Small Things (still) Growing in the Face of COVID-19
(May 9th, 2020)
Dear Small Things Grow family,
We are happy to provide an update about how things have been going in the season of COVID-19 (Coronavirus).
First, let us say thank you for going with the flow the way you have been. While we are all tired of video chats, we are delighted to see your faces and your actual smiles, since we are wearing masks everywhere else. We miss hugging you. We miss each other. But we are both well, our families are well, and our plans to stay safe during this time have been working. We have plenty of PPE. We are so lucky.
How has it been going:
Babies are still being born at home! It's such a blessing for us to be able to leave our homes and come to yours for such a special event! Simply being in the presence of you all has made us feel like we have kept a tiny sliver of normalcy and a whole bunch of personal connection that others don't get to keep. Even having a snack or a meal with our birth assistants is such a treat to do in person. So we thank you for those opportunities and for trusting us through this time.
What we've seen - COVID in pregnancy and what we are learning:
We are learning day by day what this virus means for pregnant people and their babies. While pregnant people are not at higher risk of contracting Coronavirus than the average person, it is still a highly contagious virus. And we believe it is dangerous for pregnant people.
Several people in our practice have had COVID-19. We have not been exposed but we have been able to provide telehealth to those people. Everyone has recovered without any hospitalization needed. Some people have been much sicker than others - it is a wide range.
We have now also seen in our practice a baby born COVID+ to a COVID+ client of ours (not at home - baby was too early). While the baby is getting better and better and her prognosis is good, we are fairly certain this was a case of vertical transmission that may have caused the premature birth.
Other practices in NYC are reporting higher numbers of preterm births and first trimester miscarriages to COVID+ pregnant people.
Most people are fine.That being said, please continue to take precautions and we will, too. We do believe over time we will see the scientific data reflect that COVID-19 is a virus that can cause adverse pregnancy outcomes.
How to Stay Safe:
Continue to stay home. Wash your hands. Carry hand sanitizer and use it if you touch anything at all. Do not touch your face.*If you work in healthcare, please talk with us about limiting your risk. So many of you do.Yes, get out for fresh air, but wear a mask.Stay 6 feet away from those who do not live with you. No exceptions.Reduce stress any way you can. Enjoy time with loved ones if you can get it. This slow pace can actually benefit us all in many ways.
If you believe you are sick: Please call us and let us know. We will talk you through it and monitor together. Do not go to the hospital unless you are short of breath.
Visits:
We will continue to see folks for milestone visits in person and other visits over zoom. Milestone visits are when we do bloodwork or labs, check the position of your baby, listen to your baby, and take your blood pressure.Milestone visits will continue to be in our offices. Expect to be here for a quick 15-minute "OB-like" visit - in and out. This makes our visits "low risk encounters". **During the same week, please ALSO schedule a ZOOM VISIT with either midwife so we can spend 30-45 minutes doing more of the normal talking points we would cover at a normal visit. So Milestone visits are essentially two shorter visits, one quickly in person, and one over zoom.
Milestone Visits: 1st visit (12 or 16 weeks), 28, 32, 36, 38, 40 weeks; we have the option to see you more if we need to, so keep in mind these are just routine.
When coming to see Robina please enter through the alley so you’ll be right in the office.
When coming to Tanya’s, after buzzing 2s, please come right to the third floor so you can enter up near the office itself.
Most people will also have one ultrasound at 20 weeks at one of the ultrasound offices (Carnegie or Unique Perinatal).
For regularly scheduled prenatal care, we will be having telehealth visits via Zoom.
Zoom Visits: 12, 16, 20, 24, 28. 30, 32, 34, 36. 37. 38, 39, 40, 41 wksThese visits last about 45 minutes and we go over concerns, planning the birth, etc. We will also teach you how to measure your fundus for growth and you will take your blood pressure during this visit.***If you have a blood pressure cuff after your pregnancy is over that you'd like to pass on to another newly pregnant person, please let us know so we can recycle for you.
After the Birth:
We will call you the day after the birth to check in and then make one in-person visit, by the midwife who attended your birth, on day 3 or 4. If you need to see our lactation consultant, we can arrange that virtually or in person, depending on the need. Then you should schedule a zoom visit with the midwife who did not attend your birth for sometime between week 1-2. You will receive an email reminder. Lastly you'll have a 6-week postpartum visit also over Zoom that you will schedule. If you need a pap smear or an IUD, we will schedule a 15 minute in-person visit to get that done in addition to your zoom visit. You will receive an email reminder to schedule your 6-week visit.
That's all for now!. Please don't hesitate to keep in close touch with us if you have any concerns. While we don't see you in person as much, we are doing our best to make sure you know we are here for you, we care, and we are available. We hope this helps lead us into some good socially distanced beach time this summer. Take good care of each other.
Love,R+T
(March 16, 2020)
Dear Small Things Grow family,
Things are evolving rapidly for our city and our nation. In light of recent closures, as well as updated national and international recommendations for prenatal care, we are instituting the changes listed in this email effective immediately.
