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At the beginning of March 2020, Dr. Hind Moussa entered the final weeks of her first pregnancy.
An OB-GYN with Kettering Health, Dr. Moussa had years of experience in delivery rooms. As a specialist in maternal-fetal medicine, she helps manage high-risk pregnancies. But being pregnant and older than 35, she found herself navigating her own high-risk pregnancy.
“I was a high-risk specialist who was a high-risk patient,” Dr. Moussa says. She knew what to expect during her planned C-section, as well as what complications could arise, and thought she was prepared.
She never imagined she would be one of the first patients in the U.S. to give birth during a global pandemic.
“It was a very challenging time because, back then, we did not have the knowledge of how to treat—and basically how to manage—COVID-19 and what the implications of COVID are on pregnant women,” Dr. Moussa says. “So that was my patient population and myself.”
Pregnant women are among those considered at greater risk of getting severely ill from COVID-19, requiring ICU care or a ventilator. But in the early days of the pandemic, as scientists were still learning all they could about the disease, pregnancy was not included in the list of health conditions that put patients at increased risk.
At that time, the CDC also had not yet issued a mask mandate—or even a mask recommendation—to prevent transmission of COVID-19.
“I am a researcher myself, so I did a lot of research at that time, and I wanted to wear a face mask,” she says. Despite the CDC not yet recommending masks, shortages of personal protective equipment were already a problem, making them unavailable.
Dr. Moussa had planned to continue seeing patients right up to her delivery. But she grew concerned about COVID-19 transmission. So, she used vacation days to take time off and limit her risk of exposure.
New normal with a new baby
Her daughter was born at the end of March. And Dr. Moussa encountered the social isolation that many new moms experienced during the pandemic. “We couldn’t have visitors with us in the hospital. It was just me and my husband and our newborn,” she says.
Dr. Moussa’s mother, who lives overseas in Lebanon, planned to visit when they brought their daughter home. But the pandemic changed those plans. Her sister, who lives in New York City, also planned to come but couldn’t because New York was hit hard with COVID-19 cases.
“So we didn’t have any extra help,” she says. Even their plans to hire a nanny for childcare went awry. The pandemic created a sudden nanny shortage and many working mothers had to rapidly find alternatives to their children’s closed daycare centers and schools.
One nanny candidate who visited their home seemed to be a good fit—but then developed COVID-19. Dr. Moussa’s husband, an architect, took time off from work to care for their daughter when Dr. Moussa returned to her practice. “That’s the balance we tried to make,” she says.
But it wasn’t an easy balance.
The return to work
“Coming back to work was another challenge,” she says. “We were doing mostly face-to-face visits.”
While telehealth became more popular for many types of medical appointments, virtual ultrasounds and other monitoring of moms with medical conditions weren’t an option.
“I’m sure that there are innovations in that field, but nothing that’s present right now,” Dr. Moussa says. And because hospitals had to limit visitors, “a lot of these pregnant moms who have complications during their pregnancies had to sit in a visit by themselves while they may be receiving some of the worst news that they would ever receive in their life.”
On top of her concern for her patients’ health, Dr. Moussa feared bringing home an infection to her daughter or husband. As soon as she got home from work each day, she would change out of her scrubs, put them in a bin separate from the family laundry, and immediately shower before holding her baby or spending time with her husband, who is considered at higher risk of developing severe COVID.
“I didn’t realize it initially, but anxiety was definitely present,” she recalls. “It was because of all of these scenarios of what could go wrong that I could imagine. I knew that I was lucky that everything was going well. But at the same time, it was very stressful, and COVID did not make it better. It was another layer of worry.
“It hit me, after, that I had postpartum anxiety,” she says.
Dr. Moussa says she isn’t typically an anxious person, but hormonal changes and sleep deprivation played a role. “Also, some of it was that with anxiety, a lot of times you don’t live in the moment—you try to live in the future—and a lot of it was trying to step away from doing that and to appreciate the moment and live it,” she says.
A makeshift family
“What didn’t help is that back home now in Lebanon there’s an economic crisis,” she adds. “Basically, the country is collapsing. So that also added to it—that uncertainty of what would happen to my mom or my extended family.”
Looking back, Dr. Moussa says that “even when I had the anxiety, I didn’t have postpartum depression. I was not sad; I was doing well. The only thing I felt was an insidious kind of stressor that was building up. And then with the isolation in the postpartum period—without having my family around or my support network—I think that all played into it.
“So my work colleagues actually were my support network,” she continues. “They reached out. They were extremely nice and supported me in whatever needs I had, and I actually felt better being at work and being busy because that’s what I like to do. That’s my passion. So it was a very nice transition for me after I realized that hey, yes, I do have anxiety.”
High-risk patient to experienced physician
Dr. Moussa says that her experience has not only made her more conscious of postpartum anxiety but also made her better at counseling her patients through their own medical journeys.
“When you experience something personally, that definitely gives you a different perspective,” she says. “Now I feel like I’ve been in their shoes. I was a high-risk patient who was seen by Maternal-Fetal Medicine, was seen by my primary OB, and had connections with both providers. There’s that vulnerability of having to be humble and be able to just show our weakness.
“My pregnancy was eventually healthy delivery, healthy baby,” she continues. “But I know from my patients and within our field a lot of moms have very complex medical histories and their babies can be impacted with very complex conditions. And those moms are my heroes. They basically have to face all of that and have good—not just understanding, but preparedness. Those models are very strong women, and we serve as their support. “And then to learn how humbling that experience can be—I think it made me a better physician.”