I asked my midwife to put in an order for my 20-week anatomy ultrasound early, so that I could schedule enough in advance to make sure my husband was free to accompany me to the appointment. I knew how significant this ultrasound would be for us as first-time expecting parents.
For many, the 20-week ultrasound is the first time the idea of being a parent to a real human being starts to sink in: the previously amorphous shadows from the first trimester scans transform into recognizable fingers and toes; the heartbeat you heard on the doppler in routine office appointments becomes a moving jumping vessel before your eyes. And of course, many couples look forward to the chance to learn the sex of their baby – finally settling what we have been playfully guessing at for months.
More present in my mind, however, was how this ultrasound would also be a critical time that we would learn of any birth defects possibly affecting our baby. Our son would be scrutinized as the technician checked off a list of measurements and screenshots to send off for a physician’s review.
As a genetic counselor I am familiar with the significance of the 20-week ultrasound. Our training includes interning at a maternal fetal medicine department, counseling women who have pregnancies at higher risk of complications. I have been in the room with couples when a physician arrives to deliver the news that ultrasound anomalies have been discovered, some mild and others more serious. Soon they are whisked away to a genetic counselor’s office to discuss their options moving forward including invasive testing. It can be a time when potentially difficult decisions need to be made quickly.
I was taught in graduate school that there is a 3-4% chance for any pregnant woman to have a baby with a birth defect. These are relatively reassuring odds, but when you are trained to work in the world of medical genetics and rare diseases, events that seem unique to others feel common to us. In the back of my mind, this 20-week ultrasound would mark a kind of threshold where I would finally allow myself to let my guard down about our pregnancy. My husband understood that I was anxious about the anatomy scan and he was prepared to be my support system through this appointment.
I remember first hearing about how COVID-19 was affecting pregnant women and their prenatal care. Hospitals were restricting the number of visitors as a precaution and this was including pregnant women coming in for appointments. They would be required to attend alone. I was hearing from genetic counselors about their experiences counseling individuals who had received difficult news from their ultrasound, sometimes from a physician who was delivering this critical information through the office phone rather than face-to-face. Opposite a genetic counselor on a live video screen, these patients were now trying to absorb complex medical information and facing tough decisions.
I could not imagine how much more painful it would be to experience what was potentially one of the hardest days a person would endure, magnified by the fact that they would spend it alone in a room without human contact or support from a partner, family member, or friend.
Still, this scenario felt distant from my own personal experience because at the time, there had been no cases of COVID-19 close to home. When the date loomed closer, I messaged my midwife to double check their policies and was informed that I too would be required to attend my appointment alone.
“We understand that many pregnant individuals are experiencing increased stress and anxiety due to COVID-19” the American College of Obstetricians and Gynecologists (ACOG) said in a public statement. “When counseling pregnant individuals about COVID-19, it is important to acknowledge that these are unsettling times.” Prenatal care providers have always had a responsibility to assess the emotional needs of their pregnant patients, however without the presence of an in-person support person this task would fall solely on their shoulders.
Although the current situation caused by the viral outbreak is considered temporary, the length of time that patients will be affected, and to what degree, is still uncertain. Maternal Fetal Medicine offices have had to look for guidance from their professional societies. As with other healthcare disciplines, ACOG has encouraged their providers to ““maximize the use of telehealth across as many aspects of prenatal care as possible.”
For those prenatal visits that must occur in the office like ultrasounds, the Society for Maternal Fetal Medicine (SMFM) agrees with common hospital policies of limiting attendance of on-site appointments only to patients. “If a patient brings a visitor, the visitor…should be encouraged not to enter the ultrasound unit or exam room.”
SMFM has also proposed alterations in the frequency and spacing of necessary follow-up care visits. An initial ultrasound early in pregnancy to determine viability and number of embryos a woman is carrying could be deferred until 12 weeks when it can be combined with the ultrasound that measures nuchal translucency (NT) performed as part of screening for genetic abnormalities. SMFM has also advised putting “as much space as possible between follow-up ultrasound examinations” and recommends 2-month follow-up after the initial diagnosis of major fetal anomalies or for maternal conditions that can impact fetal growth.
After confirming that my husband would not be able to be present for our ultrasound, I experienced a number of emotions including disappointment, fear, and anger. I reached out to other women I knew who recently had babies of their own or were currently further along in their pregnancies for support. I was teary and anxious imagining how I could handle any problems that arose.
Despite my strong reaction in the days leading up to my appointment, the actual day of my anatomy ultrasound I surprisingly felt at peace. I had learned to accept that this is the current reality of a world with a viral pandemic. We have all been affected in some way, and one may not realize exactly how until it happens to them.
Thankfully, my ultrasound yielded good news. Our baby was healthy and growing well, and no major anomalies were identified. My technician provided me with extra pictures to bring home to my husband. She wrote down the sex of the baby in an envelope so that we could find out together that evening over dinner.
I know this experience will not be the last time that my pregnancy will be affected by COVID-19. My next routine visit to the midwife will be via telehealth. The healthcare providers taking care of us have recommended that I come back for a couple follow up ultrasounds to pay special attention to our baby’s heart and kidneys as a precaution. I have been told that I will be alone for those visits as well. Depending on the course of this epidemic, it is likely to impact my labor and delivery. There are certainly other elements to my pre and postnatal care that will change that I cannot yet imagine.
More importantly, I reflect on how many other expecting women and couples are dealing with their own questions and uncertainties during this time, and how this is a particularly difficult time to be experiencing a high-risk pregnancy. In the context of COVID 19, the MGH Center for Women’s Mental Health says, “It is difficult to describe how much things have changed.”
As with all the uncertainty the world is experiencing, we will need to recognize and accept these challenges as they develop. Whether we are together or apart, we will find the right tools to get us through.
If you have questions or concerns about the genetic health of you or your child, please contact Please contact the experts at Genetic Support Foundation for any questions or to schedule an appointment.