HomeHealth ServicesCOVID-19 Risk Reduction and ResponseOBGYN CLINIC

Health Services

CHANGES TO HOURS OF OPERATION: 

There are currently two shifts for OBGYN operations: 8 a.m.-12 p.m. with last appointment at 11:30 a.m.; 1-5 p.m. with last appointment at 4:30 p.m.

CHANGES TO APPOINTMENTS: 

The OBGYN Clinic is contacting any patient with an appointment that will be cancelled. The clinic leaders are reviewing appointments scheduled through May to determine which appointments can be safely deferred for care in 30-60 days. Several patients have appointments that can be converted to Virtual/Tele Health appointments, such as those to review labs/imaging or concerns that do not require face-to-face encounter. Those patients are being notified of the appointment type change. All Centering classes have been cancelled. Participants in this program are being scheduled for one-on-one OB appointments.

All 6-week post-partum examinations are delayed until further notice unless there is an issue. All 6-week post-partum examinations for complicated or high-risk pregnancies are not impacted; please arrive for your appointment as scheduled.

All scheduled infertility appointments are deferred until further notice.

CHANGES TO SERVICE CAPABILITIES: 

All group Genetics or NPCL appointments are cancelled until further notice. All pre-op appointments for elective surgeries are cancelled through May.

OB ULTRASOUNDS: Out of an abundance of caution for both the expecting mother and staff, visitors are no longer permitted during OB ultrasounds. Due to the close proximity of the ultrasound technician and the patient, we are taking extra precautions to reduce risk exposure by permitting only the tech and pregnant patient in the exam room.

Effective 8 APR 2020

All patients with scheduled cesarean sections or indicated induction of labor will be tested for COVID-19, to include those who are asymptomatic. Testing must be completed 24 hours prior to your scheduled delivery at the LRMC COVID-19 Screening Clinic. Your provider will call if you with results if any necessary actions must take place prior to your delivery.

The staff in the COVID-19 Screening Clinic are taking every precaution for your safety, and theirs, and will be uniformed in proper personal protective equipment (PPE). Testing in the clinic does not take long, and should you be in the clinic at the same time others are being tested, you will be asked to physically distance from each other. The clinic staff thoroughly wipe down the waiting area and exam room after each patient encounter, and the COVID-19 Screening Clinic is professionally deep cleaned four times per day.

OB ULTRASOUNDS: 

Out of an abundance of caution for both the expecting mother and staff, visitors are no longer permitted during OB ultrasounds. Due to the close proximity of the ultrasound technician and the patient, we are taking extra precautions to reduce risk exposure by permitting only the tech and pregnant patient in the exam room.

Effective 8 APR 2020

All patients with scheduled cesarean sections or indicated induction of labor will be tested for COVID-19, to include those who are asymptomatic. Testing must be completed 24 hours prior to your scheduled delivery at the LRMC COVID-19 Screening Clinic. Your provider will call if you with results if any necessary actions must take place prior to your delivery.

The staff in the COVID-19 Screening Clinic are taking every precaution for your safety, and theirs, and will be uniformed in proper personal protective equipment (PPE). Testing in the clinic does not take long, and should you be in the clinic at the same time others are being tested, you will be asked to physically distance from each other. The clinic staff thoroughly wipe down the waiting area and exam room after each patient encounter, and the COVID-19 Screening Clinic is professionally deep cleaned four times per day.

OBGYN FAQs

Q. Are there any discussions about modifying the 2 visitor rule down to one/zero as the other local hospitals are doing? ▼

Yes, we have updated our visitor policy for both Labor & Delivery and the post-partum ward. There is only one visitor per patient allowed during both labor and delivery, and post-partum recovery. Patients who have tested positive for COVID-19, or is considered a Person Under Investigation (PUI) are not permitted to have visitors.

