BY Pam McGrath
PHOTOS BY GREGG GOLDMAN
Marta Perez, MD, Michael Chomat, MD, and their son, Paul, at home
In mid-March 2020, Marta Perez, MD, left her Florida-based private practice in obstetrics and gynecology to return to Washington University School of Medicine and Barnes-Jewish Hospital. Perez had completed her obstetrics and gynecology residence at those institutions, and now her husband, Michael Chomat, MD, was finishing a pediatric cardiology fellowship at the School of Medicine and St. Louis Children’s Hospital, and about to begin a pediatric intensive care fellowship.
Perez welcomed the move because it provided her with the opportunity to change the focus of her career. Rather than continuing in private practice, she wanted to return to academic medicine and focus exclusively on obstetrics. Now, working as an academic laborist, she serves as a hospital-based obstetrician who helps women deliver their babies and teaches residents and medical students about obstetrics.
Two factors in the timing of the move to St. Louis would prove to be extraordinary—for the world and for Perez. First, by early spring 2020, the scope and severity of a new coronavirus became evident worldwide, resulting in a pandemic. And second, Perez had learned she was pregnant with her first child, about to face many of the challenges and uncertainties her pregnant patients were facing.
When did you and your colleagues realize the seriousness of the pandemic?
I’d say April to May 2020. At first, we thought we might have to lock down for a few weeks or months until the curve of infection flattened. But as time passed, it became apparent that efforts in the U.S. to control the virus were not working well. And that a short lockdown was not going to happen.
What changes did the Women & Infants Center at Barnes-Jewish Hospital make in regard to caring for women when it was time for them to deliver their babies?
I think the first important decision the hospital’s maternal-fetal medicine team made was to try to avoid adopting a strict no-visitor policy. This restriction was necessary in New York City during the height of the outbreak there, but luckily it was not as common a response to the pandemic in geographic locations such as St. Louis. A no-visitor policy would have been an isolating and traumatic solution, enforced at a time when pregnant women most need the support of loved ones. Instead, we were able to adopt a one-visitor policy that helped reduce at least some anxiety about giving birth alone.
We made another policy decision—to allow moms with COVID-19 to remain with their babies—which also proved to be comforting. In the beginning of the pandemic, we didn’t fully understand the relationship between the virus and potentially susceptible young babies and newborns. Many hospitals in the U.S. chose to separate a mother with COVID-19 from her newborn.
Our maternal-fetal team, working closely with the neonatal intensive care physicians at St. Louis Children’s Hospital, decided to keep COVID-19 moms and their babies together. This decision was supported by emerging data showing that if moms practiced good hand hygiene and masking when touching their babies, the rates of infection in newborns were very low. And of course, all physicians and nurses involved in delivery and care of newborns continue to adhere to strict preventive protocols for the benefit of moms and babies.
As the COVID-19 virus began to spread, how did you think it would affect pregnant women?
We didn’t have any data about how the COVID-19 virus behaved in pregnancy until we moved into the summer months of 2020. However, we already knew how respiratory viruses like the flu affect pregnant people. The physiologic changes occurring during pregnancy place these women at higher risk for severe disease when they contract a respiratory virus, and that has held true with COVID-19. We now know that pregnant people have a higher risk of severe disease, ICU admission and mechanical ventilation, as well as a higher risk of death, than non-pregnant people in the same age group.
Is there a difference in treating pregnant women with COVID-19 compared to those with the virus who are not pregnant?
Selecting treatments that benefit and stabilize the mother will also help the fetus. There may be indications that some mothers with severe COVID-19 need to deliver early; that can be a difficult and complicating decision.
What treatment considerations need to be made for women with COVID-19 during delivery?
We base the medical decisions we make during delivery on the mother’s clinical status. For instance, shortness of breath is common for pregnant people in their third trimester, and it is a common symptom of COVID-19. If a person is short of breath during delivery, we consider whether blood oxygen levels are in the normal range and what a chest X-ray indicates. She may or may not need additional ventilation support. How severely ill a patient is and the symptoms she has may also determine whether she delivers vaginally or by C-section.
You became pregnant right when St. Louis was experiencing its first surge of COVID-19 cases. What was it like for you during your pregnancy as you cared for patients or interacted with visitors who may have had the virus?
I was definitely concerned about getting COVID-19, especially since there is so much we don’t know about how the virus affects the placenta and whether it can cause complications during pregnancy. I was vigilant about wearing an N95 mask, washing my hands frequently and social distancing as well as I could. And another physician on the maternal-fetal team would step in when a patient with COVID-19 needed care. That was really helpful. But rapid COVID testing was not available during a good portion of my pregnancy, so there were times I found out a day or two after helping with a delivery that the patient had the virus.
This concern definitely added a layer of stress to my pregnancy, but diligence paid off because I did not get sick.
Now that COVID-19 vaccines are available, should pregnant women consider getting the shots?
None of the available vaccines were tested in pregnant people, or those who were breastfeeding. For that reason, we don’t have data from the trials on the effectiveness and safety of the vaccine in this patient population.
However, tens of thousands of pregnant people have chosen to get the vaccine, many of them health-care workers who had first access to the vaccines in December 2020. And Centers for Disease Control and Prevention (CDC) Director Dr. Rochelle Walensky has recommended the COVID vaccine for pregnant people.
Now we are starting to see early data from researchers unaffiliated with manufacturers—and from the CDC—that indicates pregnant people have no increased adverse reaction to the vaccine compared with non-pregnant people and that they generate antibodies that pass the placenta. New research from Washington University School of Medicine suggests that nursing mothers who receive a COVID-19 vaccine may pass protective antibodies to their babies through breast milk for at least 80 days following vaccination.
It’s exciting to see research showing the benefits of vaccination. Data indicate that the fetus and neonate receive COVID-19 antibodies during pregnancy and through breastfeeding. Ongoing trials with pregnant patients receiving COVID-19 vaccines will soon give us even more data.
What have you learned about pregnancy during a worldwide pandemic?
It’s been difficult because the pandemic has taken away a lot of the normal, joyful experiences pregnant people usually have, from little pleasures like attending baby showers to more significant ones, such as having more than one person present at pregnancy visits, ultrasounds or the birth itself. The isolation all of us have experienced during this pandemic was exacerbated during pregnancy and postpartum. For that reason, we encourage pregnant people to take care of themselves by asking for help and creating a support system.
At the same time, however, we’ve seen how resilient pregnant people can be as they face each challenge of this “new reality.” Despite this strange pandemic year, there’s a joy each family feels when they see their newborn. It has been a privilege for me to be part of that experience.