Before we outline the changes, we want to say this: we know this is a really difficult time to be pregnant. The world is a really overwhelming place to be living in right now, let alone to be gestating in. We are so sorry this is happening and that what should be an unequivocally joyful time in your life has become so scary. We want to assure you of your strength and resilience, and remind you that babies, no matter the circumstances under which they are born, are a beautiful reminder of the inherent hope of life. We are here to process all of your many complicated feelings with you. We do understand that some of the changes we are making are disappointing, but they do not change the care we have for you and our commitment to continuing to build a relationship you can take comfort in and rely on. We truly believe what we outline here is the best, and therefore only, choice we can make to keep our community as safe as we can.
First, the vast majority of prenatal visits will be moving to a virtual format (ideally Zoom, or telephone at your request). The exceptions are visits that require a blood draw or other lab work, as well as some visits at full term. In other words, unless you are coming in for your initial blood work (and initial fetal heart confirmation), a genetic screening, your diabetes screening test, or your GBS test, we will likely be seeing you virtually. Naturally, if you are concerned about something that cannot be assessed virtually, then we will see you in person. Term visits (i.e. 36 weeks +) will happen in person as needed (most probably every other week), with weekly virtual check-ins.
In order to facilitate virtual visits, we recommend you purchase a home blood-pressure cuff. Here are some recommendations, and although we hate Amazon here is another that is a little cheaper than some on that list and also looks okay. Please let us know if getting a cuff constitutes a major financial hardship for you.
In addition, we will no longer be performing ANY home visits other than the 24-48 hour postpartum visit. This is to limit our exposure as much as possible. We are doing absolutely everything in our power to both keep ourselves healthy so we can continue to serve you as well as to avoid being vectors by moving from location to location. This means any term visits, as well as the 7 day and 6 week postpartum, will be virtual. To compensate there will be a fair amount of communication with us over telephone/text/facetime during the first week postpartum so we can assess that all is going smoothly for you and your baby. We will be offering virtual lactation visits with our staffed CLCs in place of lactation visits for those who need that extra help.
Lastly, all non-emergent preconception visits and well-person visits will be either rescheduled or moved to a virtual format.
If you have an appointment this week, one of us should have gotten in touch with you already. For the rest of you, moving forward, please assume your visit will be virtual unless it falls into one of the above categories. We will contact you individually with a Zoom link.
Let us know if you have any questions. We are here for you.
Love,
Robina and Tanya
(March 13, 2020)
Dear Small Things Grow family,
We know you are also justifiably concerned and anxious about the constantly evolving news coming out about COVID-19 (Corona Virus). We are too. This email is our attempt to convey to you what we know about the virus, review “social distancing” recommendations, and to answer any questions you may have about your care moving forward. We have tried to be comprehensive. Feel free to skip around as some of this information may be familiar to you, but please make sure you read the last two sections ("What your midwives are doing for you in light of COVID-19" and "What we need from you").
What we know about COVID-19 in Pregnancy
First, the good news: what we know about COVID-19 in pregnancy is reassuring. There has been no evidence to suggest that pregnant people are any more likely to contract a critical case of COVID-19. As far as we know at this time, pregnant moms cannot transmit COVID-19 to their babies in utero or during labor and birth. There is some risk, but it does not seem to be greater than in the general population.
What we know about COVID-19 transmission and symptoms
Transmission of COVID-19 primarily occurs through respiratory droplets, such as when someone with the virus coughs or sneezes. This is most likely when people are standing within 6 feet of each other and with prolonged contact. The virus can also be spread when someone touches a surface or object that has the virus on it and then touches their mouth, nose, or eyes, but this is not the main way it spreads. It is possible for people who are asymptomatic to spread COVID-19, but transmission is most likely from symptomatic individuals.
For 85% of cases, the illness will be “mild.” The main symptoms are dry cough, shortness of breath, and fever. Some people will experience fatigue, sore throat, and headache. Others will be asymptomatic or only have the symptoms of a mild cold. In general, stuffiness and congestion are not symptoms of COVID-19.
What to do if you get sick
If you get sick, let us know so we can give you personalized recommendations. But here are the basics:
You must self-quarantine for two weeks. This includes cancelling your prenatal appointments (see below!!).
Tylenol to reduce fever and over the counter cough medications such as guainifesin and dextromethorphan are appropriate . Homeopathic Chestal is also a great option if the coughing is not too severe. Lozenges, broths, tea with honey, and humidifiers or steam are all helpful. AVOID THE HOSPITAL and all medical offices (including ours) unless you are having trouble breathing. Of course, reach out to us with any symptoms so we can talk you through this.
Why recommendations for social distancing are important
Because we are still in the early stages of this pandemic, and because testing is so varied from country to country it is hard to know what the rate of critical cases or deaths will be; estimates of the mortality rate vary between .5 and 4%. The vast majority of these deaths will be the elderly and otherwise vulnerable/immunocompromised (keeping in mind you don't always know who might be vulnerable by looking at them).
