Growing a Family in the Shadow of a Pandemic

The threat of coronavirus has tormented us in many ways, but perhaps this is one of the most profound: Deciding whether to start or expand a family has suddenly become even harder.

While there’s never a perfect time to have a baby, getting pregnant during the pandemic isn’t the scenario most people would choose. But waiting to conceive carries its own risks, especially for older parents.

Thousands of families across the United States are facing this dilemma, and experts are wary of offering definitive advice. The American College of Obstetricians and Gynecologists acknowledges “there is no clear answer” to the question of whether pregnancy should be delayed. But it does list the various risks families ought to consider, including potential financial challenges and health problems that could ensue.

“There’s such a paucity of data right now,” said Mary Jane Minkin, M.D., a clinical professor in the department of obstetric gynecology and reproductive sciences at Yale Medical School.

We still don’t know how Covid-19 infections could affect a fetus during the first trimester, nor do we know the long-term effects of the virus — and now a mysterious inflammatory disease linked to Covid-19 is affecting a small number of children.

Mothers have reason to worry about their own health, too: Pregnant women are seeing their doctors less frequently, sometimes via telemedicine instead of in person; some expectant mothers with Covid-19 have become very ill and were placed on ventilators; and at many hospitals, laboring mothers can only bring one support person.

Then there are the financial considerations: Hundreds of thousands of people are out of work and the economy’s future is uncertain.

Families who are on the fence might consider waiting a year, Dr. Minkin said. But for those who want to get started right away, the good news is we have no evidence to suggest that Covid presents a greater risk to pregnant women than anyone else, and so far it appears as though the virus isn’t transmitted to a baby in the womb or while breastfeeding, she added.

Everyone needs to look at their own values and priorities and make decisions based on that, said Pooja Lakshmin, M.D., a perinatal psychiatrist and clinical assistant professor at George Washington University School of Medicine who has counseled patients struggling to figure out if they should wait to conceive. “It’s really important here not to compare yourself to friends or family.”

Here’s how six households have grappled with family planning during the pandemic:

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Credit…Scott McIntyre for The New York Times

Manhattan

It was New Year’s Day when Jenny Norris, 39, first tried to conceive. Two weeks later, she found out she was pregnant. Norris and her wife, Jenna Samotin, 35, were thrilled

Then, at 10 ½ weeks pregnant, Norris had a miscarriage.

Trying again wouldn’t be so easy. In March, their midwife informed them that she was no longer doing intrauterine inseminations because of the coronavirus. By May, a lot had changed. Their midwife said she would offer the procedure at her home rather than going into her clients’ homes, as she had in the past.

Was it safe to move forward?

“We’ve had countless discussions about this,” Norris said. Both of their therapists steered them in the direction of holding off for as long as possible, the couple said.

But they felt certain they wanted to continue.

“I have a lot of ‘what-if’ questions running through my mind constantly,” Norris said. “What if I get sick while I’m pregnant? What if Jenna gets sick while I’m pregnant? What if the baby is exposed? What if we both lose our jobs and we don’t have money?”

Ultimately, this is a personal decision, she added, and to let the coronavirus stand in the way would be “gut wrenching.”

“If I were to not be able to have a child because of this, I would feel regret for the rest of my life — and I know that with all certainty,” she said.

Norris plans to do a second IUI in July.

“Time is a luxury in terms of fertility and Jenny’s age,” Samotin said. “And we just don’t have that.”

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Credit…Michelle Gustafson for The New York Times

Allentown, Pa.

Lauren Wellbank had always wanted to have three children, until she had two.

It was “kind of a lot,” she said.

So a third wasn’t originally in the plan — too expensive, too time-consuming. Then, last summer, she unexpectedly got pregnant. When the pregnancy ended in a miscarriage, Wellbank “panicked.”

“I was like, ‘Oh my god, what if I can’t have anymore children — this might be a now-or-never thing, whether we’re financially ready or not,” said Wellbank, 38, a freelance writer. A couple months later, she got pregnant again.

But she still wasn’t sure they were done. Her husband, Kenny Wellbank, 34, said he would follow her lead.

“If she told me that she wanted 10 kids, I’d be down for it,” he said.

With the pandemic, all that changed.

Her husband, 34, said he wanted her to stay healthy, and a fourth might be too much to handle, especially with the recent need for distance learning and the unstable economy.

His workplace, a distribution center for a hospital, has cut employees’ hours, and he is currently on a leave of absence to take care of his newborn.

“Am I even going to be going back to a full-time job?” he asked. “We rely on my steady paycheck.”

Their third child, a boy, was born in April.

Will they eventually try for a fourth?

“No, we’re definitely not having any more,” Lauren Wellbank said.

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Credit…Jim Wilson/The New York Times

San Jose, Calif.

The morning of Jan. 8 started out like any other for Yvonne Jackson. But by that evening, she felt bloating and sharp pains: the “worst cramps of my life.”

A friend drove her to the emergency room, where Jackson learned that she was bleeding internally and having an ectopic pregnancy. She needed surgery right away.

