By Khanh Nguyen
The COVID-19 pandemic has drastically changed how people seek health care, including how women receive prenatal and postpartum care and how they give birth.
During normal times, pregnancy and childbirth often involve numerous visits to doctors’ offices with many providers and loved ones participating in care. Over the last few months, however, providers and patients alike have shifted to practices that involve less in-person contact.
Many hospitals and medical offices implemented protocols to reduce the risks of exposure to and transmission of COVID-19. For example, some providers reduced in-person visits for nonemergency care and hospitals restricted visitors.
The Centers for Disease Control and Prevention (CDC) also provided specific recommendations for hospital delivery units, including limiting visitors during delivery and recovery, setting screening protocols and separating patients who have tested positive from those who have not. Some health systems have implemented policies in addition to those recommended by the CDC, in some cases not allowing any visitors or separating newborns from COVID-positive mothers.
So far, it does not appear that COVID-19 affects pregnant individuals differently than others, but pregnancy does increase the risk of other respiratory diseases. Many of the precautions described above aim to prevent maternal and infant infection, but experts fear they may inadvertently lead to increased stress and negative outcomes because of reduced access to routine care and the absence of family members or other individuals who can provide emotional support.
These concerns have led health care experts and organizations to call for easing some restrictions to ensure healthy pregnancies and deliveries. The CDC recommends that patients do not miss any prenatal or postpartum appointments, whether in-person or virtual, and that if in-person visits are necessary, providers take steps to assign separate visit times for sick patients and healthy patients.
The American College of Obstetricians and Gynecologists created a guidance document to help providers maintain adequate prenatal and postpartum care during the pandemic. One recommendation is to use telehealth whenever possible so that no appointments are missed.
Federal agencies are investing in telehealth to support maternal and child health. In April, the Health Resources and Services Administration awarded $20 million to improve telehealth access and infrastructure during the pandemic, with $15 million in funding going toward improving services for providers, pregnant women, children, adolescents and families.
States also recognize the role that telehealth plays in maintaining necessary health care access and have passed several bills expanding coverage. Maryland enacted HB 448, creating policies regulating telehealth practices. Alaska enacted HB 29, which requires insurance coverage for telehealth services, and New Jersey enacted AB 3843, which requires insurance and Medicaid coverage for telehealth during the state’s public-health emergency.
For some women, however, telehealth does not adequately offset the impact of distancing measures on their pregnancy. As a result, some are choosing to deliver at home, rather than at a health care facility, where they might be exposed to sick patients or might not have their support network present.
Policies previously introduced to license midwives and birthing centers may now expand access to non-hospital deliveries and home births at the same time that demand has grown during the pandemic. For example, Utah passed HB 428 in March, amending its laws related to licensing birthing facilities to include non-freestanding birthing centers eligible for designation as an alongside midwifery. Oklahoma passed SB 1823 last month, setting up licensing and oversight for midwives and creating an Advisory Committee on Midwifery.
States have also taken non-legislative action to address maternal and child health during the pandemic. New York’s and Oregon’s governors issued executive orders requiring hospitals to allow a support person to be present at delivery. Health care organizations, such as St. Vincent Healthcare in Montana, made exceptions to their no-visitor policies to allow laboring patients to have limited visitors.
Other states have sought to extend Medicaid coverage from 60 days to one year postpartum through Medicaid waivers. The extensions aim to reduce pregnancy-related illness, such as postpartum depression, and address health disparities in maternal mortality that may be exacerbated during the pandemic. The federal Families First Coronavirus Response Act, passed in March, requires all states to continue coverage for Medicaid enrollees throughout the national emergency to receive additional federal funding. This effectively extends coverage beyond the typical 60 days postpartum for the duration of the emergency.
The full impact of the pandemic on maternal and child health may not be known for some time. NCSL will continue to monitor state and national discourse and action on this emerging issue.
Khanh Nguyen is a senior policy specialist in NCSL’s Health Program.