Caring for Special Populations
- Planning Guide. Fill out your own plan for returning home
The term “elective” is often used to describe procedures for which there is no medical indication. As you know, the health system is currently canceling many elective surgeries and procedures in order to keep patients without acute care needs out of the hospital during the peak of the COVID-19 epidemic. For a surgery that can be rescheduled later this year with no health consequences for the patient, this makes sense. However, childbirth is unique in that it absolutely has to happen- no one at the end of their third trimester can postpone giving birth for several months.
In the past, researchers believed that labor induction increased the risk of cesarean delivery. Typically, women who deliver via cesarean spend more time as inpatients than women who deliver vaginally. In 2018, the ARRIVE study (A Randomized Trial of Induction Versus Expectant Management) concluded that the risk of cesarean delivery is not increased by induction of labor in the 39th week of pregnancy and therefore does not lead to much longer hospital stays for post-partum women.
This is great news for pregnant women interested in induction and has the double effect of helping hospitals prepare for a potential “surge” of patients during COVID-19 although the practice began before the current pandemic. Women who are ready to give birth and who are at least 39 weeks pregnant, can be induced now, with no fetal risk and no increased risk of a cesarean delivery.
-Sindhu K. Srinivas, MD, MSCE, Associate Professor, Director of Obstetrical Services at the Hospital of the University of Pennsylvania and Vice Chair for Quality and Safety in the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine
- FAQ on Pregnancy and Breastfeeding
Compiled by Dr. Florence Momplaisir, Assistant Professor of Infectious Disease, Hospital of the University of Pennsylvania and Dr. Karen Puopolo, Chief, Section on Newborn Pediatrics, Pennsylvania Hospital, Associate Professor of Clinical Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA ***All OB policies in this document reflect current practice at HUP. If you don’t plan to deliver at HUP, please check with your OB provider about policies at the hospital where you will deliver.
A mother with confirmed COVID-19 or who is a symptomatic person-under-investigation (PUI) for COVID-19 should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well care for and feed the expressed breast milk to the infant.
Persons with confirmed COVID-19 infection should remain separate (home isolation precautions) from other family members and friends or neighbors including the infant, except for breastfeeding.
Ideally there is another uninfected adult to care for the infant’s needs including feeding the infant expressed breastmilk if the mother is expressing milk and working to maintain her supply of milk. The mother should practice careful hand washing and use of a mask as noted above for at least 5-7 days until cough and respiratory secretions are dramatically improved. It may be useful to involve a healthcare professional and/or the health department in the decision to discontinue home isolation precautions.
FAQ on Pregnancy and Breastfeeding. Compiled by Dr. Florence Momplaisir, Assistant Professor of Infectious Disease, Hospital of the University of Pennsylvania and Dr. Karen Puopolo, Chief, Section on Newborn Pediatrics, Pennsylvania Hospital, Associate Professor of Clinical Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA ***All OB policies in this document reflect current practice at HUP. If you don’t plan to deliver at HUP, please check with your OB provider about policies at the hospital where you will deliver.
In these times of uncertainty, it can be challenging to know how to prepare yourself and your family for a period of illness or “quarantine,” self-isolation, or potentially long periods of disruption due to restrictions on business and local services. These situations can be especially challenging for older adults ...
I do think using FaceTime and Zoom with older adults can really help. We assume that they can't use technology, but that is not true-- especially for the "younger" older adults who have smart phones. Additionally, caregivers are likely to have phones which can be used-- even if your loved one isn't able to communicate back, it is reassuring for family to see their parent ... Read more recommendations from Dr. Rachel Miller and Mariana Gonzalez, MD, MPH, Geriatrics Fellow, on how older adults -and their caregivers -can prepare to weather the coronavirus pandemic ...