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Delivering Babies During a Pandemic: Dr. Heather Kipa-Joseph

If you've been following this series, you know we have been profiling families who have given birth during this pandemic, are expecting or have had to halt or adjust their fertility and/or adoption proceedings due to the coronavirus pandemic. It's been powerful to read the stories of families navigating a new path through the joy we've come to assume and expect in regards to growing a family.

This week is a little different. In a series about the journey to bring life into this world, it would be a missed opportunity if we didn't allow space and acknowledge our healthcare heroes working tirelessly on the frontlines, delivering babies and more during these uncertain times. So, we took the time to speak with Dr. Heather Kipa-Joseph, who serves families at Swedish Issaquah and has been practicing for more than 15 years. Her voice is an important one that's beyond necessary to elevate.

When she's not working with growing families, you can find Dr. Kipa-Joseph enjoying time with her husband, two sons and chocolate lab. Living in the PNW, this family loves biking, hiking, traveling and exploring.

Seattle Refined: Ok — let's set the stage. It's March 23, 2020, and Gov. Inslee just issued the 'Stay Home, Stay Healthy' order. As a doctor, what were your immediate thoughts? How had the medical world been prepping for this possibility as news of COVID spread worldwide?
My immediate thoughts: Shock. Disbelief. Fear. Is this just a nightmare I will wake up from tomorrow? Can this really be happening? Our hospital immediately went into disaster plan. We were introduced to PPE, underwent N-95 mask fitting, how to don and doff garments to keep from getting infected. Virtual medicine was introduced and implemented within days.

Wait, what — PPE? Don & doff? Electronic visits? What do I tell patients? I knew nothing of this virus and its effects in pregnancy. How could I help my patients when I knew nothing??? Back to changes; routine visits canceled. Pregnancy classes canceled. Emergency office visits only — half in person, half virtual. All of our staff learning as they go, mostly from home. Office family, gone, just left with texting, emailing and group chatting with my team members. Surgeries were canceled. Hospital rooms being remodeled as negative pressure rooms. Screening checkpoints created at every hospital entrance for every patient and employee. Absolutely no visitors or companions. As for Labor and Delivery, patients were limited to one support person and absolutely no leaving their room. If I remember correctly, most of this happened before the Governor's announcement.

Take us forward from there. How did your job change? What were you thinking/feeling? What kind of prep & processes did you have that you didn't have prior when working with expectant families?
My job changed tremendously. So much of what I enjoyed about medicine changed. I went into this survival mode, as did most people. We discussed and did only what was absolutely necessary. All of our ancillary services were canceled (no prenatal classes, no physical therapy, prenatal massage, support groups), so education about pregnancy became more generalized and less individualized. I had less opportunity to get to know my patients and their families, less time creating personal connections/relationships. The idea of holding someone's hand to comfort them when they just found out of their miscarriage or a huge hug of congratulations after delivery of their baby no longer existed. Medicine became robotic. And, for the most part, patients were understanding about this change.

What have been your biggest joys during this time?
Strength of so many people — hospital and office staff, nurses, doctors, my group. They have been the ones who come to work every day, risking their lives every day to provide the best care they can. From the staff that work at our front desk checking in patients for their appointments to the tremendously hard-working nurses and doctors providing endless advice over the telephone or email and at the bedside, they are angels, my angels. They have been my strength to keep going, to never give up.

Also, the strength and resilience of my children. My children are a true inspiration. With every change: school closing (although that was pretty easy for them to handle initially), to cancelation of all after-school activities (baseball, marching band, piano), to online learning, then hybrid learning and now back at school full time with masks, they persevered. Don't get me wrong, there were many times of tears and frustration, but they kept going. They adapted. They even tried new things, joined new online after-school activities (debate, temple youth group, jazz band)! Voluntarily trying new things in a pandemic, seriously?!

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What have been your biggest hurdles during this time?
Finding support for patients before, during and after pregnancy. With closed borders to family members sharing different opinions about COVID, many patients have found themselves alone. This joyous time became filled with reluctance and uncertainty. The lack of family support only added fuel to the fire of fear and doubt.

Finding accessible mental health professionals as people struggle with anxiety and depression from this fear and isolation. A mental health crisis was identified before COVID. This pandemic stressed out the current system. Our mental health providers are so overbooked and overextended. It is hard for everyone.

Fear of infecting other people — patients and family members. Every day I go to the office, I change into scrubs and work shoes. I clean my desk with disinfectant wipes. I continuously wear a mask, sanitize my hands before and after each patient visit and wear gloves with every examination. It has become my new norm.

Before my children were able to be vaccinated, I changed out of my clothes and showered immediately before seeing anyone at home. I wiped down every light switch, remote and toilet 2-3 times a week. Lysol was a new best friend. I had a very small bubble and forced my children to do the same. I couldn't live with ever harming another person. Thankfully, my family was and still is very supportive and understanding. It did set me up for struggling with the depression from the isolation. However, through behavioral therapy and meditation, I am feeling better.

But by far, the biggest hurdle has been getting pregnant and lactating patients vaccinated. Trying to separate fact from fiction, science from politics, has been extremely challenging — something I have never encountered before while in practice. I encourage my patients to ask questions, take control of their health and, if in doubt, get a second opinion. But politicization and disinformation have significantly undermined medical and scientific facts. This lack of confidence is attributing to the strain on our hospitals and all the healthcare providers who work within them.

Final Update: Where do things stand now? What's it like in your delivery room these days?
We have come a long way since January 2020, but we are far from done. As a profession, we are adaptable and resilient, but not sure we can manage our resources and keep hospital and office staff healthy for however long this pandemic lasts. We definitely are struggling with a staffing shortage in the hospital and are relying on "travel nurses" to bridge the gaps. Our staff who have been there since the beginning have had to step up to train and support them in hopes they may consider a permanent position. Currently, in our delivery room, we are able to provide one-to-one nursing care when in active labor. We do require masks for all unvaccinated patients, all partners. Patients are allowed to have two support people and a certified doula if desired.

Initially, this was an enormous adjustment. Now, parents are appreciating this time to themselves — getting to know the newest member of their family, working with doctors and postpartum nurses discussing their recovery, meeting with lactation consultants, sleeping when able and not entertaining endless visitors. It actually has become a less stressful environment in that way.

For people whose loved ones are giving birth, pregnant, bringing a baby home or on fertility journeys right now – from a doctor's standpoint, what words of advice can you give?
Today is a gift. Use it as if it were your last. People often try to determine when is the best time to start a family or have another child. No one has the correct answer. So, if you see yourself with child/children, then there is no time like the present. I would recommend talking with your Ob/Gyn to help prepare for this journey — emotionally, mentally and physically as well as provide current hospital environment.

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And to other families reading this, working to grow their families but worried about the state of hospitals, frontline workers, the medical world in general right now — any words of encouragement, support or advice?
Like most things, this will make us stronger. No one goes through trauma without learning from it. When you think about those who have lived through the Great Depression, World War II and the Cold War — humans have persisted. They have seen extremely tough times but survived. We can too. We are learning. We will continue to grow through kindness and compassion.

My best advice, get vaccinated. It is the only way COVID will become part of our past and not persist into our future.

Whether you're expecting, already welcomed a little one, or had to put your fertility treatment or adoption proceedings on hold due to COVID-19, we'd love to hear from you and share your story in this weekly feature on Seattle Refined. Email Kateneidigh611@gmail.com or reach out on Instagram @June.In.January to be featured.

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