Q. Is the staffing at Labor and Delivery lower to try and mitigate potential exposure? If so/not, is there any impact to laboring patients? ▼

No, there is no reduction in staffing on labor and delivery. We are staffed with safety and quality of care at the forefront. We are following CDC guidelines of hand washing/hand gel use, social distancing and screening all visitors to our area to reduce exposure.

Q. Is it a possibility that husbands will not be allowed to attend births? What would cause that to happen, if so? ▼

We understand the importance of having your significant other present during the birth of your child. However, there is always the possibility that the entire hospital moves to a no visitor policy. Labor and delivery, as well as the post-partum unit, would modify the visitor policy in accordance with the hospital's visitor policy.

Your spouse, if active duty, is eligible for parental leave in order to help you with your recovery and childcare when at home.

Q. Will the Patient Liaison Officers still be available to those who are delivering on the economy, specifically for my case in Homburg? ▼

The PLOs will still be available, though they will likely be conducting a lot of business and communication via phone in order to mitigate risk.

Q. Is there a way to ensure that 6-week post-partum appointments are not cancelled or conducted via Virtual/Tele health? A mother's care needs to be taken seriously and post-partum depression cannot be detected over the phone. ▼

We take maternal care very seriously. We made every effort to minimize the loss of access to care for our patients. Our clinic has only reduced access by about 20% during this time period because we understand how important a face-to-face encounter is to many patients. The decrease in access was done so that we could reduce the risk of COVID exposure to our patients. We did a 100% chart review to assess post-partum risk and safely determine which patients we could reschedule for appointments at a later date. Post-partum examinations for higher risk patients, including those with a higher risk for post-partum depression, are still being scheduled as a face-to-face visit. Depression screening can still be performed via a telephone visit and as long as the patient is honest in her answers, and an appropriate referral to Behavior Health can still occur at that time.

Patients are encouraged to reach out to the OBGYN clinic directly should there be any change in status from an uncomplicated recovery. Based on the triage discussion, the patient may be brought in for a face-to-face appointment.

Q. Can we get more information on what type of appointment is considered essential (i.e, I see a lot of people getting an anatomy scan canceled and I'd consider that essential) or how we should reach out to the OBGYN office if the phone lines (are very understandably) busy all day? I have a 28 week appointment coming up and I've been unable to reach anyone for a few days on the nurse line to follow up on something. I know the staff are working hard and we appreciate it! ▼

We understand the difficulties in accessing the Nurse Advice Line at this time. Please keep in mind that the Nurse Advice Line receives calls from TRICARE patients from around the globe; they are working on increasing network bandwidth as well as staff.

However, OB patients can call the OBGYN clinic to speak to one of our Triage nurses directly. If you have secure messaging with our clinic, patients can also send their questions to us that way.

Essential appointments are those in which a delay in care could lead to a negative outcome. Anatomy scans were recently cancelled by our Radiology Department for those patients in the upcoming 2 weeks only (through the first week of April). However, the plan was for those scans to be rescheduled after the 2 week period. The current recommendation is for an anatomy scan to occur between 18-22 weeks of pregnancy, so the range allows a small amount of flexibility in scheduling. Our clinic is currently reaching out to some of these cancelled patients who are closer to the tail-end of that recommendation for an anatomy scan in order to get their scan done in our Perinatology Clinic. The OBGYN Clinic now plans on scheduling an OB appointment on the same day that the patient has an anatomy scan (in Radiology or Perinatology). However, should we have illness within our provider/technician teams, that may change.

In addition, we just received guidelines on scheduled OB care. We will now be conducting the first dating ultrasound at the same visit the new OB is scheduled. This will be an hour long appointment to be scheduled between 10-12 weeks of pregnancy, again, reducing the amount of visits that patients have to the hospital. We will be removing the 16 week and 24 week OB appointments and can conduct a phone visit unless a patient has complications that require additional visits face to face.

