Pregnant women in Sonoma County filled with hope, fear amid coronavirus pandemic

Brenna and Jim Paustenbach have been trying to get pregnant for years. When the pair found out they were due in August, they were over the moon. Jim Paustenbach calls his unborn child “Baby P.”

So when the couple went to a prenatal appointment on March 30 to learn the baby's gender, their excitement was palpable. But Jim Paustenbach was prevented from entering the building, even though he was wearing gloves and a mask like he had routinely donned for doctors' visits with his wife. The disappointment was searing.

“We expected my husband could go with me. It's a big moment,” Brenna Paustenbach said. “We got there and they turned him away at the door.”

It is a scene repeated over and over in Sonoma County, where 12 babies are born every day, on average.

Kaiser Permanente, like many health care providers in Sonoma County, is now limiting the number of people it sees in medical settings in order to limit the spread of the coronavirus. Pregnancy care and delivery protocols are changing at a dizzying pace.

Pregnant women are classified among high-risk populations susceptible to the pandemic, but research is scant on how the virus and the associated respiratory disease COVID-19 affect pregnant women or their unborn children. That uncertainty, in a time when many parents-to-be are already feeling excited and anxious, makes this generation of pregnancies especially emotional.

Brenna Paustenbach, an administrator who works at a biopharmaceutical company in San Rafael and lives in Rohnert Park, feels it all. And the self-described studier and planner, who has researched every step in her 40-week pregnancy journey, knows the safety protocols put in place by health care providers make sense during a historic pandemic. But the emotional wallop of leaving her husband outside on the day they were to learn the sex of their unborn child? It was too much.

“I cried for a lot of the appointment,” she said.

So the quick-thinking technician offered to print out the sonogram, slip it into an envelope and seal it so the Paustenbachs could open it together.

“She could tell I was really emotional,” she said.

Brenna Paustenbach brought the sealed envelope to the car where her husband was waiting for her. They didn't wait.

“We took a selfie in the parking lot, with our masks and our gloves on,” she said. “We'll never forget it.”

And?

“We're having a girl,” she said.

Questions, no answers

While pregnant women are considered a high-risk population, the Centers for Disease Control reports that it is not known whether expectant moms are at a greater risk of contracting COVID-19 or of getting more seriously ill if they do become infected. The disease is too new, the sample size too small.

“That is a big question,” said Dr. Erin Lund, maternity care director at the Sutter Santa Rosa Family Medicine Residency Program and a family physician with Santa Rosa Community Health.

“We are not seeing rates of complication in pregnant women that makes us think that (it's more dangerous) compared to SARS and compared to flu, but it might be because the data is not great still,” she said. “I don't think anyone is comfortable saying, ‘No definitely you are not at higher risk.'?”

And that is a difficult spot to be in as a physician.

“I think we always want to provide factual, up-to-date, evidence-based recommendations and it's really hard to do that when the evidence is literally coming in different every day,” she said. “Just today I got another email on labor and delivery guidelines for COVID. It just came out. We're trying to read all this and keep up with this and see what is different, knowing that what this says today and we are telling our patients today could be different from what we are telling our patients a week from now. We just don't know everything there is to know.”

Lund understands the frustrations of her fellow professionals who do not have all of the answers about a new virus. But she also understands the desires of an expectant mother seeking as much information as possible to keep herself and her baby safe: Lund is almost six months pregnant with her second child.

The CDC has also not determined if the health of the baby is put at risk during either pregnancy or delivery if the mother tests positive for COVID-19. The virus has not been found in amniotic fluid or breast milk.

Still, health care providers have largely modified their schedules for patient visits, moving many to phone or video conferences to lessen the chance an expectant mother could be exposed to the virus in a hospital or clinical setting.

Appointments that were four weeks apart are now held six to eight weeks apart, and information that can only be gleaned in person is being folded into a single visit, to the extent possible.

But there are limits to that strategy.

“It's hard to assess blood pressure and fetal position on the phone,” Lund said.

Will he be there?

For Monika Zapata, a crucial piece of her way forward with labor and delivery is making sure her husband, Jose, can be with her. Jose Zapata works in construction, a profession considered essential under shelter-in-place edicts, so he has been out in the wider world while Monika has been at their Santa Rosa home with their 4-year-old daughter.

Monika limits her trips out and Jose does the vast majority of the grocery shopping and errands, and he has a full cleansing routine when he returns to their Santa Rosa home. But still, there is concern. Current protocol calls for a newborn to be separated from a COVID-19 positive mom.

