For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.

The COVID-19 outbreak is drastically changing the way health-care workers in emergency rooms across the country operate—but what if you are both a frontline health worker and you’re pregnant?

“Working in an ER is not conducive to being pregnant. We’re constantly on our feet and exposed to sick people and high-intensity situations,” said Dr. Elizabeth P. Clayborne, an emergency room physician at the University of Maryland Prince George’s Hospital Center in Maryland. “As an ER physician, I normally work in a hectic and stressful environment, but the COVID-19 pandemic has created another level of chaos.”

The pandemic is uniquely affecting expectant parents, as many unknowns surround COVID-19 and pregnancy. The American College of Obstetricians and Gynecologists (ACOG) stated in March that pregnant people should be considered an “at-risk” group, though current data doesn’t indicate whether they’re at increased risk of infection. In hard-hit areas such as New York City, some hospitals have placed restrictions on the number of visitors during labor and delivery. New parents who have tested positive for COVID-19 may be separated from their newborn.

“Many providers are frustrated with the lack of organization, consistent information, and understanding of the steps coming from the government, hospital systems, and professional organizations,” Clayborne said. “We’ve entered uncharted territory, and it’s clear that while we’re all well-intentioned, the outcome will be devastating no matter what we do.”

Rewire.News spoke with Clayborne, who is pregnant and treating COVID-19 patients; she shared how the pandemic is impacting the ER and what she’s learned from the front lines of fighting the virus. The following interview has been lightly edited for clarity.

Name: Dr. Elizabeth P. Clayborne
Age: 36
Location: Prince George’s County, Maryland
Occupation: Emergency medicine physician at the University of Maryland Prince George’s Hospital Center

Tell us a little bit about your work.

I work in a busy, underserved area of Prince George’s County, Maryland, just outside of Washington, D.C. I take care of patients of all ages with problems as simple as a sprained ankle to as life-threatening as a stroke or heart attack. I always tell everyone you don’t want just a doctor on your flight, you want an ER doctor!

I see the extremes of human nature—we witness people in their lowest and most vulnerable moments but are also present for the beauty of human nature and the infectious energy of hope, love, and care.

Can you take us back to the moment you realized you’d be working directly with the COVID-19 pandemic?

I first heard about coronavirus in mid-February when it seemed severe outside of the United States, but within a week it became clear the virus was spreading quickly and would become an international crisis. I was six months pregnant. I went into preterm labor with my daughter, who is a toddler, likely from working too hard in my third trimester. Working in an ER is not conducive to being pregnant. We’re constantly on our feet and exposed to sick people and high-intensity situations.

Early on, it was clear that coronavirus was very contagious and could be spread by asymptotic patients. I was aware that this disease would be a serious threat to our elderly population and those with weakened immune systems, but I wasn’t prepared for the news that it could ravage the young, be unresponsive to medical treatments, and kill fellow health-care providers. The scariest part is knowing that we don’t understand why some people have mild cases and others do so poorly.

In the last month, my thoughts and fears have drastically changed. I’m taking a risk—my weakened immune system puts me in jeopardy for preterm labor, which would mean having a premature infant in a hospital full of sick people and possibly no ventilators. This is terrifying.

Every day, I’m balancing my decision to help patients and not abandon my fellow physicians with my instinct to protect myself and my children at all costs. I’m currently working with three other pregnant providers, and our absence at the same time would strain the department. My superiors have made it clear that I can stop working at any time.

How has the COVID-19 outbreak affected your work?

COVID-19 has become all-consuming. It’s on the mind of every health-care provider every hour of every shift that they work.

I come to work prepared to find out the status of our PPE (personal protection equipment) supply and understand new protocols for triage, airway management, and testing. I now expect things to change on an hourly basis. We’re on the front lines of a global war against an enemy that does not see age, race, religion, nationality, or economic status.

Most ER physicians are even-keeled, calm, collected, and operate with precision and confidence during times of chaos. I became more worried when I noticed peers, advisers, and veterans start to crack. Other local hospitals are initiating surge protocols and are running out of ventilators.

The air is tense when I enter the ER. You can feel the anxiety in the department from the patients and staff. It’s an eerie and unfamiliar feeling.

With all of those changes in mind, what are some of your worries, fears, or frustrations surrounding your work right now?

We’re preparing for difficult decisions that have never faced our health-care workforce. We’re calling on experts in our field and across the spectrum of science and ethics to decide how to best use scarce resources.

Many providers are frustrated with the lack of organization, consistent information, and understanding of the steps coming from the government, hospital systems, and professional organizations. We’ve entered uncharted territory and it’s clear that while we’re all well-intentioned, the outcome will be devastating no matter what we do.

How has that extra anxiety impacted your pregnancy?

Stress can negatively impact pregnant mothers. Caring for patients on the front lines of COVID-19 is stressful. Simple things such as drinking water on a shift is difficult since I’m constantly wearing a mask.

I’m careful to be conscious of my mood, fatigue, and physical needs. I remind myself that I won’t be helpful to anyone if I’m sick. I’m taking it a day at a time for now but trying to be honest with myself and know my limitations.

I’m most concerned about getting my daughter sick or going into preterm labor and jeopardizing the life of my unborn baby. I sat down with my husband and reminded him of my wishes if I become acutely ill, what I’d want if our baby can be saved, or if difficult decisions would have to be made about my life or the lives of our children.

This is a sobering and chilling moment, to admit that my mortality is real and that death, which I am confronted with at work regularly, could be the outcome of my illness or my loved ones’.

What is keeping you hopeful and positive among all of this chaos?

Every day I receive text messages, calls, and social media posts from family and friends who remind me that they’re praying for me, proud of the work I’m doing, and admire the health-care hero I’ve become. I’m struck by the positive energy that has come out of this crisis, by the laughter and enjoyment of families spending time at home with one another, and by the charity and renewed sense of community that has arisen from the charge to help one another.

Even though I think some of our darkest days may lie ahead as we face the medical and financial fallout from this devastating disease, I’m encouraged that it has brought to the forefront our most important human qualities of hope, love, compassion, and resilience. The COVID-19 pandemic will help to renew the global sense of community and our responsibility to care for one another to prosper.