Q. How do the new COVID operations at LRMC impact the newly pregnant mothers coming in? Some host nation hospitals are not accepting TRICARE Select at this time ,so will that continue? ▼

Currently, the LRMC OBGYN Clinic is only accepting new OB patients who are covered under Tricare PRIME. We are unable to accommodate patients that are covered under TRICARE Select at this time.

Q. Is there talk of voluntary/early inductions to try to pace the L&D floor? ▼

There are no voluntary inductions of labor at this time. The OBGYN Clinic may offer induction after 39 weeks gestation based on labor and delivery space, staffing, any co-morbidities in the pregnant patient and cervical favorability.

Q. What kind of circumstances would come up that would force those of us who want to deliver at LRMC to have to deliver at a German hospital? ▼

For a pregnant woman receiving her care at LRMC, she would be expected to deliver at a German hospital only if our labor and delivery was at full capacity because we had no bed availability. We currently have no plans to stop delivering OB care at LRMC. In addition, we have contingency plans in place in the event that we receive a COVID positive laboring patient. These patients will be cared for in our hospital unless there is a medical indication otherwise.

TRICARE Select patients who have been receiving their care at a host nation healthcare facility will still be able to deliver on the economy. German OB physicians are not sending these patients back to LRMC. Even if one of their facilities starts to decrease services for OB care, they have contingency plans for where they would want to their patients to deliver.

Q. Are mothers (and possibly fathers) going to be tested upon admittance or sometime around there so to protect the staff and newborn baby? ▼

Testing for COVID-19 is based on the current CDC guidelines. There are currently no guidelines recommending blanket testing for all pregnant women (and partners) upon admission.

Q. Any chance of making some of the tours or classes virtual that we can no longer attend in person? ▼

Thank you for your suggestion! Currently, there are no classes or tours being conducted virtually, but it is something we will consider moving forward.

Q. I have an 8-year old daughter who we wanted to attend the birth, along with my husband and doula. Finding childcare for what could be days during a pandemic when everyone is supposed to be social distanced/quarantined is next to impossible without putting my daughter or the other family at risk. Are there exemptions or plans being made to support our families while mothers are in L&D and recovery after? ▼

There are no exemptions to the number of visitors allowed in our labor and delivery rooms and post-partum ward. We recommend that family members begin to initiate or develop emergency care plans now so that it is in place when the pregnant patient is admitted. However, there is a possibility that the father may have to remain at home caring for another child(ren) if childcare is an issue when the mother is admitted.

Q. Is there any consideration to have pregnant and the newly post-partum women with newborns to have a separate entrance than everyone else? ▼

The hospital has designated specific entrances in order to conduct the appropriate screening for COVID-19. This screening is important for all populations. There is no plan for a separate entrance for postpartum mothers or their newborns.

Q. Is there a way that pregnant women with symptoms can be screened away from other sick people? ▼

Any patient with COVID-19 symptoms has the potential of carrying a pathogen that is infectious to others. Therefore, appropriate hand hygiene, social distancing and wearing a mask when arriving to the hospital is important no matter what the type of infection. The hospital has designated specific areas to conduct this important screening to prevent the spread of disease to others that have no symptoms.

Q. Is there any talk of amending profiles to stay home/quarantine? Everything I read on CDC says we are "at risk" and my office, although not customer service is continuing on with split-shift minimal manning. It seems there isn't any consistency across different bases/commands as to how pregnant women are being advised. ▼

Currently, the CDC does not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections and other viral respiratory infections, such as influenza, during pregnancy. Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick. In other words, there is no higher risk to pregnant women exposed to COVID as to influenza or other viral respiratory illnesses.

At this time, guidance has been for liberal teleworking for jobs that can support telework. Pregnant patients are encouraged to engage in open dialogue with their supervisors about transitioning all or part of their duties to telework if their job is amendable to this type of work. OBGYN is not providing letters or profiles indicating that a pregnant woman needs to stay at home. Quarantine is only indicated for those who have been identified as a close contact of a person with a confirmed COVID-19 infection.

