best indication of fetal well-being is feeling fetal movements daily starting at about 24 weeks.

Additional COVID-19 resources for pregnant people:

This public health crisis is a fast-moving situation, so you want to stay in regular communication with your care provider. Here are other resources that can also help keep you informed: 

• COVID-19 Patient Resources from the American College of Obstetricians and Gynecologists
• CDC Pregnancy and Breastfeeding Guidance

This article was originally published by our friends at Cleo. Cleo aims to give the most accurate information about COVID-19, but details and recommendations about this pandemic may have changed since this story was published. For the latest information, please check out resources from the WHO, CDC, and local public health departments.