When Ansley Bechtolt realized she was in labor at 12:50 a.m. on March 26, her husband dropped her off at the Family Maternity Center at EvergreenHealth in Kirkland and drove home to be with their three other children.

She would have preferred to have her husband with her at the hospital, but that wasn’t an option. Just two weeks earlier Evergreen had found itself at the center of the nation’s novel coronavirus outbreak. The hospital had 65 patients diagnosed with COVID-19 and 15 deaths due to the illness within a 12-day span. Thereafter, Evergreen enacted new policies that limited each delivering mother to one support person.

So Bechtolt, a Bellevue resident, had to go it alone because her husband had to take care of their other children. To cope with the pain of her contractions, she leaned with her head pressed against the chest of a nurse she barely knew. Sometimes, she said, the nurses seemed understandably wary and standoffish about such contact.

This was not the birth story she’d imagined nine months ago, but with a pandemic spreading around the world, it’s the birth she got.

As COVID-19 spreads, many pregnant people find themselves isolated from family and friends, cut off from certain perinatal support resources, and navigating uncertainty and fear as health professionals adjust prenatal practice and hospitals adapt their policies in light of the global crisis.

That babies continue to be born represents a sliver of hope at a time when the U.S. now has the most diagnosed COVID-19 cases in the world, and cities like New York are burying people in mass graves.

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But for those bearing these new lives into the world, giving birth in a pandemic is a terrifying task, full of unprecedented new challenges and uncertainty during what is already one of the most challenging of life’s milestone events.

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“It definitely takes away from the experience I thought I’d have”

After losing her last pregnancy to a miscarriage, Allie Johnson, 32, struggled to get pregnant again. Now five months along and finally past the riskiest early months of pregnancy, she had hoped to celebrate the milestone with family and friends. Instead, she finds herself isolated and her anxiety renewed as COVID-19 presents new worries for her pregnancy.

Pandemic has changed everything about the experience of pregnancy and new parenthood, from the first trimester through the postpartum period, and it has burdened parents-to-be with several new difficult decisions to make as they grow their families.

At hospitals that allow only one support person, some pregnant people have to choose from among their partners, family and doulas. Many are opting for early inductions or C-sections. Others have switched to home births or birth centers out of fear of contracting COVID-19 at a hospital. Those who test positive for COVID-19 may have to decide whether to follow CDC recommendations and be separated from their newborns — or to stay with their infants and risk spreading the disease to them.

As the executive director of Perinatal Support Washington, a nonprofit that provides mental health support during pregnancy and the postpartum period, Johnson is familiar with many of the resources available in Washington for expecting families.

However, even Johnson has experimented with different coping strategies as she mourns the loss of the family-filled, celebratory pregnancy she’d envisioned after trying for so long to conceive.

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New parents cope best if their experience matches up with their expectations, Johnson says, so managing expectations is an important way for them to support their mental health during the perinatal experience.

But: “The kicker, of course, during a pandemic, is that it’s hard to make plans that you can keep, to be ready when you’re constantly adjusting your expectations,” Johnson said.

Le’Jayah Washington, whose first child is due Aug. 21, is concerned about receiving quality care during childbirth and also worried that maternal mortality outcomes for Black women might be worsened as COVID-19 stresses the health care system. “It feels like I have to be very, very, very cautious,” she says. “It definitely takes away from the experience I thought I’d have.” (Erika Schultz / The Seattle Times)
Le’Jayah Washington, whose first child is due Aug. 21, is concerned about receiving quality care during childbirth and also worried that maternal mortality outcomes for Black women might be worsened as COVID-19 stresses the health care system. “It feels like I have to be very, very, very cautious,” she says. “It definitely takes away from the experience I thought I’d have.” (Erika Schultz / The Seattle Times)

Le’Jayah Washington and her boyfriend hadn’t planned on having a baby right now, certainly not during a pandemic. Now, as the virus continues its spread, Washington is 21 weeks pregnant with her first child.

Just entering her second trimester, Washington should be enjoying a fresh burst of energy and a reprieve from first trimester symptoms. Instead, while she physically feels better, the pandemic has added new troubles. She’s seen a severe reduction in hours in her job as a childcare provider, and because of social distancing guidelines and new hospital policies, she is going to prenatal appointments alone.

“I don’t really want to do all of this alone,” Washington said, adding that several experiences with her OB/GYN have her worried that the country’s high maternal mortality rates for Black women may worsen at a time when health care workers are dealing with a pandemic. (According to the Centers for Disease Control’s National Vital Health Statistics Reports released in 2020, Black women die in childbirth at more than twice the rate of white women in the U.S.)

After her doctor forgot about a prescription she had written for her, and reordered a test that had already been done, Washington began looking for a doula to help her advocate for herself in pregnancy.

