Now that COVID-19 is easing, are pregnancy-related visitation policies shifting? Some are, some aren’t.

CHICAGO — The first time Pat O’Brien attended a pregnancy-related appointment with his wife was the day they walked into Northwestern Memorial Hospital for the birth of their first child.

Like many couples last year, Pat and Ellie O’Brien were not able to share the experiences of pregnancy at prenatal appointments, as COVID-19 precautions restricted visitor policies.

“I mean, it stunk,” said Pat O’Brien. “Not being able to hear the heartbeat is one thing, but not being able to be there and support Ellie and her having to go it alone was frustrating.”

The virus altered visitation policies at Chicagoland hospitals, sometimes creating hardships for Illinois residents with chronically ill or dying family members.

It also added stress during pregnancy, where partners could not be there for ultrasounds or regular visits associated with becoming a parent.

As the pandemic begins to ease, many hospitals are updating their visiting policies; at the height of the virus, visitors were in some places completely restricted. Now, policies allow visitors in some situations. Hospitals including Northwestern’s downtown campus and the University of Illinois at Chicago are still not allowing visitors with most outpatient appointments.

The prenatal space is unique. Hospitals make rules surrounding births taking place in labor and delivery wards, but most OB-GYNs who deliver babies are independent practitioners, and their offices for pregnancy appointments are off-site. So rules for a visitor differ from practice to practice, and from a birth to a 12-week appointment.

Partners have been allowed at births for the majority of the pandemic, after initially being restricted when it began. Rush allows both a partner and another person like a doula. UIC recently began allowing partners for delivery.

Dr. Emily Miller, Northwestern Memorial Hospital’s chief of obstetrics, has been helping to craft policies to guide obstetricians throughout the pandemic.

“We have to be attentive to how many extra people are in these tight spaces and coming in and out of these tight spaces, and what is the impact of that on pregnant people, our health care teams,” Miller said.

Providers have tried to compromise by allowing FaceTime, which was not always allowed in the past. Rush spokesman Charles Jolie said OB-GYNs report that this allows partners to be engaged, ask questions, hear a heartbeat and observe an ultrasound in real time.

Rules are beginning to shift. At the downtown practice of Northwestern Medical Group, for example, pregnant patients can now have a visitor at the 20-week anatomy scan, the large midway prenatal appointment.

“It’s really taking a baby step forward,” Miller said.

Otherwise, a spokeswoman confirmed, they are following Northwestern’s overall policy for outpatient appointments, which does not allow partners unless the patient has a disability requiring assistance.

At other locations, such as Northwestern’s Central DuPage Hospital in Winfield and Delnor Hospital in Geneva, partners have been allowed for early ultrasounds and the 20-week ultrasound since last spring. In May, they updated the policy to allow one accompanying visitor at all prenatal visits.

University of Chicago Medicine allows one person at prenatal visits, a shift from the previous policy that restricted visitors for all appointments, prenatal or otherwise.

Even where partners are allowed, restrictions are encouraged. At the NorthShore University Health System, OB-GYN chair Dr. Richard Silver said patients are allowed one partner per visit but they ask families to be selective, for example, suggesting visitors at an ultrasound versus a blood pressure check.

Partners were largely restricted last year, leaving women to go to appointments alone that typically are a hallmark of a pregnancy that many couples experience together. Beyond the joy of hearing a heartbeat, it also left partners handling potentially hard information alone, and also taking on the work of distilling logistics. Whether a partner tested positive for COVID-19 also affected their experience.

Concerns for Ellie O’Brien’s autoimmune health history meant she was attending weekly appointments in her third trimester. Her husband could not attend. After starting the year with a miscarriage, and stressors including isolation for COVID-19 while working full-time and launching their business Square Root, for which they created granola mixes and butter inspired by her journey with celiac disease, the lack of support was an additional anxiety.

“It was really difficult at the beginning, that Pat couldn’t join me, especially because the last time we were at the doctor together was to confirm that I did have a miscarriage,” she said.

At Northwestern, during the pandemic, the hospital gave providers discretion to allow a partner or visitor to accompany the patient in special circumstances, such as when a problem is found or a difficult decision needs to be made. Still, obstetricians might not know until the ultrasound that a situation should have both partners present.

“It is so hard as an obstetrician to say, ‘Bring your partner in, we’ve got something to talk about,’ I can’t even imagine as a patient how long those five minutes of your partner running from the parking lot to the room must feel,” Miller said.

The American College of Obstetricians and Gynecologists updated its guidance in March, saying modifications to visitation policies should be made on a facility level and based on community spread, local and state recommendations, and infection control and space considerations, such as whether postpartum recovery rooms are individual or shared.

“Although it is recommended that the number of visitors be reduced to those essential for the pregnant individual’s well-being,” the guidance states, “ACOG encourages facilities to consider innovative solutions and localized, collaborative approaches that ensure patients have the support and stability they need while pregnant, during labor, and postpartum if in-person support must be limited.”

Visitors should be screened for symptoms, according to ACOG, and not allowed if they have a fever or respiratory symptoms.

Miller said they considered whether to require proof of vaccination or a rapid COVID-19 test, but the logistics — deciding who would verify documentation, the expense and time consumed by tests — made that not pragmatic.

Miller said she expects visiting policies to evolve, as they monitor cases of COVID-19 and this first step of allowing more people in the waiting room.

“Obviously we go into obstetrics because we love the concept of seeing new families emerge, and not being able to see it in an entire context is really hard,” she said. “I think everyone’s really eager to get back to how we’d love to practice medicine, but I also think you can’t unsee the things we’ve seen this year, and we still see people sick with COVID.”