In the last weeks before Melissa Motzkin gave birth, everything was changing rapidly.

With the number of coronavirus cases growing in Maine, hospitals were limiting visitors and telling women to come to appointments without their partners. Motzkin heard stories of women being forced to give birth alone and was so terrified she would have to do the same that she talked to a midwife about delivering at home so her husband could be there.

“We had our minds set on this window of a week for almost a year,” she said. “To have it fall right in the middle of this time, you think how could it possibly be now?”

The coronavirus pandemic has changed just about everything about giving birth.

The arrival of new babies is still a time of great joy, but parents say there is also a sadness as celebrations like baby showers are canceled or moved online. Many mothers are going alone to prenatal appointments and parents are isolating for weeks at home before their due date to limit their exposure to the virus. Grandparents aren’t able to hold their new grandchildren as newborns.

While experiencing that mix of anticipation and sadness, expecting parents are also dealing with the anxiety of keeping up to date on changing hospital policies, including limited access, protective equipment requirements and the possibility that a mother will be separated from her newborn if she’s infected with COVID-19 when she gives birth.

In Maine, some women have scheduled inductions and are staying for shorter times at hospitals, while other pregnant women are talking to midwives about giving birth at home so they can avoid hospitals entirely.

In the first weeks of the pandemic, some hospitals in the United States – but none in Maine – barred all visitors from the delivery room, including fathers. Most hospitals now allow one person to be with a pregnant woman, but no other visitors are allowed. Hospitals also require incoming patients to have their temperature taken and symptoms screened before they are admitted.

Dr. Elizabeth Gittinger, lead physician at Northern Light Mercy Women’s Health, said medical providers are doing their best “to maintain as much normalcy as we can in a world that is not normal right now,” but acknowledged it is an especially challenging and emotional time for parents welcoming new babies.

“The social isolation has been stressful and exhausting and challenging. For many moms, they aren’t having baby showers. They’re losing those momentous occasions you’re supposed to have when you’re having a baby,” she said. “Everyone is doing the best they can and understands, but it’s a loss. There’s a mourning process and there’s anxiety about what’s going to happen over the next few weeks and months.”

Alayna Marchessault, a 33-year-old doula from Portland, has been looking forward to being a mom her entire life. She’s expecting her first child in June and this is not how she imagined her last trimester or the arrival for her baby. She plans to give birth at home with her husband, Steven, but knows she will probably not have her extended family with her in the days and weeks after.

“This is a lesson in letting go,” she said. “This is a really valuable lesson to learn when you are expecting children. I’m trying to learn to let go and move forward in a safe way.”

FEW BABIES TEST POSITIVE

Since the start of the coronavirus outbreak, Maine hospitals have limited visitors, increased the use of personal protective equipment and screened people for symptoms as they arrive. All of those policies also apply in maternity departments, where medical providers say they are focused on providing positive birth experiences despite the pandemic.

The U.S. Centers for Disease Control and Prevention says it does not appear pregnant women are at greater risk of contracting COVID-19 than adults who are not pregnant. A study released earlier this month in the American Journal of Obstetrics & Gynecology MFM found that women are unlikely to suffer more severe effects than anyone else from COVID-19, but scientists are still doing research.

Mother-to-child transmission during pregnancy is unlikely, but after birth a newborn is susceptible to person-to-person spread, according to the federal CDC, which reports a “very small number” of babies have tested positive for the virus shortly after birth. It is unknown if those babies got the virus before or after birth. The virus has not been detected in amniotic fluid or breast milk, according to the CDC.

Since early April, the CDC has been advising that anyone, including pregnant women, cover their nose and face with a cloth mask when in public. At both Maine Medical Center and Mercy Hospital in Portland, women and their partners are asked to wear masks at all times, even during labor and delivery.

Because of strict limitations, parents can have no visitors during their hospital stay. That also means mothers can’t have an extra support person such as a doula with them during labor. A doula is a person employed to provide support and guidance through the process, but is a not medical professional.

Maine Medical Center and other facilities in the MaineHealth network have prioritized allowing women to have one support person with them while they are delivering, said Dr. Elisabeth Erekson, who chairs the obstetrics and gynecology department at Maine Medical Center. When they arrive at the hospital, they are screened for fever and other coronavirus symptom before being taken to the maternity wing.

Women with coronavirus symptoms stay in a separate area from women who do not have symptoms. Erekson said if a pregnant woman is showing symptoms, doctors and the parents start to have conversations about what to do after birth. Together, they decide to either separate the mother and baby, or to stay in the same room and follow physical distancing guidelines from the CDC, she said.

Maine Medical Center will not disclose whether any women with coronavirus have given birth there to protect patient privacy, according to a hospital spokeswoman.

Mercy Hospital has not had a pregnant patient with coronavirus, but doctors and nurses have increased the use of PPE in the delivery room, according to Gittinger. During delivery, doctors and nurses now wear face shields, masks and gowns instead of just gloves.

Gittinger said the hospital has seen an increase in women scheduling inductions, including four within 48 hours this past week. People want to get in and through the process as quickly as possible so they can get back home, she said.

At both Portland hospitals, women are staying for shorter amounts of time after giving birth because they’re eager to get home.

