Presented by Alaska Native Tribal Health Consortium

In the months since COVID-19 arrived in Alaska, families have found safe ways to mark life’s milestones. Graduations take place over Zoom. Weddings have become intimate, outdoor affairs.

And in hospitals, homes and birthing centers across the state, babies continue to be born.

“I am always amazed at the resilience of families,” said Dr. Matt Hirschfeld, medical director for maternal child health services at the Alaska Native Medical Center. “They’re the true heroes of this whole COVID pandemic.”

As the person responsible for overseeing maternal health strategy and program development for Alaska’s Tribal health care system, Hirschfeld has been working throughout the pandemic to ensure good outcomes for expectant parents and babies all over the state.

It’s OK to feel nervous about being pregnant during a pandemic, Hirschfeld said -- in fact, that’s how most expectant parents are feeling right now. But that doesn’t mean you should be scared to bring a new baby into the family. Pregnancy and childbirth can be done in a safe and healthy way as long as parents understand that, just as with nearly every other aspect of life right now, they’ll need to take some extra precautions.

“If the reasons are right for you to have a baby right now, you just have to realize that it’s going to be a little bit of a different experience,” Hirschfeld said.

COVID-19 precautions during pregnancy

Current research indicates that pregnant women may be at higher risk for more severe cases of COVID-19.

“That doesn’t mean you hole up in your basement for the nine months that you’re pregnant,” Hirschfeld said. “It does mean … you do all the stuff you need to do to keep you safe.” That means staying home as much as possible, sticking to your household bubble, wearing a mask when you’re around other people and practicing good hand hygiene.

It also means that, as hospitals take precautions to keep COVID out of maternity wards, your labor and delivery experience might be a little bit different than you might have envisioned.

At Alaska Native Medical Center, maternity patients bypass the emergency department when they check in, and the labor, delivery and recovery areas are separate from areas of the hospital where most of the COVID patients are being treated. Patients who have been exposed to the coronavirus are isolated away from other families, and testing is routine.

“We test everybody who walks through the door,” Hirschfeld said. “When you come in to deliver, you get a rapid PCR test that’s back within a couple of hours. That helps us help moms stay safe.”

Like most hospitals, ANMC is limiting visitors, including in the delivery room. Hirschfeld acknowledged that the restriction can be tough, especially for patients who would ordinarily rely on family members for support during labor.

“Some Alaska Native families tend to share the birthing experience with a lot of people,” Hirschfeld said. “(But) it’s too risky to have that many people in the room. That can be pretty stressful for moms, as they don’t have the support system that they usually have when they come to the hospital.”

With as much as hospital procedures have changed, Hirschfeld said it’s more important than ever that expectant parents keep up with prenatal appointments -- not only to keep an eye on the baby’s healthy development, but so they can stay up-to-date on what to expect when it’s time to deliver.

“I think the scariest thing for anybody is not having enough information, or to show up at the hospital and have something unexpected happen,” Hirschfeld said. “We’re really trying give people as much information before their due date so when they get to the hospital it’s not a surprise.”

Bringing home baby during a pandemic

While labor and delivery are certainly stressful for parents in cities like Anchorage, Fairbanks and Juneau, the basics of a hospital stay, including when parents and babies are admitted and discharged, are fundamentally the same.

“You get to come into the hospital when you’re in labor, you get to deliver,” Hirschfeld said. “The real difference is for the rural families.”

As usual, patients with high-risk pregnancies who need to deliver at ANMC are advised to travel to Anchorage four weeks ahead of their due date to ensure they don’t deliver in rural parts of the state where they may not have the resources to treat any issues that arise during the delivery. The big change during the COVID pandemic is during the return journey. With quarantines, local restrictions and travel protocols designed to fight the spread of the coronavirus, getting home can take weeks. New parents may have to quarantine multiple times if they travel through regional hubs en route to remote communities, and often a mother is coming alone with a brand new baby.

