For continuing coverage of how COVID-19 is affecting reproductive health, check out our Special Report.
States are extending their COVID-19 lockdowns as they fight to slow the spread of the virus that has interrupted every part of life in the United States. As the weeks and months of quarantine and distancing add up, questions about how and when to pursue medical care persist. And if you’re like us at Rewire.News, you have myriad questions about how the coronavirus outbreak may affect abortion access, or how it might impact a reproductive health system that had already been undermined by the Trump administration and many state governments.
Dr. Diana Wu, a family medicine physician in New Hampshire and Physicians for Reproductive Health fellow, returned to answer more questions from Rewire.News staff and readers. The interview, conducted over email last week, has been lightly edited for clarity.
Rewire.News: If health centers have stopped taking appointments, what’s the best way to get my birth control?
Dr. Diana Wu: Everyone deserves access to the birth control method that is right for them, especially during a pandemic. Reach out to your established health center or clinic to see if they are doing video or phone telehealth appointments. If you just need a refill of birth control, many health-care providers are willing to do this without an appointment at this time. If you cannot find a health center or clinic to provide telehealth, there are many established telehealth groups. Some of them are listed here.
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What happens if I want to terminate my pregnancy during lockdown? What are my options?
DW: You can still access abortion care during the COVID-19 pandemic, with few exceptions. In general, your options for pregnancy termination are medication or procedural abortion, and this decision should be made in consultation with a health-care provider. Call ahead or check their website to see what protocols may be in place as they adjust to conditions with the pandemic.
Be wary of anti-abortion clinics, or unregulated crisis pregnancy centers, that are open with the primary goal of convincing patients not to get an abortion. Use this National Abortion Federation website to find a reputable clinic.
How will patients gain access to procedural abortions? Are they considered “elective” right now? How can people gain care in states where that is being argued right now?
DW: Abortion is time-sensitive and essential health care. Delaying abortions leads to more complex and expensive care. According to guidelines from several leading medical organizations, abortion care should not be considered elective and any delays in care should be minimized.
Clinics across the country remain open, but some state lawmakers are exploiting the pandemic to further restrict abortion access. Because of these unconscionable restrictions, patients are forced to travel further across state lines to access abortion care, increasing expenses and risking their health during travel. The legal issues are dynamic and can change daily. Find a reputable clinic and contact them to receive the most updated information.
Will medication abortions be available through telemedicine for those who need it?
DW: Medication abortion through telehealth is as safe as in-person treatment. Both ensure that the patient receives all information, support, and options that they might need. Telehealth also reduces the need for travel and can reduce the cost of childcare. Contact a reputable clinic to see if they can provide abortions through telehealth.
Which appointments with my health-care provider can wait? Should I go in for a sexually transmitted infection (STI) test or to treat a urinary tract infection (UTI), for example?
DW: Annual checkups and screening tests for healthy individuals without medical conditions or abnormal results can wait. Screening tests are for healthy individuals without symptoms or risk factors. Diagnostic or monitoring tests are for individuals who have symptoms or prior abnormal test results.
If you do not have any new symptoms, then you can wait to do a screening STI test. If you have symptoms of burning with urination, frequent urination, discharge, or pain, you should be evaluated by a health-care provider. If you have a prior abnormal result that needs to be followed up with STI testing, Pap smear, or mammogram, for example, you should follow up with your health-care provider on the next steps. Your health-care provider can determine if you need to go into a clinic instead of a phone or video appointment.
Can I still be seen for non-emergent, but concerning, health issues? How do I know when I need to go in, and what should I do if there are no clinics open in my community?
DW: If you have a concerning health issue, the safest option is to call your health-care provider and ask their opinion. Because most health-care providers are offering telehealth during this time, they will likely only ask you to come in for an appointment if it is necessary.
If there are no clinics available in your community, reach out to other providers in the region and see if they will do telehealth for a new patient. You can also look for telehealth urgent care options. If it is not an emergency, please do not go to the emergency department.
Is it safe to give birth in a hospital?
DW: Yes. American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives, American Academy of Family Physicians, and Society for Maternal-Fetal Medicine released a joint statement affirming that hospitals and birth centers “that are both licensed and accredited remain safe places to give birth in the United States.”
Many of these institutions have made changes to their policies to reduce the transmission of COVID-19 and therefore protect pregnant people, support people, and newborns. For example, visitors are now limited, and some institutions are testing asymptomatic patients in the hospital for COVID-19. You can ask your hospital or birth center what protocols have been implemented to continue to provide safe care during delivery.
Prior to COVID-19, ACOG noted that “planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).” The decision to choose a hospital birth, a birth center, or a home birth should be made between the pregnant person and a health-care professional after discussing the risks and benefits of each option.
If I’m pregnant and showing signs of COVID-19, should I go to the hospital?
DW: If you are showing mild symptoms, you should inform your health-care provider. They can evaluate you and assess if it would be beneficial to see you in person or if it would be better to stay at home. If you are showing severe symptoms that are an emergency, call 911 or go to the hospital immediately.
Has miscarriage management changed amid COVID-19? If so, how?
DW: Once a miscarriage is diagnosed by ultrasound or blood levels, the options are expectant management (“wait and see” if the body passes the pregnancy tissue), medication management to help the body pass tissue, or a dilatation and curettage (D&C) procedure to remove the pregnancy tissue.
During the COVID-19 outbreak, your health-care provider may recommend expectant or medication management to limit procedures and unnecessary exposure to a health-care setting. Expectant or medication management would not be options if there were concern for infection or harm to the patient.
Can I get fertility treatments right now?
DW: During the COVID-19 pandemic, the American Society for Reproductive Medicine recommends that new treatment cycles and elective surgeries are suspended and that cancellation of all embryo transfers should be strongly considered “given the paucity of data surrounding the impact and potential risk of COVID-19 on pregnancy, the fetus and child well-being.” These recommendations are in line with guidance for social distancing, limitation of unnecessary travel or exposure to health-care settings, and preservation of limited resources, such as personal protective equipment (PPE).
At what point is it safe to begin dating and having sex with new people again after social distancing ends or pauses?
DW: You can reduce your risk at this time with video/phone dating and sex. Once businesses are returning to normal activity, shelter-in-place orders are lifted, and the CDC is no longer recommending cloth face coverings, it will be safe to begin in-person dating and sex with new people.
For more questions and answers about sexual and reproductive health during the pandemic, see here.