Pregnant women throughout the country are taking their prenatal visits into their own hands as the COVID-19 pandemic changes the healthcare landscape. They’re stocking up on fetal dopplers, pee kits, and measuring tape as their doctor’s offices switch to telemedicine.
Kelly Keever’s doctor switched all her prenatal visits to virtual visits until she the third trimester, despite the fact that she was high risk with her first baby.
“I’m about to buy a pee kit and blood pressure gauge on Amazon because I feel personally responsible for tracking everything now,” says the Portland woman. “It’s totally scary, but I just have to make sure my baby is moving and know who to call if I get any indication that something is wrong.”
It’s happening across the country.
The American College of Obstetrics and Gynecology has provided suggestions for ways that OB-GYNs can provide alternate prenatal care for some visits, including conducting some as televisits, and consolidating tests in others, while the Department of Health and Human Services has waived HIPAA penalties for healthcare providers using FaceTime and Skype to conduct televisits.
Britney Trinidad, of Massachusetts, says her OB changed her prenatal visits to phone calls, even though she’s 34 weeks pregnant. Trinidad is worried that she’s close to her due date, but no one is checking her dilation.
These telemedicine visits aren’t universal... yet.
In Connecticut, for example, most obstetricians are keeping their offices open for prenatal visits though routine annual gynecological exams are on hold, says Mary Jane Minkin, M.D., a clinical professor of OB-GYN at Yale University.
Still, Minkin did offer some tips for women whose doctors have already switched over to telemedicine.
First, pay attention to the basics, she advises.
Keep An Eye On Fetal Movement
While fetal activity (movement) slows as you get toward term, you should notice if there’s a significant decrease in movement.
Quick fixes involve drinking some sweet fluids like orange juice and lying on your left side.
“If that doesn’t perk up activity, that needs an immediate call to your OB group,” Minkin says. “And even if that does work, do alert your care providers.”
If you have a fetal heart rate monitor, the heart rate should be between 110 and 160 beats per minute, but make sure you listen to it for a few minutes rather than just putting the doppler on your belly for a few seconds, Minkin says.
Listen To Your Body
Next, you need to listen to your body and watch for signs of toxemia (pre-eclampsia).
If you get a significant headache which doesn’t get better with extra fluids and Tylenol, call your doctor stat, she says.
You may also want to purchase a few tools.
Having an at home blood pressure monitor is a good idea. If your blood pressure scoots up, lie on your left side and drink lots of fluids.
“Certainly, anything of 140/90 or above needs notification to your provider,” Minkin says. “But if you are someone who usually runs 110/70 and your blood pressure is now 130/85 or more, do let your provider know.”
Chart Your Baby's Growth In Utero
In order to measure the size of your baby, you’ll need a tape measure. If you’re lying on your back (which is fine for a few minutes), feel for your pubic bone and then feel up to the top of your uterus (the uterine fundus), Minkin says. The distance from the pubic bone to the top of the fundus in general measures about 1 cm per week, so a metric tape measure is easiest to use.
If you feel that your uterus isn’t growing, give your doctor a call, Minkin says.
While these tools will help, it’s important that only low-risk patients switch to telemedicine - and this should be done in lieu of only some appointments, says Shieva Ghofrany, M.D., an OB-GYN at Coastal Obstetrics.
This means the woman should have no history of hypertension, diabetes, stillbirth, placental abnormalities, preterm deliveries and preeclampsia.
And even if the woman is deemed low risk, she should only do her 16, 24, 30, and 34-week visits over telehealth, Ghofrany says.
As for the other appointments? These are essential and need to be done in the office, Ghofrany says.
The Prenatal Visits You Need To Keep
At the initial 8-week appointment, the doctor checks for the fetal heartbeat and measures the fetus to determine the due date (this is the time when it’s most accurate), Ghofrany says.
At 12 weeks, there’s the nuchal translucency sonogram to rule out chromosomal abnormalities and certain birth defects. Then at 18-20 weeks, there’s the anatomy ultrasound. At 26-28 weeks, there’s the test for gestational diabetes, and at 32 weeks, some women need a sonogram to evaluate the growth of the baby. At 36 weeks is a culture for the GBS bacteria, and at every week after 37 weeks, it’s important to be seen to evaluate the baby’s wellbeing and blood pressure of the mother.
“I am currently working on a pregnancy kit that would include a few items that low-risk patients can use during a telehealth visit to confirm that she is continuing as is expected,” Ghofrany says.
At Michigan Medicine, for example, in-person prenatal care is now only available for the initial visit, an anatomy ultrasound, plus the 28, 36 and 39-week visits. All lab work will be conducted during those visits, and the doctors are recommending that the patients use at-home doppler devices, blood pressure cuffs and scales.
Finally, all those years of playing doctor are paying dividends.
Mary Jane Minkin, M.D., clinical professor of OB-GYN at Yale University
Shieva Ghofrany, M.D., OB-GYN at Coastal Obstetrics
If you think you’re showing symptoms of the coronavirus, which include fever, shortness of breath, and cough, call your doctor before going to get tested. If you’re anxious about the virus’s spread in your community, visit the CDC for up-to-date information and resources, or seek out mental health support. You can find all of Romper’s parents + coronavirus coverage here, and Bustle’s constantly updated, general “what to know about coronavirus” here.