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“I’ve heard a lot of stories about how women, especially Black women, don’t get the best care. I don’t want anything to happen to me and I don’t want anything to happen to my baby,” she said.

Washington and Johnson are both due in August, and they’re hoping that by then the situation will have improved and they’ll be allowed to have their families around as they deliver their babies.

But those who are further along in their pregnancies don’t have a choice. Births can’t be postponed, so they will deliver in these strange, uncertain circumstances.

“I can’t change anything right now”

Due in June, Jessica Speigel is carrying a baby with a rare heart defect. With hospital policies continually evolving, she’s not sure what her delivery day will look like — which is stressful in itself. She only knows that her baby will need special care at a time when hospital staff nationwide are stressed and resources are scarce.

Speigel has had to quell occasional panic attacks, by staying off social media and minimizing how many personal stories she reads about people who have contracted COVID-19. But there are some concerns she can’t work around. While many midwives and doctors have cut back on prenatal visits or are holding appointments virtually, Speigel still has to make regular trips to an obstetric specialist because of her baby’s heart defect.

Jessica Speigel, photographed at 31 weeks, shows a rainbow sweater she is knitting for her baby at her home in Seattle. While en route to her 20-week exam, she saw a rainbow and hoped it would be good luck. At the appointment, she learned her child has Ebstein’s anomaly, a rare heart defect that puts the baby in a high-risk category. However, she also found out the baby has a good prognosis. “When I saw that yarn, it reminded me that the rainbow was a good sign after all, so I made it into a tiny sweater,” she says.  (Erika Schultz / The Seattle Times)
Jessica Speigel, photographed at 31 weeks, shows a rainbow sweater she is knitting for her baby at her home in Seattle. While en route to her 20-week exam, she saw a rainbow and hoped it would be good luck. At the appointment, she learned her child has Ebstein’s anomaly, a rare heart defect that puts the baby in a high-risk category. However, she also found out the baby has a good prognosis. “When I saw that yarn, it reminded me that the rainbow was a good sign after all, so I made it into a tiny sweater,” she says. (Erika Schultz / The Seattle Times)

“It’s so nerve-wracking going out of the house,” she said. “I don’t want to get out of the car. I don’t want to get in the elevator with another person.”

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And while other parents have the option of switching to home births with midwives if they’re worried about exposure to COVID-19 at hospitals, Speigel’s high-risk pregnancy means she has to deliver at a hospital.

“Yeah, it sucks to be pregnant during a pandemic,” said Speigel. “There are so many risk factors. I can’t change anything right now, so I’m trying not to think about it too much. I’m choosing to believe it will be OK.”

“I’m probably more stressed out than I know”

The challenges exacerbated by the pandemic don’t stop after birth, either. Post-delivery, parents face a host of new concerns at home with their newborns.

When Simon Adriane Ellis gave birth to his daughter six months ago, he was surrounded by family and friends, something he says was particularly important because being transgender and pregnant can be such an isolating experience.

So when he first started hearing about hospitals restricting the number of support people during labor and delivery, Ellis, who is a midwife, was conflicted.

“I couldn’t have done it without every single person who was there,” he said, remembering the four support people he had, in addition to his midwife, during his own birth experience.

Midwife and new parent Simon Adriane Ellis goes on a walk with his baby, Irie Storm, in Seattle. After giving birth six months ago, Ellis now feels isolated from his chosen family and community due to coronavirus-prevention measures. However, Ellis believes that children represent promise and resilience. (Erika Schultz / The Seattle Times)
Midwife and new parent Simon Adriane Ellis goes on a walk with his baby, Irie Storm, in Seattle. After giving birth six months ago, Ellis now feels isolated from his chosen family and community due to coronavirus-prevention measures. However, Ellis believes that children represent promise and resilience. (Erika Schultz / The Seattle Times)

As a health care worker and a new parent, Ellis endures stress from both sides of the health care system. At work, his heart aches as he enforces hospital policies limiting the number of support people for patients giving birth. His own hospital allows two support people.

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“I feel a little sadness every time I deliver a baby knowing the grandparents can’t come and the chosen family can’t come,” he said. “I just go home and hug my baby.”

Ellis is also feeling the toll that isolation can take during the perinatal experience. Many new parents like Ellis are mourning the loss of the support network that usually gathers to celebrate the birth of a new child.

A few months ago, Ellis’ calendar was covered with the names of people who wanted to come meet his new baby girl. Now his calendar is empty, with those names and events crossed out.

“It’s really important to me that she be raised in community,” said Ellis. “Now that whole thing is just gone.”