“These moms have been away from home now for eight weeks or more,” Hirschfeld said. “COVID has made getting care in Anchorage really difficult for families from rural Alaska.”

Health care providers are “trying to be as creative as possible” to minimize travel and quarantines while still ensuring a high level of care, he added. Telemedicine, which was pioneered in Alaska’s Tribal health care system and has become increasingly vital during the pandemic, is a valuable resource for expectant parents.

If a pregnancy becomes complicated, however, additional travel may be necessary.

“Prenatal care for high risk pregnancies is very ultrasound-focused, and you need the high resolution ultrasounds and the expertise of experienced healthcare providers to provide the best possible care,” Hirschfeld said. “These services are really only available in the bigger cities of Alaska, like Anchorage.”

ANTHC’s Ronald McDonald House, located on the Alaska Native Medical Campus, provides housing for patients who must travel to Anchorage for prenatal care and delivery. It’s not quite like being at home, Hirschfeld said, but the staff and volunteers work hard to make it comfortable and welcoming, especially for patients who are traveling alone.

Keeping baby healthy at home

Once a family is discharged and makes it home with their new addition, it’s important to keep up the same preventive measures everyone should be taking. It is possible for newborns to get COVID before birth, but this is less common. Because of the risk of transmission from a COVID positive mom to her baby, some hospitals are suggesting formula feeding, but Hirschfeld said ANMC is committed to breastfeeding. ANMC is continuing to encourage breastfeeding with good maternal hygiene and mask-wearing to limit the baby’s exposure to COVID while receiving the health and development benefits of breastfeeding.

“However, if parents don’t have COVID, there’s nothing extra they should be doing,” Hirschfeld said. “It’s all about social distancing, handwashing, limiting exposures to additional people -- all the things you should be doing anyway.”

That includes routine care, which is especially important in those early months when babies are marking milestones and mothers may experience postpartum depression and anxiety. Well-child visits are a “four-pronged” approach designed to keep an eye out for the health of the baby as well as its parents, according to Hirschfeld.

“One, you want to make sure the family’s doing well and adjusting to the new baby being home,” he said. “That’s easily done by telemedicine -- sometimes better, because you can interact with people in their own space. No. 2, you want to make sure the baby is growing well. No. 3 is you want to check development. Babies’ brains are developing faster than at any point in their life, ever. You really want to make sure that all those milestones are being met appropriately. No. 4, you want to make sure that every baby gets their immunizations on time.”

ANMC has taken some steps to help parents protect their babies during the pandemic. Pediatrics has split into two separate clinics, one specifically for patients with respiratory symptoms. The respiratory clinic has its own separate waiting area, so patients who are visiting for preventive care (such as well-baby visits) aren’t knowingly exposed to sick kids. The hospital also held a drive-through immunization clinic and is employing telemedicine for more appointments, including for patients who live in Anchorage.

“We’re trying to meet the parents halfway here to try and help allay some of their fears,” Hirschfeld said.

Some of these pandemic innovations may stick around long after families have stopped “hunkering down.”

“I really think it’s going to be hard to go back to the old way of doing care,” Hirschfeld said. “If we can do a lot of the usual well-child check at home and just (have you) bring your baby in to measure growth and give immunizations, that could be a big benefit for busy families.”

Preventing COVID is a community effort

Although the pandemic may add a layer of stress, there’s no reason you can’t have a perfectly healthy pregnancy, according to Hirschfeld, as long as you follow recommendations about COVID-19 safety -- and ask that your loved ones do the same.

“I can’t reiterate enough how important it is to do good public health practice,” Hirschfeld said.

That means masking up, washing hands and staying distanced, maintaining a small, stable social bubble, and protecting your new baby from people who may have COVID.

“If you’re a friend or family of a pregnant mom, the last thing you want to do is bring COVID into that person’s life,” Hirschfeld said. “It’s everybody’s responsibility to keep babies and pregnant moms safe by following good public health guidelines until this pandemic is over.”

This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.