Everything was ready for Arion Moore-Smith’s baby shower, set for April 4. The decorations, the caterer, the cake. Even the party favors had been made. At about 100 friends and family, it wasn’t going to be small. Moore-Smith, 29, had endured three miscarriages to get to this place: a healthy pregnancy with a month and a half left before her due date on April 30.
In professional “baby on board” photos taken before, she beams in a fuchsia gown that hugs her full belly and sets off her red-tipped hair. Moore-Smith had fought for the last eight months for a pregnancy that felt in her control — planning for her mother to be there at the birth, along with her husband, and to deliver naturally, without an epidural, working with a new doctor who she felt listened to her concerns, especially as a Black woman.
On March 13, Gov. John Bel Edwards banned gatherings of more than 250 people. Five days later, he banned gatherings of more than 50 people.
“And we were like, ‘Oh my God, 50 people, but it’s only the middle of March. Maybe it’ll change by the 4th,” Moore-Smith remembers. “Maybe it’ll, you know, die down.’”
Instead, the coronavirus entered the final weeks of her pregnancy as a new threat, dramatically shifting labor and delivery protocols in hospitals across the state and country, upending expectations and stripping much of the control away from expectant parents and putting it into the hands of hospital officials. Where Moore-Smith once had choices, the virus now dictated much of what would come.
“It really takes the power from you, knowing that all the things that you thought were gonna happen is out the window,” she said.
The doctor she had trusted to deliver her baby wasn’t there at the birth, thanks to new shift protocols at Ochsner Baptist medical center.
“Even getting through the pregnancy thus far, it still doesn’t take away the scary part of actually delivering,” she said. “We know the health outcomes of many women in the United States, especially minority women, Black women dying at a higher rate giving birth, and I was very afraid that that could happen.”
In the midst of contractions on April 23, she entered the hospital alone, “wheeled by whoever, I don’t know,” to the delivery room, while her husband was required to come in separately. No other family, including her mother, was allowed at the birth, something that she said left her frightened and without moral support when the pain grew, and sapped her resistance to an epidural. She wore a mask the entire labor, one that her husband at times lifted away from her mouth when she struggled for breath.
Moore-Smith’s baby boy, Aamari, was born healthy on April 24 at 10 p.m., but no other family was permitted to welcome him. Then the pandemic presented new struggles: At home, when Moore-Smith had trouble breastfeeding, there was no in-person consultation to help. She persisted and became one of the 69 percent of Black mothers nationally who breastfeed at birth, compared to 85 percent of white mothers (Louisiana’s breastfeeding rate is among the lowest in the nation).
And then came George Floyd’s killing. A few days after we talked, protests sprung up around the country against racism and police violence. Moore-Smith texted me to say she wanted to wear a T-shirt in her photo illustrating her new reality as a mother of a Black baby boy who would one day be a Black man in America.
“Witnessing the current state of the world, where a Black man’s life can be taken away so suddenly at the hands of someone who swore to protect and serve, shatters my heart in so many ways,” Moore-Smith texted. “The concept of that even happening to my little angel is unimaginable and all too overwhelming to express.”
Moore-Smith is a Christian. She wants to teach her son “how we should love our enemies and to trust God. But how can I teach him this in a world that doesn’t love him?”
“What I do know is I can’t let him be next. I can’t let my husband be next… I, myself don’t want to be next.”
Fear, Uncertainty and isolation compound anxiety in an already anxious time
There’s an innate incongruence in bringing new life into the world during the gaping stretch of a global pandemic. And pregnant women and new mothers in Louisiana say what the virus has stripped from all of us is being felt even more in the advent of birth: intimacy. Intimacy lost among a community hoping to celebrate an awaited baby, between mothers and daughters during labor, in families that would have otherwise swarmed a new parent’s home, bringing food or gifts and hoping to hold a tiny new human and touch their virgin skin.
What is already an anxious time has only been made more so by the uncertainty and stress of a virus we’re still trying to understand, and the sense that they can’t rely on others as they’d hoped.
Early in the pandemic, small studies indicated that COVID-19 doesn’t cross the placenta to harm the fetus, but fears of contagion isolated pregnant women in delivery wards across the country. In New York in March, hospitals considered forcing women to give birth without a single family member or friend. Doulas have been banned from many New Orleans hospitals during the pandemic, unless they’re the only support person. Masks are mandatory in some labor and delivery wards, as they were for Moore-Smith, and laboring people are told to enter the hospital alone, where they’re temperature-checked and screened for COVID-19. Protocols can shift swiftly, sometimes weekly, said Stephanie Visco, the manager of Birthmark Doula Collective. This month, Ochsner began letting doulas and a birth partner into the hospital, plus one visitor per day. At Tulane, infants born to COVID-19-positive mothers are isolated from their mothers to protect them from possible exposure and tested for the virus, and the CDC recommends that those mothers don’t breastfeed.
Women said the virus made them scared of giving birth — an event already fraught with uncertainty and risk. Marion Nicolai, a nurse at Tulane Medical Center, was already afraid of getting sick with the coronavirus, or her baby getting sick, before she found herself delivering in a room across the hall from a suspected COVID-19-postive patient at Touro on March 27. She was told no staff treating that patient would be assisting her, assured that the person was held in a negative pressure room, which limits viral spread.
She “freaked out” when she thought she’d be required to wear a mask during labor for this, her third child, she said.
“I cried a bunch,” she remembered. “Just like, ‘Oh my God, this is gonna be really hard.’”
But then a doctor told her the mask wouldn’t be required.
“By the time it was time to push, I had nothing left. I was just so worn out from the pain, but also just from the anxiety,” she said.
Arlo, her son, was born healthy, with a bit of a tug from the doctor, she said.