Our country's labor and healthcare policies do not provide the kind of safety nets we need to control this pandemic. We don’t have adequate equipment, hospital beds, or hospital providers; we don’t have guaranteed paid sick leave or guaranteed financial support for people who should quarantine (which means that people won’t stay home when they should); we don’t have universal healthcare (which means people won't get the care they need); and our government has not acted in a timely enough fashion to contain this.
We don’t mention this to scare you but to let you know that in the face of systemic failures, we need to be our own hope and support. As much as possible we all must take responsibility to slow down the spread of this virus so that the systems we do have do not become overrun. The earlier you take precautions, the more lives you can impact and save.
How to be a catalyst for good in a time of fear
1. We know you know this, but wash your hands with soap and water frequently for at least 20 seconds. There are many lists floating around of songs to sing to pass 20 seconds. Robina’s favorites are the choruses of “Ms. Jackson” and “Truth Hurts;” while Tanya is partial to "Rich Girl" and "Good As Hell." At minimum you (and your children) should be washing your hands every time you use the bathroom, before you eat, and anytime you come into your home.
2. Clean highly used surfaces such as doorknobs, light switches, and faucets often. You may use bleach, peroxide, or alcohol based cleaners. Consider taking off shoes before coming into your home.
3. Try not to touch your face. We know, we're primates, and this is hard. Just being cognizant of it will help. Don't let perfection be the enemy of the good.
4. Although your president might be doing otherwise, do not shake hands. Avoid hugging as a means of greeting, but definitely still hug your immediate family (see: we're primates! Try to still get those 12 hugs a day).
5. Avoid using your hands and instead use knuckles, hips, elbows, a sleeve, or napkin/paper towel/tissue when opening doors or pressing elevator buttons. (And then when you get inside, wash your hands!)
6. Avoid crowds. Work from home (if your company hasn’t already implemented this, ask). If you have the financial capability, keep your kids home from school, activities, daycare, etc. Robina is a longtime homeschooler and can assure you that it’s okay to not replicate school at home. Do arts and crafts. Read. Bake. Cuddle up with popcorn and watch a movie without guilt. Don’t worry about your kid “falling behind.” Just love them. They will be okay. Here is a good resource for talking to them about what’s happening.
7. Eat food that nourishes you. Fresh fruits and veggies, warming foods, broths. Try to limit sugars and processed foods. But don’t beat yourself for eating the cookies that you bake with your kids; that is a form of comfort too and keeping your stress down is immune boosting (see below). Feel free to supplement with Vitamin C, Vitamin D3 (ideally paired with K2), Cod Liver Oil, probiotics, and curcumin/turmeric to boost immunity.
8. Don’t hoard food. Panic buying stresses our systems, standing in line with hundreds of people isn’t helpful, and hoarding keeps resources from those who don’t have the disposable income to stock up. Buy a little more than what you need, but no more than that. Still, try to continue to support your local business owners. Order takeout. Buy gift certificates for restaurant dates later. Consider not asking for a refund for an event that’s been cancelled. Also: donate to food banks.
9. See the people you love…six feet apart, outside. Isolation is tough. Consider low risk activities like walks outside (vitamin D and exercise!!) Pace yourself. We may be living like this for a long time.
10. Try to reduce stress as much as you can. Meditate, workout (there are lots of videos on YouTube!), stretch, take baths, read a good book, watch something funny, stop stress scrolling, shut off the news.
What your midwives are doing for you in the light of COVID-19:
We are obviously taking extra care to sanitize our offices and equipment. We are practicing all the recommendations discussed above, including washing our hands until they basically disintegrate and avoiding hugging all you people we care for so much.
We are offering phone and/or Zoom visits in place of in-person prenatals. This can be a viable and safe option, especially in the second and early third trimesters, as well as for six week postpartum visits (and we can reschedule an in-person meeting later). Please reach out to us if you would like to utilize this option. All consults, preconception visits, and non-emergent well-person care will also be virtual until further notice.
We are committed to facilitating your birth at home no matter what. If one of us becomes ill, we will self quarantine appropriately, and the other midwife will be on call for that time. If we are both sick, we will rely on our backup midwives (of which we have several).
What we need you to do:
We need you to help us keep the entire STG community healthy by CANCELLING your appointments if you or any member of your household are ill (and take care of the larger community by self quarantining!). It is important to note that because many cases of COVID-19 will present as a common cold, this means you should cancel if you are feeling unwell even in a mild way. We also ask you cancel appointments (and appropriately self-quarantine) if you suspect you have been exposed to COVID-19.
We ask that you take off your shoes and wash your hands upon entering our spaces.
Midwives put their own health and the health of their families on the line every day to take care of their clients in every possible scenario. The nature of our jobs is such that we CANNOT socially distance as much as might be ideal. We need you to show consciousness of that fact and try your best to keep us healthy. It is important we try to limit our risk and avoiding getting sick so that we can care for everyone when they most need us (i.e. birth). If we need to make requests or change policies in order to reduce our risk (reducing home visits or suggesting televists depending on how things evolve, for example), we ask you to comply from the same ethos of care and generosity we extend to you.
We hope this update has helped and provided some comfort. This is a scary time, and the only way we will get through it is together. We are here for you. Please reach out with any questions.
Love,
Robina and Tanya