Like other new parents, he also worries about the shift to telemedicine and what to do if his daughter gets sick. His daughter’s upcoming wellness check will take place virtually and he laments that he won’t have the reassurance of an in-person appointment. On the other hand, Ellis also worries that he or his partner, who also works in health care, might bring the virus home; at work, Ellis and his co-workers feel abandoned by the federal government as they struggle with supply shortages.

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The constantly changing situation, the stresses of working in health care, the flood of pandemic-related parenting worries, and feeling of isolation can be overwhelming, Ellis says.

“I’m probably more stressed out than I know. Every once in a while some random thing will happen and I’ll just think, ‘I can’t do this anymore,’” he said.

Still, the stress and fear all melt away at the sight of his newborn daughter’s smiling face.

Watching her development reminds Ellis that babies can be a guide for all of us. As they rapidly grow and constantly change, they force their parents to remain flexible and adaptive.

“The thing that’s isolating me is also my greatest source of joy,” he said. “The thing with babies is they change dramatically all the time. Those of us in this situation are better suited to adapt because of this. We’re all OK.”

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Advice from new parents on giving birth during COVID-19:

“Have a backup set of cloth diapers on hand. If diapers are hard to come by, finances are tight due to job loss, or you’re just trying to eliminate the risks involved with going to the store or receiving packages, adjustable sized, washable cloth diapers are the answer.

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“Make sure you have everything you’ll need from home or the store already packed into your car, especially things like the car seat. Otherwise, your support person may be denied re-entry if they have to leave the premises to pick up essential items. Hospital policies are changing often, so stay informed on a regular basis until birth.

“Right before you are discharged from the hospital, take a shower and put on fresh clothes to minimize the risk of bringing anything home.”

— Ansley Bechtolt, Bellevue resident who gave birth to fourth child March 26

“You’re not alone. It’s OK to ask for help. Anything people offer, just say ‘yes.’ Just let people help you … from 6 feet away.”

— Tina Jander, health care worker, due May 4 with second child

Between two medical appointments, Heidi Garcia, right, waits outside the Polyclinic Madison Center in Seattle. Garcia, 36 weeks pregnant, is avoiding waiting rooms to practice social distancing. She says she is required to attend appointments without her husband. “Even if you aren’t overly concerned about catching the virus, there’s still a lot of extra anxiety that comes with knowing that you have to go to the hospital in the middle of this,” she says. “It is hard to shake the fear that there won’t be adequate resources to care for you.” (Erika Schultz / The Seattle Times)
Between two medical appointments, Heidi Garcia, right, waits outside the Polyclinic Madison Center in Seattle. Garcia, 36 weeks pregnant, is avoiding waiting rooms to practice social distancing. She says she is required to attend appointments without her husband. “Even if you aren’t overly concerned about catching the virus, there’s still a lot of extra anxiety that comes with knowing that you have to go to the hospital in the middle of this,” she says. “It is hard to shake the fear that there won’t be adequate resources to care for you.” (Erika Schultz / The Seattle Times)

“This is taking my normal advice … and escalating it in a strange way. The core skill of parenting is flexibility in the face of uncertainty. That feeling of lack of control you’re having, that desire to know when the baby’s going to be born, that frustration you feel when you’re 40 weeks and 3 days. All of those things are a developmental process to help you become a parent. You have to feel a loss of control so that you can start being flexible. You have to want your baby out enough that you’re willing to let your actual heart come out of your body and live in the world. All of this is developmentally appropriate. But now it’s on a scale that’s not developmentally normal, taking this normal human process of encountering uncertainty, walking into it, being brave and being flexible, and then asking so much more than an already huge ask on pregnant people. My advice doesn’t change, but I’m so sorry that you have to do it to this degree.”

“Whatever you have to do to take a shower, do it.”

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— Simon Adriane Ellis, certified nurse midwife, gave birth to first child in October

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Resources

Program for Early Parent Support (PEPS) — support groups for new parents, launching virtual peer support for expectant parents in early May; COVID-19 resource page for parents: peps.org/ParentResources/by-topic/covid-19-resources-for-parents

Perinatal Support Washington — parent support warm line 1-888-404-7763 (se habla español); warmline@perinatalsupport.org, perinatalsupport.org

The Maternal Coalition — updating list of birthing policies and restrictions at local hospitals, COVID-19 resources list for expecting parents thematernalcoalition.org/covid19

Parent Trust for Washington Children — Family Help Line 1-800-932-4673, parenttrust.org/coronavirus

Families of Color Seattlefocseattle.org

Postpartum Support Internationalpostpartum.net

Smart Patients Postpartum Communitysmartpatients.com/partners/ppd

Zero to Three — age-appropriate responses about coronavirus, activities, and a guide to self-care, zerotothree.org/resources

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