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What resources or guidance is there for expecting mothers, new mothers, and health care providers? What rules are in place for labor and delivery during COVID-19?
In partnership with the New Jersey Health Care Quality Institute, the Department of Health has issued guidance for pregnant individuals and health care providers to ensure they can obtain safe and equitable care during this public health crisis.
- Pregnant women and their families should take all possible steps to avoid infection.
- In-person medical visits should be minimized to the extent possible while maintaining patient safety. Patients who have a moderate or high-risk pregnancy, or emergent obstetrical needs, may need to be seen in person more often or have additional telehealth visits for follow-up.
- Patients should be encouraged to attend their visit alone when possible. Health care providers should follow best practice protocols aimed at maintaining both patient and healthcare worker safety including pre-screening patients who need an in-person visit for COVID-19 exposure and symptoms.
- Providers should develop a system for patients to wait for their appointment outside of the office to limit the number of individuals in the office at one time, keeping in mind that not all patients have a car they can wait in. Providers should also reconfigure office areas so that patients can maintain social distancing recommendations
- Prenatal education group classes should be encouraged and conducted via telehealth. This education should include lactation education, education on assessing blood pressure at home, and guidance on supplies needed for the postpartum period.
- Patients should receive education on what to expect when they arrive at the hospital, such as new triage procedures around labor support and discharge.
- Additionally, moms choosing to breastfeed their infant should be educated on precautions to take to prevent the spread of COVID-19 to the infant such as using a dedicated pump, washing hands before touching any pump or bottle parts and wearing a mask while feeding your infant.
- Patients who are pregnant may be arriving to a facility due to illness, pregnancy-or non-pregnancy related complications, in labor, and/or for scheduled inductions or c-sections. All pregnant patients should be rapidly assessed based on the facilities' guidelines to allow the care team to best guide the birthing process and maintain patient, infant, and health care worker safety.
- If possible, all pregnant patients should be tested prior to or at the time they present at the hospital. Hospitals should have plans in place to accept patients being admitted with suspected or confirmed COVID-19 including placement of patients into designated rooms or negative pressure rooms.
New Guidance During Labor
To better support expecting mothers and families in circumstances where support is essential, the Department of Health has made some accommodations.
- All pregnant patients must be tested for COVID-19 when they present at the facility or prior to admission for labor and delivery.
- Hospitals are required to allow at least one designated support person to be with a pregnant patient during labor, delivery, and the entire postpartum hospital stay. The person can be a spouse, partner, sibling, doula or any person the expectant mother chooses. Doulas are exempt from limits on support persons during the hospital stay.
- The support person(s) and doula must be asymptomatic for COVID-19. They must not be suspected of or a confirmed positive for COVID-19 (with a molecular test less than 14 days after the result) even if asymptomatic.
- Hospital staff must screen the support person(s) and doula for symptoms of COVID-19 (e.g., fever, cough, or shortness of breath), conduct a temperature check prior to entering the clinical area, and every twelve hours thereafter, and screen for potential exposures to individuals testing positive for COVID-19.
- PPE must be given to and worn by the support person(s) and doula. Once in the labor and delivery unit, the support person(s) and doula must have extremely limited access to other areas of the hospital (except for the cafeteria and other open amenities for visitors) and must not be permitted to leave and re-enter the postpartum unit without being rescreened.
Additional information can be found in this directive from the Department of Health.
To improve maternal and infant health, the State Medicaid program now covers doula care while no longer paying for non-medical early elective deliveries.
The new coverage and requirements were effective January 1, 2021. Visit njfamilycare.org to learn more about accessing free or affordable health care coverage.
The new doula coverage stems from a law signed by Governor Murphy in 2019 that allows doulas to enroll as Medicaid providers and receive reimbursement for care services.
The new prohibition on Medicaid paying for non-medically necessary early elective deliveries (EEDs) also stems from a 2019 state law.
EEDs are scheduled cesarean sections or medical inductions performed before 39 weeks of gestation without medical indication. Studies show non-medically necessary EEDS performed before 39 weeks of gestation carry risks for babies and mothers, including higher incidences of neonatal intensive care unit admissions, pneumonia and longer hospital stays for infants.
The Department of Health continues to support expectant mothers, children and families and has modified many of its programs as part of the COVID-19 response. Telehealth is now used to provide:
- doula support
- home visiting
- the provision of critical early intervention services
In addition, virtual support groups are available for new mothers.
To access any of these programs, call the Family Health Line at 1-800-328-3838, or visit the New Jersey Department of Health's information hub for mothers for additional resources.
Source: https://bit.ly/QIMaternityCare; https://www.state.nj.us/health/legal/covid19/6-29-20_ExecutiveDirectiveNo20-020_LaborDelivery.pdf; https://nj.gov/governor/news/news/562021/approved/20210202b.shtml