Mandi Cambre, who’s now over a week past her June 1 due date, was already having contractions in late-May.
“I’m just sort of physically and mentally exhausted at this point,” she said.
There are constant questions: “Am I safe? Is the baby safe?”
“I’ve almost had to kind of dissociate from my pregnancy and in a sense,” she said. “There’s so much stress and just so much fear about everything that’s happening right now, and so many questions that sometimes I just, I can’t think about the fact that I’m pregnant and having a child, because I’ll just be full of anxiety.”
Steph Bates, who’s due in a few weeks, said it was hard not to have her husband at prenatal appointments — many hospitals now won’t allow a partner for ultrasounds or to hear the fetal heartbeat. Like other new parents, they’re struggling with when to let grandparents visit their newborn daughter, when she arrives, given the dangers the virus poses to people over 60.
“When I first realized that maybe it wouldn’t be wise for my parents to come down as soon as the baby was born, I went from zero to 60,” she said. “I got home from the gynecologist and was kind of a mess.”
“I want her to meet her grandparents and I want them to meet her as soon as possible,” Bates said. “But I also want her to have her grandparents for a couple more decades.”
She also worries about being on maternity leave and not being able to let people into her house to help. But expecting a baby has also given her something to focus on, to look forward to, when so much of even the near future remains a fog.
“It was this one piece of certainty that I could track towards, and be like, OK, so we know that’s happening, and if we can backwards plan from there, we can like decide on a lot of other things,” she said.
Dr. Meghan Klavans, an OB-GYN at Ochsner, has helped a handful of pregnant patients with the coronavirus give birth, and she’s not seen any adverse effect for newborns. Still, an infant’s vulnerable immune system has doctors worried.
COVID-19-positive parents are encouraged — but not required — not to keep their baby in their rooms. Those that do are told to stay 6 feet away and pump breast milk rather than having their newborn on their bodies.
“The lack of conclusive information, I think, is probably the hardest thing for all patients and physicians as well,” she said.
The case rates of COVID-19-positive babies have been “extremely, extremely rare,” said Dr. Pooja Metha, an OB-GYN at the Louisiana State University Health Sciences Center in New Orleans. “It certainly does not seem to be the case that babies are at higher risk for getting COVID or getting it particularly easily.”
And even for those who’ve had the virus, “we definitely still encourage breastfeeding. We just talk about a lot of hand washing if you know you’ve had COVID, wearing a mask when you’re in close contact with the baby, if you’re no longer symptomatic, just taking really normal precautions, but babies need contact and physical touch,” she said.
Doulas are hamstrung — and worry outcomes will be worse for Black mothers
LSU Health Sciences Center has allowed both support partners and doulas at births, Dr. Mehta said, something that “really helps promote supported birth and helps people feel accompanied, and takes some of the stress of being in the hospital away and also has been shown to actually prevent outcomes like a C-section.”
Visco, who’s a doula herself, said the virus has disrupted much of what Birthmark Doula Collective strives to be: a physical, supportive presence in their client’s lives. And it’s been particularly hard on Black and low-income clients.
“Some of our clients don’t have access to the internet, some of them don’t have housing right now or reliable housing,” she said. “So some of our doulas have continued meeting clients in-person in a safe way, wearing masks or social distancing while meeting. And then our other doulas have switched to virtual meetings only.”
But Visco worries the virus will lead to worse outcomes for Black and low-income patients.
“With lagging triage times and less postpartum care and less, like, lactation support in hospitals, all of those are things that healthcare has said right now are not as important as working to really quickly assess and tamp down on the spread of coronavirus,” she said.
She’s seen less follow-up care in hospitals, less lactation consultation, less consistent blood pressure monitoring. Relationships built to try to address racial disparities through continuity of care have fallen away amid the eruption of the virus.
“It’s hard, I think, for us to really fault anybody because we know that the health care workers are stretched extraordinarily thin,” she said “But I think it’s frustrating.”
Their Black clients especially “know that they’re going into a hospital setting facing implicit bias from providers. And now they’re being rushed through triage, and rushed through their postpartum healing in a way, even more so than before. I think there are going to be long term implications of that.”
One client felt her doctor was pushing her towards being induced — which can increase cesarean sections and other neonatal complications — something Visco said she’s seen grow during the pandemic so physicians can be sure they’ll be available for their patient’s delivery. Instead, the woman ended up giving birth precariously in her car.
“As doulas, we want to be able to go into their house, clean their house for them, make them a meal, offer them a foot massage, draw a bath for them. All of those are things that we have to do in a very different way right now,” she said.
Jamilla Webb, a labor and delivery nurse in New Orleans, said the pandemic has “been scary for all of us. The thing that I’m most grateful about is that the mom does not have to be alone, or I should say the pregnant or birthing person does not have to be alone, that they can at least have one person with them.”
She’s worried about the virus’s toll on Black communities and the added stress that places on Black expecting parents. And she’s worried about the potential for another wave of an outbreak in the fall.
“I can’t protect him from everything”
Ahead of her labor, Moore-Smith feared that she wouldn’t be given enough attention by staff overwhelmed or preoccupied by the coronavirus. Would nurses or doctors be distracted?
“Because I was seemingly healthy,” she said, “would they still pay attention when stuff didn’t seem to be?”
But in recovery, the nurses stepped in where she had hoped her mother would be. They helped her begin to breastfeed and came anytime she was in pain. She and Aamari are safely at home now, the pandemic still churning, the protests ongoing, and her son’s future before her.
“As his mother, I want to nurture and protect him, but I can’t protect him from everything,” she said. “My prayer is that the world is now listening and embarking on change that will truly value life such as my son’s.”