Dr. Corrie Anderson, an ob-gym at Mercy Women’s Health, has seen those changes both as a doctor and a patient. She delivered her second son, Theodore, on April 15 at Mercy and went home 24 hours later.

“It was really a time for just the three of us to work on skin-to-skin and breast feeding. I’ve been encouraging my patients to think about it from that perspective, but I know that’s hard. Not everyone has that. They’re really grieving the loss of a mother or support person outside of their partner,” Anderson said.

Despite the coronavirus, Anderson said pregnant women should still feel safe going to the hospital to deliver their babies and to see their doctors for follow-up care, especially to treat postpartum depression amid growing concerns that isolating will make women even more vulnerable.

“Postpartum is the time women need their community around them,” Anderson said. “That’s the time I fear will be hardest for women who are isolated.”

MIDWIVES GETTING MORE CALLS

Melissa Briggs of Bayside Midwifery says she and other midwives across Maine have had an influx of calls from women exploring the idea of having a home birth rather than go to a hospital during a pandemic. About 200 babies are born at home each year in Maine, while more than 12,000 are born in hospitals or birth centers, according to the Maine Center for Disease Control and Prevention.

“Right now, the biggest consideration is not having the support team they want for the birth and not wanting to birth in a facility with active cases,” Briggs said of the women inquiring about switching to home births.

Doctors at Maine Med and Mercy say they have not seen patients decide to switch from planned hospital deliveries to home births.

Midwives are also making adjustments to protect themselves and patients from exposure and to adhere to physical distancing standards. Briggs is now wearing masks, washing her hands more often and asking siblings to stay in another part of the house when she makes home visits to patients. During birth, no more than five people can be in the house and Briggs asks them all to self-quarantine ahead of time.

“We’ve had to step back from being so intimate and personal with our clients,” she said.

When Brittany Harty, 26, of Naples gave birth to her daughter Marlo at home in Naples on March 30, she did not have her two best friends and a birth photographer with her as she had planned because she felt it was too risky. Instead, it was just Harty, her husband, Rius Coles, and Briggs.

Harty said she was nervous about the coronavirus as she neared the end of her pregnancy because it was becoming more of an issue and there were so many unknowns.

“It’s hard to tell your body to relax and open up when you don’t feel like the outside world is a safer place than your womb,” she said.

Harty said she never imagined her postpartum period would be marked by isolation instead of visits from family and friends.

“It’s really sad for our family and friends,” she said. “They were so excited to meet her. The fresh newborn phase doesn’t last long and you can’t get it back.”

Marchessault, the Portland woman expecting her baby in June, has always planned for a home birth if possible, and is especially glad now for that plan. But she is also preparing herself for the reality that she would have to deliver in the hospital without her midwife if she does contract COVID-19 or has symptoms during labor.

“If I can be at home and not expose myself to the virus, I’m so happy,” she said. “I don’t want COVID-19 to be the thing that takes away my home birth.”

Marchessault, a planner by nature, has been deep-cleaning her house and cooking and freezing food because her family won’t be able to come help with those things after birth. She hopes by the time her baby has arrived she’ll be able to see her family, but if not she plans to show them the baby outside.

“It’s so precious to welcome a new family member and this new person we’ve been anticipating long before we heard about the coronavirus,” she said. “It’s heartbreaking, but we want to do what’s right by everyone.”

THE SAFEST PLACE

For weeks before Motzkin gave birth, she and her husband, Jonathan, had been isolating at home in Cape Elizabeth with their 4-year-old daughter, Isla. They had groceries delivered and only left home to walk the dog and play in their yard.

When, Motzkin, 38, went into labor, they had to let their guard down twice: first to let her mother into their house to care for Isla and again when she and her husband arrived at Mercy with masks on their faces.

“To let that guard down and walk into a medical facility was strange,” she said.

But with the hospital used only as a birth center right now, they soon felt like it was the safest place in Portland and welcoming their son there was a “lovely” experience, she said. They stayed for two days after Arlo was born on April 2.

“We were in this little cocoon and didn’t see anyone else,” Motzkin said. “Leaving and taking him back out into the world was surreal and brought back all of those feelings of ‘Is this safe?’ ‘What are we going into?'”

Now tucked back in at home for three weeks, Motzkin and her family are thankful for their health, their yard and the time they are spending together as a family of four. But there has been a roller coaster of emotions.

“People keep saying to me that this time will go down in history as a great birth story for Arlo. And I keep hearing myself respond that I just hope this is a novel concept in the story of my kids’ lives,” she said. “Because in the end, my real fear is that this is going to be their normal, and that feels really hard to accept.”

Motzkin said one of the most difficult things to deal with has been the physical separation from her family, especially her mother, who can’t hold her grandson.

“That’s really hard and that’s really sad. Every day we wonder are we making the right decision by upholding this separation. This is a moment in time that we’re never going to get back. It feels like a great loss not to share this with family that’s nearby. It’s so hard to know how long this will last, how long we will have to hold out. It’s a very confusing space to be in,” she said.

“On the other hand, there is some serenity in the quiet. Our expectations have been adjusted very quickly. We’re not expecting anybody or anything. We’ve settled into the quiet. We’re not overextending ourselves. It’s very much our family being together and in a way that’s an unexpected silver lining.”

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