The plane leaving New York was nearly empty.
Ariella Tabick, one of a handful of passengers flying to Colorado on Thursday evening, was 31 weeks pregnant, and the idea of giving birth at a hospital in New York City had started to feel too risky. So Tabick, a special education kindergarten teacher, and her husband and 2-year-old son left their apartment in Manhattan to stay with her parents in a suburb of Denver.
She knew it was the right decision for her family, she said. But after the flight took off, she began to cry.
“I felt so sad to leave my home,” she said. “It’s where all my friends are, and I feel like I’m leaving them behind in the trenches because I had an easy out.”
In a matter of weeks, New York has become a hot spot for the new coronavirus, leaving some pregnant women anxious about their upcoming deliveries as doctors and nurses fall ill, protective gear disappears and the hospital system becomes so strained that emergency rooms are running out of lifesaving equipment like ventilators. Choosing to leave the state and to give birth in areas with less besieged hospitals and fewer coronavirus cases has become an appealing option for those who can afford to do so.
“I’d rather be in a less burdened hospital system if I can,” Tabick, 31, said.
Early last week, two major hospital systems, NewYork-Presbyterian and Mount Sinai, instituted a ban on support persons in the labor and delivery rooms, which many expectant parents, midwives and doulas vocally opposed. On Saturday, Gov. Andrew M. Cuomo signed an executive order requiring hospitals to allow support persons in the delivery room and during the immediate postpartum period. But that change hasn’t fully alleviated pregnant women’s concerns.
Right now there are more than 75,000 coronavirus cases in New York State and over 1,500 deaths. In Colorado, where Tabick will give birth, the numbers are far different: 2,990 known cases and 68 deaths.
After she arrived in Colorado, Tabick said she felt as if she had traveled back in time to the way New York was several weeks ago, when you could still find disinfectant wipes, economy packs of diapers and Amazon Fresh delivery slots.
And because she’ll be living with her family, she and her husband will have child care during those first exhausting, hazy months with their newborn. Tabick, who said she might need a second cesarean section, is already anticipating a reprisal of the postpartum depression and anxiety that she experienced after her first pregnancy.
Choosing to go elsewhere, however, is economically prohibitive for most expectant mothers in New York. Leaving aside the cost of a flight or car rental, not everyone has family in another state with spacious, free lodging. Many women still have jobs and family connections in New York, as well as rent or mortgage payments they must meet.
And for lower-income families, leaving isn’t even a consideration, said Eugenia Montesinos, the co-chairwoman of NYC Midwives, a professional association.
“They don’t even think about that,” said Montesinos, who sees women at NYC Health + Hospitals/Metropolitan, a city hospital in East Harlem. “They’re going to be thinking about: ‘How am I going to pay my rent? How am I going to get something to eat?’”
While some ob-gyns have been supportive of their patients’ decisions to leave the New York area, there are risks involved in traveling, especially late in a pregnancy. Public health experts recommend avoiding nonessential travel to reduce your potential exposure to the virus and the risk of inadvertently infecting others.
“Delivering in a system that has provided you with all your prenatal care and knows you is more optimal,” said Dr. Mary E. D’Alton, the chief obstetrician and gynecologist at the NewYork-Presbyterian/Columbia University Medical Center in Manhattan. “We now have probably the best firsthand information about Covid and how obstetric patients are responding to this virus, and quite honestly, other centers in the United States are looking to us to give guidance on what we are doing.”
She estimated that fewer than 5 percent of the pregnant patients in her practice have left.
And there’s no guarantee that another area won’t eventually see a surge in coronavirus cases, she added.
The American College of Obstetricians and Gynecologists said in a statement on Monday that pregnant women in America should feel comfortable delivering babies in any licensed and accredited U.S. hospital.
The organization also advised women — especially those in Covid-19 hot spots — to discuss any concerns with their doctors.
