Giving birth during the COVID-19 pandemic: an obstetric anesthesiologist’s perspective [PODCAST]

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Thank you for listening to the podcast. There were some audio difficulties, which I hope you can overlook. It certainly does not take away from Dr. Sheikh’s message and her wonderful interview.

“‘It’s a strange time to be having a baby,’ my patient said as she sat alone in her labor room. The state order to shelter-in-place in California had left her family with few options as her husband had to stay home to take care of their toddler. She is one of many pregnant women who do not have the choice to even consider a home birth due to her congenital heart condition, which puts her at risk for sudden cardiac death.

She understood that she was part of a ‘high-risk’ population, the ones with preexisting conditions that are more likely to have severe disease if they contract COVID-19. If she got sick, it would mean total isolation and separation from her baby and family for weeks.

I sat with her a little longer. She smiled, but I could see the fear and uncertainty in her eyes — fear of giving birth alone and of what life would look like with a newborn in our new apocalyptic reality. Pre-pandemic, I would have sat closer to her and even held her hand to ensure her that she was not alone. But I sat six feet away and consoled her from a distance and simultaneously wondered if she could sense my own fear and apprehension.

‘I’m sorry that your husband can’t be here with you. These are unprecedented times for all of us, and we’ll do the best we can to keep you and your baby safe.’

We must be strong for our patients. As young physicians, we have seen our fair share of trauma, death, and despair. But most of us have never had to come face-to-face with our own mortality. Now, we have fear.”

Maria Sheikh is an obstetric anesthesiologist who blogs at The Epidural Doc and can be reached on Twitter @MariaSheikhMD.

She shares her story and discusses her KevinMD article, “Giving birth during the COVID-19 pandemic: an obstetric anesthesiologist’s perspective.”

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Maria Sheikh. She’s an obstetric anesthesiologist, and she wrote the KevinMD article “Giving birth during the COVID-19 pandemic: an obstetric anesthesiologist’s perspective.” Maria, welcome to the show.

Maria Sheikh: Thank you, Kevin.

Kevin Pho: So we’re going to get into your article in a little bit, but I was wondering if you could share your story with me and tell me a little about your journey to where you are now.

Maria Sheikh: Sure. So I am a third-generation physician. My mother is an internist, still practicing, and my grandmother was a gynecologist practicing in Pakistan. So medicine kind of runs in the family. We moved to the United States in 1996, and I kind of followed in my mom’s footsteps in medicine. I always had a passion for global health, public health, and especially maternal health, since we’ve got quite a few disparities here in the United States.

So I chose to go into the obstetric anesthesiology path because we get to be patient advocates. A lot of people think anesthesiologists are just putting patients to sleep, but our subspecialty is unique in that our patients are awake. They remember us, and we get to spend quite a bit of time with them before delivery and do delivery planning, especially for the high-risk patients, the ones that have cardiac disease or other complicated conditions. So that’s kind of how I got here, and I’m finishing my fellowship in two months, and I’ll be heading over to New York City to take my first job as an obstetric anesthesiologist.

Kevin Pho: Excellent, and congratulations. So let’s look at your KevinMD article, “Giving birth during the COVID-19 pandemic: an obstetric anesthesiologist’s perspective.” Can you share the story behind that article and maybe share some of your experiences as an obstetric anesthesiologist during the pandemic?

Maria Sheikh: Absolutely. So, I’ve always been writing since I was a teenager, but I really started writing for the public only a few years ago as, I’ll say, a way to kind of cope with what was happening in residency, and now especially the stresses of the COVID-19 pandemic. And right when we had announced the shelter-in-place and social distancing, it was just a very unprecedented time for everyone.

My colleagues in other fields were making plans to postpone elective surgeries and kind of have surge teams available for backup in case we all needed to go to the ICU, but the truth is the show kind of just went on in labor and delivery. Babies keep coming during a pandemic, and we really were not being assigned to any other ICU teams or backup teams because we were our own backup. As fellows, we were the backup for our resident positions, and we were essentially backup for our attending positions if something really bad happened.

So, I remember talking to a patient, and she couldn’t have her husband with her at that time because there was no child care. We allowed one partner, so she was by herself, and she was putting a smile on for us. The fear and the nervousness and just the overall sense of apprehension, everything was just visible. We have to be strong for them, so we have to say whatever we can to make them feel better because, in OB, we don’t really give them a lot of anxiolytics or anything. It’s just mostly you’re awake, and then you get a labor epidural.

So, I think just navigating this new path with our patients was a very unique experience, to have to give birth at this time. You’re thinking, “Is this the time to have a child? And then I won’t have child care.” You might not have help from the family.

And emergencies happen all the time in labor and delivery. So, we can’t really slow down and say, “Oh, hold on. I’m going to take 10 minutes to put on my PPE,” because, well, we have to protect ourselves, but we’re on the clock. If there’s a fetal deceleration, we’re not just thinking about ourselves or the patient. We’re thinking about the patient, the baby, and now ourselves. So, it was this third-patient concept, which caused a lot of mental anguish and stress.

Kevin Pho: So, we often read about the end-of-life situations during the pandemic, but you’re absolutely right. Labor and delivery never stops during the pandemic. So, what are some of the things that you did specifically to help comfort some of the women who are in labor?

