The pandemic has reshaped the experience of childbirth in New York hospitals, adding more tension into what is an already uncertain event.
Rebecca Arian, a few hours into labour at a Brooklyn hospital, was balancing on her hands and knees, trying to ease a biting contraction in her lower abdomen with no painkillers.
Then her midwife walked into the room and delivered upsetting news: Arian, 32, had tested positive for the coronavirus. While Arian tried to process this, the staff asked her to put on a surgical mask.
Wearing the mask during childbirth made it feel like she was gasping for air while her body was splitting in half, she said. In that moment, a potential diagnosis of Covid-19, the illness caused by the virus, was the last thing on her mind.
"I was dealing with the idea of getting the baby out of me," said Arian, whose son was born in May.
Each year, over 100,000 infants are born in New York City, where the pandemic has now reshaped the experience of childbirth. The virus has added more tension into what is an already uncertain process, as women are entering hospitals that have been overrun by a disease that has killed nearly 22,000 in the city and more than 120,000 nationwide.
Most women, like Arian, are immediately tested for Covid-19 when they enter maternity wards; then they may spend hours waiting for the result. In many cases, they go through labour in a mask. Some pregnant women with the virus have reported feeling shunned by staff members who they believe are fearful of contracting the illness.
Jesse Pournaras, a New York City-based doula, has tracked hospital policies in the city during the crisis and says they have been difficult to determine and "extraordinarily variable," and have contributed to New Yorkers' anxiety.
"People are confused and they're upset, and they're going into the labour and delivery units in a state of fight or flight," Pournaras said.
During the pandemic, Governor Andrew M. Cuomo has tried to shape guidelines for childbirth at hospitals, but his executive orders on the subject created confusion because facilities interpreted them differently. Critics have also said it felt like New York slid back to a time when pregnant women had less input over their care.
New York City's Department of Health said that to protect health workers and patients, it was providing guidance to hospitals from the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynaecologists. But the CDC advises each facility to adopt policies based on rates of community transmission, as well as on space and staffing needs.
In late March, after public outcry, Cuomo reversed a new rule banning partners from labour and delivery wards. In April, under another order, he clarified that hospitals are required to allow partners and doulas to stay with most patients through labour, delivery and postpartum care.
His office convened a Covid-19 Maternity Task Force that released recommendations in April for birthing facilities, which included universal testing for patients and partners, after a study in New York City found that nearly 14% of pregnant women who tested positive for the virus were asymptomatic.
Dr. Dena Goffman, the chief of obstetrics at NewYork-Presbyterian Hospital/Columbia University Medical Center and an author of that study, said that she recognised the stress of the circumstances, and that her team was "working around the clock" to create rules that would keep everyone safe.
"I think the hospital is still the safest place to have a baby," Goffman said.
Infectious diseases experts said there had been little evidence of maternity patients acquiring the virus in the hospital.
"We have not seen a significant number of hospital-acquired infections in labour and delivery," Dr. Jeanne Sheffield, director of the Division of Maternal-Fetal Medicine at Johns Hopkins.
However, Sheffield said, labour and delivery staff members have reported getting sick after being exposed to virus-positive patients.
"We certainly do know of cases that came in positive and ended up transmitting to nurses and physicians," she said. "Those reports were more abundant earlier on in the outbreak and have become less as we've learned to screen better and do better testing."
On the whole, maternity care has morphed in the wake of the virus. In-person prenatal appointments are being canceled or conducted remotely, especially if someone has symptoms of Covid-19. Hospitals have suspended maternity ward tours and obstetric classes.
Doulas and one healthy support person are now allowed in the delivery room in most hospitals in New York City. But typically no one can leave the room once they arrive.
"I'm teaching my patients to go in like they're camping," said Denise Bolds, a doula who works in the city. "I'm telling my families they have to pack food, hydration and clothing."
Hannah Mermelstein, 40, said she sat with her partner, Gretchen Virkler, 36, for three days as she laboured at Maimonides Medical Center in Brooklyn. Then their medical team called for a caesarean section. The hospital's policy — which has since changed — meant Mermelstein was not allowed in the room.
As Virkler prepared to go to the operating room, tears fell down their faces and they sang to each other in Hebrew.
"I wanted to be there for the birth of my child and I wanted to be there for Gretchen," Mermelstein said.
A spokeswoman for Maimonides said that at the time, it would have been impossible to social distance in the operating room. So instead, Mermelstein called a midwife on FaceTime so that she could watch her daughter come into the world.
Rachel Beider, 36, was so scared to enter the hospital in late March that she left a note to her husband, in case anything went wrong. "I just had a really bad feeling," she said. "I was just telling him how much I love him."
When the couple checked into a room at Metropolitan Hospital Center in Manhattan, Beider said she immediately wiped the room down with hand sanitiser. She wished that she could distance herself from the staff members in masks who kept coming in.
Beider and her baby, Noah, are healthy. But in retrospect, she said, she would have left the city for the birth.
"It was genuinely scary," she said.
In some cases, hospitals have separated women who test positive for Covid-19 from their newborns to protect the infants.
Cristal Brown, 36, of Brooklyn, checked into NewYork-Presbyterian/Lower Manhattan Hospital to give birth in late March. She was tested for the coronavirus when she arrived.
The next morning, Brown learned her result was positive. Her boyfriend, Jose Bueno, was asked to leave immediately. "I felt shocked and helpless," she said.
When the baby was born, a hospital worker held up the child — named Jose after his father — so that Brown could see him. Then the staff quickly took him away.
"I never held him, put him on my chest," she said.
Brown did not see her son again for nearly two days, and said that she had to ask multiple times for updates.
"I felt super guilty," she said. "I felt like I couldn't protect him, or help him, or explain to him what was going on."
Some hospitals that were heavily hit by the pandemic had fewer nurses on the maternity floors to care for patients.
Sara Capitani, 49, a maternity nurse at the Brooklyn Hospital Center, remembered driving past temporary morgues when she arrived at work each morning.
Walking onto the labour and delivery unit, many of the rooms were occupied by women who had the coronavirus or who were suspected of having it. Nurses were also calling out sick, which made it harder for Capitani to do her job.
She said she brought her own Tyvek suits and N95 masks into work to reduce her chances of getting sick.
"It's not so much a fear of the patient," she said. "It was this invisible beast. And just by caring for this person, am I at risk? I felt ashamed."
Three hours after Arian learned she had the virus, she gave birth to her son, Geva Eliyah, named for her grandfather, at NewYork Presbyterian/Brooklyn Methodist Hospital.
Health care workers put the baby in an Isolette, an enclosed plastic box that is used for premature infants. They told Arian to wear a mask and only pick him up if she was breastfeeding.
She said that she barely slept and felt like she had to repeatedly ask for help. She asked for ice packs to soothe sore spots and mittens to stop Geva from scratching his face. A nurse who brought the ice left it by the door to avoid entering the room.
"It felt like I was in Puritan New England, and I had a scarlet letter on my chest," Arian said.
But she understood the staff was also worried. "I could definitely feel this heightened level of anxiety," she said.
In the weeks since giving birth, Arian has had two negative tests and has not developed any virus symptoms.
"Even though I feel very sad that I did not get to have the experience of becoming a parent that I wanted," she said, "I'm also really glad that Geva is able to brighten people's day in the middle of a really dark time."
Written by: Katie Van Syckle
Photographs by: Alice Proujansky
© 2020 THE NEW YORK TIMES