During the COVID-19 pandemic, it's understandable wanting not to be anywhere even near a hospital for possible exposure to the virus. But it's inevitable if you're about to give birth.

"Mas malaki ang risk kung walang healthcare provider na maga-assist sa inyong delivery," obstrictirian-gynecologist and infectious disease specialist Dr. Sybil Lizanne Bravo stressed on Dr. Anna York Bondoc's #LibrengKonsulta Instagram Live session held on May 2.

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Pregnant women are strongly advised to give birth in hospitals or lying-in or birth facilities. This ensures that they can still receive proper immediate care in case of any emergency, especially if it would require a C-section. Home births are not for everybody due to the many risks involves. (Click here to know more about home births.)

But with the COVID-19, there are changes to how preggos usually give birth in hospitals. Dr. Bravo helped formulate the national guidelines on pregnancy and COVID-19. Here, she explains the reason behind the changes in childbirth protocols.

Pregnant women need to go through triage in the ER

Usually, doctors give Admission Slips (also called Admission Orders) to their pregnant patients a month in advance. They also instruct them to go straight to the labor room/delivery room (LR/DR) to skip the emergency room (ER) fees. The Admission Slip includes instructions for LR/DR healthcare professionals who will attend to the patient.

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But now, pregnant women cannot go directly to the LR/DR even if they have their admission slip from their doctors. Preggos are advised to only go if they're about to give birth, but to not cut it too close. Due to COVID-19, everybody, including a pregnant woman in labor and her lone companion, needs to undergo triage in the ER.

"All hospitals, even before COVID-19, do triage. It's basically a risk assessment or screening procedure," Dr. Bravo said. Included in the protocols now are asking if the person has any respiratory symptoms such as cough or colds, sore throat, difficulty in breathing, and fever. Doctors will also ask is if you have had any exposure to COVID-19 confirmed patients or any person with other infections, and any travel history.

Pregnant women need to be assessed, so doctors know where to direct you. "Halos lahat po ng ospital ngayon, meron na pong labor and delivery room na pang COVID-19-suspect or COVID-19-positive or confirmed," Dr. Bravo explained.

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If a pregnant woman "passes" the triage...

If the pregnant woman passes the triage or has no symptoms, no exposure to COVID-19 positive patients, or no history of travel, she will be directed to the labor room for suspected COVID-19 patients. "Lahat technically ay considered suspect or person under investigation (PUI) because of community transmission," Dr. Bravo said.

It doesn't mean that preventive protocols are relaxed in the COVID-19 suspect labor room. "May mga buntis po na asymptomatic, o walang nararamdaman, ngunit sila ay infected na pala ng COVID-19 kaya maingat pa rin naman tayo," Dr. Bravo emphasized.

If a pregnant woman "fails" the triage...

If you're classified as high-risk for COVID-19 infection, then you will be directed to the labor room for COVID-19 confirmed patients. "Priority kayo na ma-test for COVID-19," Dr. Bravo stressed. Ideally, you get a swab test before admission or while in the labor room.

Some hospitals require pregnant women to undergo a chest x-ray and complete blood count (CBC). The reason? SARS-COV2, or the virus that causes COVID-19, is a respiratory pathogen, and the most prominent symptom is pneumonia, which doctors can detect via X-ray. Other infections can be seen in the blood test.

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"In the absence of an RT-PCR test, although hindi recommended [na screening tool], karamihan ng ospital ay nagpapa-chest X-ray," Dr. Bravo shared. "Don't worry po, meron naman po tayong lead abdominal shield, so safe naman ang bata. Maliit naman po ang risk of radiation exposure to your fetus," Dr. Bravo explained.

All pregnant women should receive the same level of care, and all healthcare professionals who will attend to them will be wearing full personal protective equipment (PPE). The only difference is that each bed in the COVID-19-confirmed LR/DR is enclosed in a plastic, acrylic divider (like a shower curtain).

You can still have your pain relief medication, such as epidural, and C-sections should only be done if there's a medical indication for it. Your husband, however, cannot be beside you during childbirth and cannot wait outside the delivery room. He would have to go straight to your room after admission and stay there to limit both his and the other healthcare workers' exposure risk.

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