Maria Sheikh: I assured them, you know, if they were not COVID-positive. At that time, we were only testing people who were symptomatic or had a real reason to be tested, and then we were incorporating universal testing, which improved the anxiety of the whole situation for most of us. But to comfort them, I would let them know that even if they can’t have more of their family members, we are here for them. And we’re sharing in their fear and their grief about it. We’re all going through a collective grief, that we haven’t experienced something like this before, that we’re all in the same boat here. And we do whatever we can to make them feel better. If they want us to sit with them a little bit longer, that’s also possible. And we just kind of let them know that we’re all in this together and that they are not alone.

Kevin Pho: So, you wrote the article back in the beginning of April, and that was at the height of the pandemic. Can you share some of the challenges that you faced and how those challenges have evolved, because we’re filming this now, the first week of June?

Maria Sheikh: I would say the biggest challenge for me was the time constraints, because we had several patients who, like, in labor and delivery, the most nightmarish situation is if a patient just comes in through the door and then you don’t have fetal heart tones. The patient doesn’t even have an IV. You’re not even ready for anything. So, as anesthesiologists, we get the call from the obstetrician saying, “All right, hey, we’ve got to rush back to the OR.”

So, in a normal situation, in non-COVID days, we would be getting an IV, or we’ll be taking the patient to the OR. We have maybe our anesthesia resident physician or the attending getting an IV while we are pre-oxygenating the patient to go to sleep under general anesthesia, and we’re doing a crash stat C-section. So, that’s already an extremely stressful situation, and especially if you have a terminal fetal bradycardia or if you have no heart tones, we need to get that baby out as soon as possible.

Now, you add a symptomatic person under investigation in that same situation. They’re febrile. They maybe had recent sick contacts. So, getting on all of your PPE, getting on your N95 appropriately, if you’re using a respirator like a CAPR or PAPR, is just unrealistic in that situation. So, I thought it was almost darkly amusing that we practice all this and we train, but it’s not practical in an obstetric setting. Get our N95 on, get everything on, and be in the room and ready to go, and we are doing the most dangerous procedure. We’re doing an aerosolizing procedure in an uncontrolled setting.

So, it was kind of overcoming that stress, and we had a couple of real-life drills like that where we had to move quickly, and we were in our PPE, and we were head to toe just sweating, and you’re yelling, also, because people can’t hear you. It was just very challenging, and also with the patients, just trying to explain to them what was happening in that situation. Things are moving quickly, and nobody wants to be asleep for their C-section. Most people don’t. They want to be awake and be there for the baby.

So, we were trying to do all those things in a rapid manner, but also earning the trust of the patient, a patient who’s never met you before, as to why you’re putting a mask on her face and why you were attacking her from all sides. So we’re just trying to do all of those things very rapidly. On top of it, being in full PPE, that was the roughest of all, for people to realize that things were very tough for us.

Kevin Pho: And how’s the situation with the PPE now compared to back in early April?

Maria Sheikh: The situation is much better because of the universal testing, which we started in April, I believe. We now know if somebody is positive or negative. Of course, there are sensitivities and specificities, but if somebody tested positive, you can be pretty sure that they’re positive. But if they tested negative and if they’re still symptomatic, we might have a much better idea of who is positive, where to use the PPE, and where to conserve it, rather than just blindly, well, “We didn’t test this person because they didn’t meet the criteria,” and at the time, the criteria had been evolving. So, it’s being a lot more sure about where COVID patients might be.

Kevin Pho: So, let’s take a step back. I was wondering if you could share with my audience something that you’re passionate about or something that you’ve been curious about over the last few months.

Maria Sheikh: So, I’m quite curious, and most of our multidisciplinary research efforts with the OB team also are to study why certain populations are being disproportionately affected by COVID-19, especially in our obstetric population. We’re seeing very asymptomatic positives in the slightly lower socioeconomic status and people of color. And once again, they’re disproportionately affected by disease, and that’s an area that we’re studying right now. And as more research comes out across the world, I’d like to compare that with other data to see what other people are seeing across the world.

Kevin Pho: And my final question: What’s your take-home message for the KevinMD audience?

Maria Sheikh: My take-home message is that being a doctor is a very, very challenging experience, from premedical training to medical training, and even as you graduate on into your fellowship and also into being an attending physician, which is the transition I’m in right now. You need to find something that is uniquely yours, that really makes you feel like you’re doing something bigger than yourself. For me, that’s writing. It’s telling people’s stories also, kind of like how you’re doing here. And really, especially in this political climate and the unrest that we’re going through, it’s really finding something that centers you.

And also really listening to other people. It’s difficult to validate someone else’s experience if you haven’t experienced it yourself, but it’s really listening to other people and knowing that other people think differently than you. And that is the first step that we have to take if we want to make any change in our society. So, we change the world where we are before we go out to, you know, third-world countries that need changing. We have a lot of work to do here. So, find something that centers you, and really, really just learn to listen. Learn to listen a little bit more, and that, I think, will take you really far in medicine.

Kevin Pho: Well, thank you for sharing those wise words. On the show today, we have Maria Sheikh. She wrote the KevinMD article “Giving birth during the COVID-19 pandemic: an obstetric anesthesiologist’s perspective.” You can find her on The Epidural Doc at epiduraldoc.com. And Maria, thank you so much for being on the show.

Maria Sheikh: Thank you so much, Kevin.

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