Though most pregnant women who have COVID-19 tend to have mild cases – unless comorbidities are present – obstetrician-gynecologists often face difficult medical and logistical problems when caring for those patients, according to physicians who took part in the Texas Medical Association’s fourth telephone town hall meeting – one devoted specifically to the issues facing OB/Gyns.
For instance, OB/Gyns frequently must change their normal procedures when isolating pregnant women who have or are suspected of having COVID-19, says Catherine Eppes, MD, an OB/Gyn at Baylor College of Medicine in Houston who sits on TMA’s Committee on Infectious Diseases.
In those cases, physicians must be vigilant about keeping a woman’s friends and family connected to the birth, she says.
“I myself have had the lesson of having a pregnant woman become very upset and even leave against medical advice because of feeling that her family wasn’t adequately involved in the experience,” Dr. Eppes said.
Usually, the solution is improving communication with people close to the woman and her newborn child, Dr. Eppes says.
“I’ll call them on rounds,” she said. “And I’ll do that as much as possible and update them on how their family members are doing.”
The town hall also addressed OB/Gyns’ business concerns. For instance, many physicians who have recently adopted telemedicine are still unsure about the most effective way to use it, says Joseph Valenti, MD, a Denton OB/Gyn who chairs TMA’s COVID-19 Practice Viability Work Group and sits on TMA’s Board of Trustees.
For OB/Gyns, telemedicine can be especially useful for breastfeeding support, contraceptive counseling, pre- and post-operative visits, medication refills and counseling, and mental health screenings, Dr. Valenti says.
“And that is [also] a very good time to dispel myths and rumors, like, ‘My mask may cause carbon dioxide poisoning, therefore I’m not going to wear it,’” he said.
Dr. Valenti suggested physicians check out the TMA webpages on telemedicine and practice viability.
OB/Gyns took part in two telephone poll questions about how COVID-19 has affected their practices financially. First, physicians were asked how severe the impact has been:
- 38% say moderate, meaning a 20% to 40% reduction in patient volume;
- 35% say major, or a 40% to 60% drop in volume;
- 14% say devastating, or a drop in volume of 60% or more;
- 12% say minimal, or a drop in volume of 20% or less.
Another question sought to find out the main cause of those financial problems:
- 30% say a drop in the number of patients was the main cause;
- 12% say a decrease in elective surgeries;
- 1% say an increase in overhead or similar problems;
- 55% say a combination of several factors.
OB/Gyns should stress to pregnant women that it’s safe to go to a physician’s office, says Eugene Toy, MD, chair of the American College of Obstetricians and Gynecologists Texas District.
“I know of several cases of women who didn’t come in for their OB care and because of that, developed preeclampsia or bleeding or other complications,” he said.
Several physicians called into the town hall with questions, including Jean McClintock, MD, a Dallas OB/Gyn. While there is a lot of information about the personal protective equipment (PPE) physicians should wear around patients who are under investigation for COVID-19 infection, there’s little guidance about what they should wear around other types of patients, she says.
“What is the appropriate PPE for those routine patients in the office?” she asked.
The Texas Medical Board recently released new standards on routine medical care, says Tyler pediatrician Valerie Smith, MD, a member the TMA COVID-19 Task Force. Those standards call for wearing both a mask and face shield if the physician is performing a procedure with a high risk of aerosol transmission.
Otherwise, the standards say “that if everyone is within 6 feet of one another that everyone should have a mask of some sort,” Dr. Smith said.
OB/Gyns also were asked in another telephone poll about their personal stress level caused by COVID-19:
- 43% say moderate;
- 28% say severe;
- 25% say mild;
- 3% say unbearable.
“This is a really, really tough time,” Dr. Toy said. “Physician burnout and suicide rates are ever increasing and especially during this crisis. If this is a time where you’re about to break, take time to talk to somebody.”
The TMA Committee on Physician Health and Wellness promotes the health and well-being of physicians. Find more on the TMA website or by email.
TMA co-hosted the tele-town hall event with the American College of Obstetricians and Gynecologists District XI (Texas) and the Texas Association of Obstetricians and Gynecologists.
Physicians also can stay up to date with the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.