Q. After delivery, how is the 'take baby home classes' being done with the restrictions of gatherings? ▼

The discharge classes are no longer being held as a group in the Mother-Baby Unit. We are utilizing bedside discharge instructions and watch the discharge videos in the patient's room.

Q. Are you keeping moms as long (24-48 hours) after delivery or trying to release them earlier? ▼

The minimum length of stay following a delivery is 24 hours. We can have a discussion with a patient that is motivated to leave at that time and who has no other medical indication to remain in the hospital. However, length of stay is sometimes determined by the baby's status following delivery. We are no longer allowing boarding status so that we do not keep patients in the hospital beyond the time that the mother meets discharge criteria.

Q. What type of appointments are being rescheduled? How do we know if we can keep our existing appointments? ▼

Only essential appointments are being kept as face-to-face. Some appointments are conducted via telephone call. If an appointment is being cancelled, the patient will be called by our clinic in order to let them know.

Q. Will the new visitor policy also bar doulas from serving their clients during labor? ▼

Doulas will be subjected to the one visitor policy. If your doula is identified as the birthing partner, he or she will be the only person allowed with the patient during labor and delivery.

Q. Are the nurses/midwives going to stay with the laboring moms if we go to a no-visitor policy? ▼

The nurses and midwives can assist with labor support for the patient but they also have other patient care to perform and therefore may not be able to remain in the room the entire labor process.

For COVID positive patients or persons under investigation for COVID at the time of admission, no visitors will be allowed in order to minimize risk to the healthcare team and to the delivering infant. These patients will have a dedicated laboring team in which there is one-to-care the entire labor and recovery process.

Q. What is the plan for support during labor if the hospital moves to a no-visitor policy? Are you bringing in more staff so women have support? ▼

Our labor and delivery nurses as well as the remainder of the delivery team assigned to the patient will provide caring and compassionate care and support during her labor.

Q. Why are spouses/support persons considered "visitors?" They are also part of the birthing process. ▼

Any person who is not admitted to the hospital as a patient is considered a visitor to the facility.

Q. If the hospital moves to a no-visitor policy, will the nursing staff be able to help keep our spouses/birthing partners part of the process through photography and virtual services (e.g., Facetime)? ▼

Video/photography/virtual services of procedures is still not allowed. Photographs of the mother and infant after delivery can be taken by staff and forwarded to the spouse/family members.

Q. If the hospital moves to a no-visitor policy, would it be possible to make an exception for the spouse/birthing partner if they tested negative for COVID? ▼

The false negative rate for testing asymptomatic persons is unacceptably high (67%). That means that a negative spouse/partner could still be shedding the virus despite a negative test. This will put the healthcare team, you and your baby at risk.

The only exceptions to the no-visitor policy, following the hospital’s current guidance, is end of life or bereavement situations.

Q. Is there currently an anticipated date for this restriction to be lifted? ▼

There is currently no anticipated date for the hospital visitor policy to change.

Q. Will exceptions be made for women in L&D/MBU who are nursing another child at home? ▼

Children under the age of 16 are not allowed in the hospital as visitors. Therefore, they are also not allowed to come into labor and delivery or the post-partum units. We encourage you to work with our Lactation Consultants for means to keep your breastmilk supply going for your other child(ren).

Q. Do the decision makers consider the recommendations from the World Health Organization? ▼

We are following guidance issued by the CDC, as well as the American College of Obstetricians and Gynecologists and Society for Maternal Fetal Medicine which are the organizations more specific to the specialty of obstetrical care.

Q. Can someone drop a gift off at the MBU without actually being considered a "visitor?" ▼

A person may drop a gift off at the front desk. The gift may need to be wiped down to avoid potential transmission of coronavirus on the surface of the gift.

Don't forget to keep your family's information up-to-date in DEERS.