These changes are leaving health care providers, industry associations and patients reeling as they try to make informed decisions. “It’s changing day by day,” said Thorild Urdal, a nurse in the San Francisco Bay Area with almost 35 years of experience in labor and delivery.
Coronavirus is straining a U.S. health care system that, for years, has had the worst maternal mortality rate in the developed world. In 2007, 12.7 of every 100,000 women died during pregnancy, labor or within 42 days of giving birth, the measurement set by the World Health Organization. In 2018, that number had risen to 17.4 deaths per 100,000, according to data from the Centers for Disease Control and Prevention.
Health outcomes are even worse for women of color, especially black mothers, with C.D.C. data showing that in 2018, black mothers died at twice the rate of white mothers. Other studies suggest that the C.D.C.’s numbers are conservative, and that black mothers are dying at 3.3 times the rate of white mothers.
With this kind of maternal health baseline, many birth workers are concerned that efforts to contain the coronavirus pandemic will have unintended consequences on mothers and infants that will only become visible after the pandemic ends.
Meanwhile, hospitals are struggling to keep up.
Last week, the Permanente Medical Group, Kaiser Permanente’s Northern California network, which collectively delivers 45,000 babies a year, became the first major hospital group to offer induced labor to women at 39 weeks, which is considered a full-term pregnancy, or offer earlier dates for women with already-scheduled inductions. Typically, it is only offered for medical reasons at 39 weeks.
The network is intentionally “trying to get patients delivered before this pandemic gets worse, as long as they are past 39 weeks,” said Dr. Amanda Williams, the head of ob-gyn at Kaiser Permanente Oakland in California. That way, they can “get delivered and get back home before they get sick, their partner gets sick and staff gets constricted.”
“We cannot force anyone to have an induction,” Williams added, “but we can very strongly recommend it if this continues to get worse.”