COVID-19 Update Letter II

Dear TMC Clients and Friends,


This letter is a comprehensive update of the changes we have made at TMC to maintain the highest level of health and safety for our clients, staff and their families during the COVID-19 pandemic. These changes are consistent with CDC guidelines as well as recommendations from the American Association of Birth Centers and the Commission for Accreditation of Birth Centers. 


Here is a list of our current policies to reduce the risk of infection:

  • If you, our client, have symptoms or are exposed to someone who is ill please NOTIFY OUR OFFICE at 412-321-6880 so that we can reschedule your appointment and direct you to the next steps. Please be aware when you call, if we are unable to answer please leave a message and we will call you back as soon as possible.
  • When you call in labor, we will be asking some screening questions to see if you have symptoms of coronavirus or other flu-like illnesses (body aches, a cough, a sore throat, and/or fever).
  • No person under the age of 18 is currently allowed in the building.
  • We have decided to ask that during labor you come with one person and a professional doula if you have one. We are happy to help additional family/support video in for support during labor. 
    If you or anyone in your household has a fever or symptoms consistent with these types of viruses, we do not feel it is appropriate to send you and your baby home on early discharge, your care will be directed to the hospital where you may be tested and followed closely. 
  • No postpartum visitors will be allowed in the center, except for your one support person and doula (as mentioned above). 
  •  We request that if at all possible, you come to your in-center office visits alone. We understand how valuable these visits are for partner involvement and we will happily video them in if desired. Please remember no children less than 18 years old are currently able to come with you to visits. 
  • If a person who accompanies you to your office visit (including your partner) exhibits symptoms, please have them wait in the car/outside for you.
  • During visits, in-labor, and at your in-person checkup after birth, you will notice all of our staff will be wearing masks. In addition, we will ask that you wear a mask during your time in the center for visits and times during labor when the staff and your family interact. When you are pushing your baby out and for the first hour after the birth, you can remove your mask and the staff will take additional precautions to keep you safe. We know this is not ideal for everyone, but we appreciate your understanding. 
  • We have decided to stop using nitrous at the birth center at the advice of our Anesthesia colleagues due to a possible increased risk of transmission during use. We know that this is a tool many of you were looking forward to, but for now, we are halting use. 
  • The birth center staff made the decision as of March 16th to not have our midwives go into the hospital for birth care. We want our midwives to have as little exposure as possible to illness to be healthy to care for you and your family at TMC. Our colleagues at our referral hospitals have been gracious to be accepting of our clients in the need for a transfer. 
  • We are going to be suspending the in-home postpartum nurse visits typically done between 24-72 hours. We will ask families to come to the center for these visits with our nurses. We ask that you follow CDC guidelines for social distancing, limiting visitors, and only going out when necessary.  We strongly encourage you to facetime/video chat anyone who would have normally visited you after the birth of your baby.
  • All of our scheduled classes are being held remotely via an online meeting platform.

Another major change for care at TMC is that we have moved most of our visits pregnancy-related, lactation, and behavioral health visits to a telehealth format. This is based on recommendations by the CDC that we move to a telehealth visit schedule to minimize the traffic of people in and out of the center.  


We have paused all routine gyne visits, and are only seeing essential visits in the center. However, some visits like our in-house lab work, some lactation, problem gyne, and some prenatal visits will still be in-person. 


The rough outline of the telehealth pregnancy schedule that you should expect is as follows: 


10-12 weeks New Ob visit (in person) 

14-16 weeks Telehealth visit 

20-22 weeks anatomy scan ultrasound and telehealth visit

26-28 weeks in-person visit with gestational diabetes screen and Rhogam if indicated

30-32 weeks telehealth visit

36 weeks in-person visit with GBS screen

38 weeks telehealth

39 weeks in person

40 weeks telehealth or in-person

41 weeks in person


Postpartum visits can be done via telehealth if TMC is your provider at birth and feels appropriate with you and the providers. If you have a birth with another provider we will need to do your visits in-person. 


Many people have concerns about telehealth and wonder if they can be assured their baby is growing and the pregnancy is developing normally.  We consider the anatomy scan to be an “in-person” visit because the ultrasound contains growth measurements and a full evaluation of the baby. With home blood pressure monitoring and fetal movement awareness, there are enough visits in between to monitor baby’s growth and feel reassured that things are developing normally. 


People have inquired about obtaining fetal heart rate dopplers. While you are welcome to do this, it can be difficult to find a baby’s heartbeat with a doppler in early pregnancy, and cause undue stress if it’s not found. In addition, it’s not uncommon to detect the mothers’ heartbeat-which would sound abnormally slow-also causing undue stress. Once the heartbeat is easier to find, the babies are often moving enough to give reassurance that everything is normal. 


We understand that this is a very stressful time for families, and all the changes have been made with the safety of our pregnant persons and their families in mind. Most providers nationwide have moved to a telehealth model and we feel confident in the schedule we have developed. 


If there is ever a concern, please page the midwife on call. We will also refer any problems detected during a telehealth visit to an in-office provider who will be available to see people.


Between visits please notify the nurse/provider if you experience any of the following:

  • Bad headaches, vision problems
  • Feeling the need to push down or bear down
  • Fever of more than 100.4 F that does not decrease a few hours after taking acetaminophen
  • Fluid from your vagina that you think is not urine or discharge
  • Spotting
  • Painful urination
  • Severe cramps or pelvic pressure before your due date
    Sudden swelling in your face, eyes, hands, or feet
  • Vomiting and/or diarrhea for more than 24 hours

After 24 weeks:

  • A change in the baby movements, especially if the baby is not moving much or at all
  • Contractions that are very painful and happen more than 6 times in an hour or contractions that are less than 5 minutes apart

Again, we understand how uncertain all of this is and the stress on families. Please don’t hesitate to reach out with questions or concerns. 


Sincerely, 


TMC Midwives and Nurse Practitioners