Jackson, a single mother by choice, had conceived in December at a fertility clinic via intrauterine insemination. It was her first pregnancy.

“Within a span of four to five hours I’m waking up and I’m missing a fallopian tube and a baby,” she said. “I was very angry at my body.”

She faced a choice: keep trying or call it quits.

After recovering from the surgery, she was physically healed, but not emotionally. She drove to work and never got out of her car.

“I was crying uncontrollably in the parking lot,” she said.

A few weeks later, she permitted herself to try to conceive again.

But by that time the coronavirus was spreading throughout the country. The American Society for Reproductive Medicine announced that fertility treatments should be put on hold until further notice.

Jackson was devastated.

In early May, those rules were loosened and her fertility clinic welcomed her back.

“I’m frightened,” she said, “but I’m 41 years old. If I don’t do it now, I lose my window.”

Jackson started the in-vitro fertilization process in May and is expected to do her first embryo transfer this month.

“I refuse to let 2020 take this away from me,” she said.

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Credit…Rozette Rago for The New York Times

Los Angeles

Jake Gant and his husband, Louis Polidori, had finally found their ideal surrogate.

“We had an opportunity to meet her in person and we just clicked. It felt right,” Gant, 38, said.

She also checked off several wants on their list: She was in Denver, where Polidori’s family lives and she had been a surrogate before.

But as the coronavirus began its shadowy spread throughout the United States, the couple began to feel uneasy. Their surrogate and fertility clinic also had worries, so the embryo transfer they had planned for late March was postponed.

  • Frequently Asked Questions and Advice

    Updated June 5, 2020

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


They considered waiting a year or more, Polidori, 39, said, but “we don’t want to push it and wait too long and possibly lose her as a surrogate.”

In April, their surrogate got back in touch to tell them she was ready to move forward as soon as they got the clinic’s go-ahead to do so.

“We let her lead the decision because it’s obviously not our body that is going to be carrying this child, so we were extremely respectful,” Gant said. “A stressed surrogate does not a good, successful pregnancy make.”

Their new transfer date is planned for mid-June.

Because of the pandemic, Gant and Polidori won’t be attending the embryo transfer or any future ultrasound appointments in person.

“It’s still a little scary, I think we’re learning something new every day with Covid,” said Gant.

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Credit…Drew Anthony Smith for The New York Times

Leander, Texas

Jo Griffith and her husband, Troy, spent four years trying to conceive their 2-year-old son. Their journey involved three miscarriages, including one in the second trimester, followed by in-vitro fertilization.

They would like to give their only child a sibling, Jo Griffith, 45, said, and they have five more frozen embryos. But the coronavirus pandemic changed their plans.

“This virus is pretty damn smart,” said Griffith, who recently read about how the coronavirus hijacks living cells. “It’s a messed-up virus.”

Troy Griffith, 43, who is a physician assistant in orthopedic surgery, works in a hospital that has treated patients with Covid-19. He drives to work in a designated car they nicknamed “Covid car.” And when he comes home at night, he showers immediately and stores his clothes in the garage.

For the Griffiths, there are more worries than reassurances right now: worries that there might be another wave of cases, that different strains could develop, or that their future unborn baby could be affected.

Though they are still open to having another child, the couple have decided not to do an embryo transfer anytime soon.

“I don’t want to go through another loss if I can help it,” she said.

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Credit…Karsten Moran for The New York Times

Old Bridge, N.J.

Amna Husain, a pediatrician, and her husband, Dr. Zain Husain, a dermatologist, had been caught up in the daily hustle, each running a private practice and parenting their 2-year-old daughter. They always knew they wanted more children, but they weren’t sure when would be the right time to try.

Then the pandemic showed up and life slowed down.

“While I’m sitting at home with my daughter a lot more, I really realized how quickly she’s grown up,” Dr. Amna Husain said. “And I was thinking, ‘Wow, I’m not ready to have such a grown-up baby just yet, maybe I should give her a sibling.’”

Still, they had concerns.

Her husband’s practice, their biggest source of income, brought in less money during the quarantine. But it recently reopened and is slowly starting to recover.

“What if a second wave hits in the fall and we have to close down again? That’s going to be another big hit,” he said.

Dr. Husain developed gestational diabetes during her first pregnancy and is worried that she might contract it again, and face a high-risk pregnancy.

“I joked that ‘Am I going crazy that the world’s falling apart outside with a pandemic and here I am thinking of having another baby?’” she said. “But I almost feel like, ‘What better time to do it?’ Because at this time life kind of is on standstill, and I’m at a good point in my practice where I’m not incredibly busy and we can give time to the baby as needed.”

Dr. Husain, 30, and her husband, who is 34, considered waiting a year, or so.

But they want their daughter and her future sibling to be relatively close in age, he said, and they don’t know how long it will take to become pregnant again.

“There’s never going to be a perfect time, and we can’t wait for others to give us the green light,” he said.

Source: nytimes.com

Tags: health

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