Alice Anigacz, 31, who lives in Crown Heights, Brooklyn, is due in July and is planning to have her baby at Mount Sinai West in Manhattan. Her doctor recommended that she remain in New York.
“There are the unknown unknowns” about traveling elsewhere, she said, “like, is coronavirus going to hit hard there in a few weeks?”
To avoid traveling into Manhattan, Anigacz has been performing basic tests at home, like monitoring her blood glucose levels to help determine her risk for gestational diabetes.
Even though there is no official medical guidance suggesting that pregnant women ought to leave New York City, Efe Osaren, a doula who lives in Brooklyn, said she is advising her clients to deliver elsewhere if they can travel somewhere by car.
“I just predict that the hospitals are going to be so overwhelmed as well as we may lose a lot of staff due to the virus,” Osaren said. “If you have the privilege and the funds to go to a place where there’s not as many people, I suggest it.”
That’s exactly what Lauren Profis, 28, did last week: She and her husband rented a car and drove from New York City to Atlanta to stay in her childhood home. Like Tabick, Profis found an ob-gyn through a family connection. Although she is only 20 weeks pregnant, Profis realized she needed to leave New York City after being too afraid to travel to the hospital for an ultrasound when she started having unexplained stomach pain.
The pain has subsided and she’s feeling fine now, she said. She is following up with her new doctor in Atlanta.
Relocating and changing providers is not always so simple.
“There are a lot of hospitals that are in the easy commuting distance from New York City that aren’t actually accepting any transfers of any kind,” said Dr. Kelly Culwell, an ob-gyn in San Diego. “I think that even if women are trying to find ways to deliver outside of New York City, I think that they’re going to find a challenge.”
Allison Lamberth, 27, who is due in early April, drove her to parents’ home in Pennsylvania with her husband and 17-month-old son on March 15 after she asked her ob-gyn how bad things were expected to get in New York City.
The answer, she said, “wasn’t very reassuring.”
She called two different birthing centers, which wouldn’t take her as a new patient because she was too far along in her pregnancy, but finally found a hospital that would accept her. She was asked to self-quarantine and wait 14 days before coming in for her first appointment.
Although President Trump has backed away from evoking a strict quarantine of the New York region, the Centers for Disease Control and Prevention issued an advisory Saturday night urging residents of New York, New Jersey and Connecticut to “refrain from nonessential domestic travel for 14 days effective immediately.”
Alexandra Schinasi, 34, who lives in Manhattan with her husband and two children, is 35 weeks pregnant and had hoped to travel to Geneva, where her family lives, but then Switzerland closed its borders to anyone who is not a Swiss citizen. That meant her husband and children were barred from entering the country. It was a similar situation in Israel, where her husband’s family lives. In the end, she had to accept that she would be giving birth in New York City in May.
“I went through a range of emotions in the last week,” Schinasi said. “It started with a lot of anxiety and fear and sadness. Then I kind of came to terms with it, it in a way.”
India Browne, 34, who was formerly an ensemble dancer in “The Lion King” on Broadway, is six months pregnant and due in July. She has been unemployed since the theaters closed in the middle of March. Work has also slowed for her husband, who is employed in real estate.
Browne said her first instinct was to leave New York City to stay with family in Georgia, but it felt too dangerous to drive or fly. She was also concerned about having undiagnosed Covid-19 and potentially infecting her family or the larger community.
“To leave town, for me, is very selfish,” she said, adding that the impulse is also understandable.
She and her husband ultimately decided to stay and give birth at Brooklyn Methodist Hospital.
“If the entire nation is going to get back on track, we all have to cooperate,” she said. “We can’t just take things into our own hands and just try to take care of just our family unit.”
For those who are staying, either because they wish to remain in the city or because they do not have another option, Dr. Daniel F. Roshan, the director of Rosh Maternal & Fetal Medicine in New York City, urged pregnant patients to speak with their doctor if they have continuing concerns or anxieties.
“We are dealing with a crisis,” he said. “I think the best thing we can do is not to panic and keep calm.”
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