COVID-19 In Private (Practice)

Running a medical practice is more than a full-time job, even though the office is open for patients only two and a half days a week now. When I come home from the hospital, I shed my scrubs, place my Crocs in a pail with bleach, and wipe my hospital ID badge with an alcohol swab before going inside my house.

I am an obstetrician–gynecologist in a small private practice. Although I have been a physician for over 20 years, this private practice is my baby. It is the culmination of years of planning, saving, and hoping to run a practice the way I envision one should be run: spending time with patients, explaining, being available, and promoting a positive work atmosphere in the office. 
   
When this pandemic began, I realized the impact on the practice of medicine could be huge. When the first recommendations stated that people more at risk should stay home, our nonemergency visits were canceled. Only pregnant patients and patients with problems or emergencies were scheduled. We implemented screening procedures. We started wiping down all counter tops, doorknobs, and telephones multiple times a day. I worried about losing staff and staying in business. I applied for loans.
   
Babies ready to be delivered do not care about COVID-19. They will be born. Laboring and delivering before COVID-19 was generally a celebration. COVID-19 changed the mood in the delivery room, the idea of planning for deliveries, my relationship with patients, and my role in their deliveries. Delivering babies now is a new experience.
   
At the beginning of this crisis, everyone was figuring out who to test. A woman would show up in labor. No one knew if she was infected, if she was an asymptomatic carrier, or if that cough was just a cough. We donned gowns, masks, face shields, shoe covers, and gloves before going into any patient’s room.

Before COVID-19, many pregnant patients expressed a desire to let labor happen naturally. They often wanted to avoid interventions in the labor and delivery process, preferring watching and waiting. This watchful waiting and noninterventionist thinking has recently given way to the opposite: I have offered all my patients the opportunity to get their labors started, if safe to do so, in my office. When a patient is within a week of her due date, she can come to the office and I can gently strip her membranes while doing an exam, place a small thin dilator into the cervix, and the patient can go home. In the morning, she will be dilated and on her way to the hospital. The more a patient can be moved toward labor before admission, the less hospital time and COVID-19 exposure they risk. That’s the goal. One of my patients delivered her baby in the early morning and went home that afternoon.
   
 We clean meticulously, wear masks, and limit the number of patients in the office. I continue to discuss plans for deliveries and surgeries and hope to give my patients support and encouragement. I follow recommendations from the CDC, epidemiologists, and scientists. I counsel patients to do the same. For now, these efforts are working. My staff is here. The office remains open, at least for now. 

I am always tired. Who knows what the future holds?

Dr. Rebecca Levy-Gantt is the owner and solo practitioner of Premier ObGyn Napa, a private practice in Napa, CA. She is also the author of the recently published book, Womb With a View: Tales from the Delivery, Emergency and Operating Rooms.