And if Jose Zapata gets sick, he will not be allowed in the labor and delivery room with his wife.

“My husband is still working, so my fear is also very much around him getting sick and not being able to support me,” she said.

In places like New York City, considered the U.S. epicenter of the pandemic, policymakers have changed rules on who is allowed in labor and delivery rooms multiple times, sending waves of unease to expecting partners in New York and beyond.

Brenna Paustenbach has been following those reports.

“I woke up from a dream that they won't let him in the delivery room. I woke up from this dream and instantly Googled it,” she said. “I can't even fathom having a baby without having him there.”

It's a major concern for Monika Zapata, too. Thinking through her options if her husband was, for some reason, not able to be with her?

“That was when I emotionally unhinged, so to speak,” she said.

Due in mid-May, Zapata plans to deliver at the Santa Rosa Birth Center. She feels more confident her husband will be allowed to stay at the center and support the birth of their son. The choice also allays her fears about being in a hospital at what could be the height of the COVID-19 outbreak locally.

“I think if we were in a delivery room I would feel more anxious and more concerned being mixed with more nurses and having so many people around,” she said.

But while the birth center allows a partner to be in the labor area, no one under 18 is admitted ­- leaving Zapata with a substantial dilemma.

“That limits us for child care purposes, so that adds an extra layer,” said Zapata, the primary caregiver for the couple's 4-year-old daughter.

In the age of a pandemic, it's not simply about finding a babysitter at any hour that labor may begin. With a highly contagious virus, parents are increasingly anxious about who is a safe choice to care for their older children, keeping in mind the health of both the caregivers and the children. It's a hurdle that weighs on Zapata.

“Originally we were going to have my daughter stay with my parents. Now we have to step back and make the right choice,” she said. “We are not sure how that is going to look yet. It's unsure.”

Child care concerns are pushing many moms-to-be toward home birth, Zapata said.

Fear and hope

There are other, perhaps less obvious, moments of pregnancy that are also changing for women everywhere.

Brenna Paustenbach savors these last few months of life with just her and Jim and their 1-year-old golden retriever, Indigo, but thinks it would be nice if they could share a dinner out. Or tour a winery. Or make an acupuncture appointment for her aching back.

And Zapata already misses the baby shower she will never have.

For many, a baby shower isn't all about the brunch or the over-the-top gift registry. It can mean generations of moms coming together to impart a little wisdom, to offer a bit of advice and to give evidence that it all can be done. There is a reason - beyond the bounty of gifts - that showers have remained a tradition in expecting mothers' lives.

“Those are hard moments to accept,” Zapata said.

Lund encourages her patients to see the light. Stress isn't good for anyone, especially pregnant women. The rate of information and the speed that it changes related to the pandemic can be overwhelming for women trying to navigate a sometimes emotionally perilous journey in the best of times.

“We know that chronic stress definitely has negative pregnancy outcomes - premature delivery, poor weight gain, poor baby weight gain,” she said.

But the worries can be real and Lund knows it.

“I am trying to help people be in the moment, day to day. I have been counseling all of my patients not to be constantly on social media or the news,” she said. “Prioritize self-care, prioritize sleep. If you have other kids, focus on them. … A lot of people I'm talking to, they are afraid to go outside at all but outside is safer than inside places.”

For Jim Paustenbach, his job in this journey, he said, has been to be the yin to his wife's yang. He's the comic relief to her diligent planning and scheduling. He's also an anchor when he feels his wife might drift away with worry or emotions that flare far more vibrant for her than they do for him.

But sometimes dads, too, need to let go. As is typical, he had held tight to the news that they were pregnant until after Brenna passed the three-month mark. That's also the mark where partners are both invited in to hear the ultrasound. This was before any restrictions on who, and who couldn't, come to appointments.

“As soon as we got to three months and we got to hear the heartbeat, I literally walked out of there screaming at the top of my lungs. It was really embarrassing for Brenna,” he said. “But I've been waiting to be a father for many years.”

And he knows there is worry and we are at a particularly trying moment in history. But he, like Lund suggests, is choosing to focus on the light. “Baby P is on the way,” he said.

“It is a bit scary looking forward,” he said. “But it's a lot of hope, too.”

You can reach Staff Writer Kerry Benefield at 707-526-8671 or kerry.benefield@pressdemocrat.com, on Twitter @benefield and on Instagram at kerry.benefield.