Baby Arabella

For the rest of their lives, several thousand babies born in Maryland this past year will have an origin story of springing into the world during a pandemic.

COVID-positive pregnant mothers faced critical illness and a risk of premature delivery. Families who were not sick with COVID worried about catching the virus, and just its looming threat made lives more difficult.

"The babies are at low risk of getting COVID-19. Generally, it's the mothers whose health has been most at risk," said Sarah Crimmins, DO, assistant professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine (UMSOM). Crimmins also is medical director of the Obstetric Care Unit at University of Maryland Medical Center (UMMC).

"There's definitely a risk that the baby will have to be delivered prematurely because of the mother's disease," Crimmins said.

"A big win is when we have a mother who is sick but who can recover enough to avoid a pre-term delivery, and even go home, and then go on to deliver her baby at term."

Lauren and Arabella's Story

members of the Swope familyOne of the patients whose last few weeks of pregnancy threw everyone a curve ball is Lauren Swope, who was already facing risk from her congenital heart defect. COVID-19 was another threat.

Swope lives in Baltimore County with her husband, Patrick and three children, the youngest of whom was born at UMMC on the last day of November.

"I was diagnosed with COVID on the 19th of November," Swope said, when she was almost 36 weeks pregnant. "It started with a cough, and it got worse from there. I was short of breath." Her husband also had COVID, but a milder case, and her 5- and 9-year-old children were positive but asymptomatic.

In the 10 days it took for Swope to recover, she was hospitalized twice, including for pneumonia the second time. Her care was managed by Crimmins and by her cardiologist, Geoffrey Rosenthal, MD, PhD, professor of pediatrics and director of the Pediatric and Congenital Heart Program at UMMC, which is one of the top-ranked programs of its kind in the country.

Although the most critically ill pregnant patients have to be cared for in the Medical Intensive Care Unit (MICU), Swope was stable enough to be cared for on the UMMC Obstetric Care Unit for most of her stay, in one of two rooms that the UMMC facilities team had prepared early in the pandemic, with an air lock to accommodate mothers who were COVID-positive.

"The nurses and doctors were wearing double masks and the full suits, and you feel a little bit like E.T.," Swope said.

Swope had open heart surgery to replace her tricuspid valve 20 years ago, when she was 18. That valve still works, but her doctors watch her closely for signs that it needs to be replaced. Her care team included cardiac surgeons who had to be prepared to operate, should COVID and pregnancy prove too much for Swope's heart.

Needing That Connection

To reduce the risk of anesthesia drugs for her baby, Swope had to be awake for the stressful insertion of catheter lines into her neck and wrist that would help the cardiac team monitor her heart function.

"That was not fun," Swope said. "I had Dr. Crimmins holding one of my hands and my nurse who stayed with me the entire time holding the other hand, and they just kept looking at me, and they were like, 'You're doing such a great job. You've got this,' And I could cry talking about it because I had felt alone and I just needed that connection."

Her nurse was Nicole Sweeney, BSN, RN, who has been a labor and delivery nurse at UMMC since she graduated from University of Maryland School of Nursing.

"I always find myself holding their hands," Sweeney said. "The patient is probably terrified at that moment and needs the comfort of holding someone's hand and having someone tell her it's going to be OK. I just feel like I would want it that way if it were me."

Diagram of Lauren's Swopes's heart on a napkin

A diagram of Lauren Swope's heart

Worried About Everything

“I had so much going on and I was so worried about literally everything,” Swope said of the hours leading up to her daughter’s birth. “I was worried that I was not going to wake up until two weeks later. I had no idea how this was going to unfold. But my cardiac levels all stayed very stable. The support was there, just in case.”

As the obstetrics team accompanied her to the OR, Swope arrived to find a dozen surgeons and other OR team members, including a cardiac surgery team prepared for open heart surgery, should Swope need it. Neonatologists were prepared to assess baby Arabella as soon as she was delivered.

After delivery, Swope had to recover in the Pediatric Intensive Care Unit, because congenital heart patients are these nurses’ specialty, no matter the age of the patient.

“Dr. Rosenthal went to the PICU and hand-drew a picture of my heart anatomy on a napkin, and he taped it up on the wall with a Band-Aid and showed the staff, ‘This is why her blood pressure cannot drop. And if it drops, call me immediately.’ He is just above and beyond a regular cardiologist,” Swope said. “He told me, ‘I was determined that you were going to have a positive outcome.’

“As for Arabella, she is perfect. She did not have COVID. But the doctors said that my antibodies will transfer to her so she’ll have some protective effect. They don’t know how long the antibodies will last. But, it does give me a little peace of mind.”