During the best of times, pregnancy doesn’t come easily for Jessie Van Marter. She delivered her three boys preterm, and she’s experienced more than a dozen miscarriages.

Now she’s 25 weeks along with her first girl, and with COVID-19 complicating her access to health care, she’s terrified.

Expectant families are struggling to stay abreast of hospital policies, in communication with their health care team, guard their own health, and deal with uncertain finances in the face of high unemployment rates and unsafe working environments. High-risk pregnancies like Van Marter’s make a difficult situation even harder.

In previous pregnancies, Van Marter received a combination of progesterone pills and injections to prevent preterm labor. Wanting to minimize her exposure, Van Marter and her health care team decided to have insurance mail the shots for her to self-administer.

While formulating this plan over the phone on March 16, the nurse heard her cough and said she would need to be tested before she could come into the office to prevent exposure to other patients.

Van Marter went to the drive-thru coronavirus screening site on opening day, but was initially turned away because she didn’t have a fever. Her mother brought her the doctor’s note requesting the test, and she was then able to receive the test. The results were negative.

That day, Van Marter had 17 contractions, an elevated heart rate and two panic attacks, and thinks that the stress over her inability to access necessary health care contributed to her going into preterm labor. On April 2, she was in the hospital in the late evening for four hours, where she received fluids and terbutaline – a medication that stops preterm labor. This was something Van Marter went through with her previous pregnancies, but not by herself, and not before 30 weeks.

Van Marter’s due date is July 23 – she’s just hoping to hold off until June. Now that progesterone will be arriving in her mailbox, her chances are improved, she said.

“I just figured it’s, like, legit the worst time to be pregnant, ever,” Van Marter said. “Ever. My older sons, their births are memorable because they fell, like, at the opening of the Beijing Olympics and at the closing of the other Olympics. Those are memorable for fun, but this is memorable for a terrifying time.”

Home-delivered progesterone is a great option for Van Marter’s high-risk case, but there are also increasing opportunities for women with normal pregnancies to avoid the doctor’s office through the telehealth option. Calvin Wallace, MultiCare Health Systems women’s services medical director, said this was an option before coronavirus hit but has been rapidly embraced by patients and providers during the pandemic.

Wallace said the patients are provided with blood pressure cuffs and baby monitors to avoid some of the in-office visits. The patients would still need to come in for appointments on weeks 12, 20, 28, 36 and weekly after that until delivery.

Amy Gruel went into Providence Holy Family Hospital on Thursday morning for a scheduled inducement for her third son. An immediate difference Gruel noticed between her experience with her two older sons and this pregnancy was that the staff took her and her husband’s temperatures at intake, and all of the nurses were wearing masks.

The nurse started Pitocin, a labor-inducing drug, at around 9:30 a.m. and Gruel said the experience wasn’t much different from her previous children, other than the fact that only her husband was able to be there. Her two older boys weren’t induced, but Gruel and her doctor decided to go this route because she was close to her due date and her baby was large.

“I was just afraid that my husband wasn’t going to be able to be in the room, or that I would have a regular cold and they could take (the baby) away thinking I had (coronavirus),” Gruel said in a message while in labor on Thursday.

Both Providence and Multicare recommend separation from the mother if she is displaying symptoms consistent with COVID-19 or has tested positive for coronavirus. The mother would have the option of using a breast pump to provide milk for the newborn.

According to the Centers for Disease Control and Prevention, there is little risk of the baby contracting the virus during the pregnancy, but after birth the newborn is at risk of person-to-person infection. According to a limited study, there isn’t evidence of coronavirus in breast milk.

Emily Eye, who gave birth to her first child at Providence Sacred Heart Medical Center on March 29, said that even though she had an excellent experience with the hospital staff, her biggest disappointment was that her mother and sister couldn’t be there. Though delighted to be a new mom, it’s hard to hold off on family meeting her baby until the “Stay Safe, Stay Home” order is lifted. Additionally, her husband couldn’t be present for doctor’s appointments leading up to the birth and missed seeing ultrasounds of the baby.

“I want to be able to share him,” Eye said. “His name is Jeffrey. He’s named after his papas, so I can’t wait for him to get to meet them.”

Whitney Sackman’s son, Asher, was born early on March 25 at MultiCare Valley Hospital with underdeveloped lungs. Because he was delivered by cesarean section, Sackman couldn’t even hold him before he was transported to MultiCare Deaconess Hospital. Normally, someone who just gave birth would not be able to leave the hospital for 24 hours, but Sackman left after 14 because she wanted to visit her son.

Asher spent 12 days in the neonatal intensive care unit at Deaconess. Sackman said the hospital took excellent care of her son. Sackman and her husband had to get badges every time they wanted to visit. They watched as their son transitioned from a CPAP machine to high-flow oxygen and eventually was able to come home.

“We were driving to the hospital every three hours to go visit him,” Sackman said. “It was great that we could still go visit. You’d hear rumors of people not even letting parents in and things like that from across the country.”

The limit on people who can be present caused Kaydi Francis – whose fraternal twins are due May 26 – to change her birth plan. Francis had planned to have a doula to assist in a hospital birth, but when MultiCare announced the policy allowing only one person besides the mother, doulas were included in that limitation. Providence has the same policy. Francis contacted Spokane Midwives, who agreed to help her build a home-birthing plan, provided she did not go into labor before 37 weeks.

“I just worry about all the other moms who don’t have the option of birthing at home or aren’t comfortable with that option,” Francis said. “I was already in a mindset that I was OK with that, but a lot of people aren’t.”

Francis also is concerned about the policy to isolate the mother from the baby if the mom has coronavirus symptoms.

“That’s my absolute worst fear,” Francis said.

Like Francis and Eye, Adrianna Hall, whose baby is due May 22, is disappointed by the restriction on the number of people present. Though she understands, this is her first child, and she was hoping that her mother – who has had medical conditions since Hall was 15 – would be able to be there.

“It has been causing mini-breakdowns,” Hall said. “It is something I’ve been waiting for my whole adult life, and so many other women out there are doing the same thing, and it’s just heartbreaking because you’re already scared being pregnant as it is.”

Hall is hoping to have a natural birth, and the cancellation of all of her childbirth classes makes her nervous. Unemployment also has sparked stress, and she said navigating the application process since she lost her restaurant position on March 17 has caused a great deal of anxiety. She had also hoped to obtain essentials at her baby shower, which she had to cancel.

“We’re trying to figure out how to do that and get stuff, but also having to not go out and about and go shopping,” Hall said.

Jasmine Aiken, 22 weeks pregnant with her second child, is also in a precarious financial position. She works as a mental health technician at Eastern State Hospital, but has taken leave from work to minimize exposure after hearing that someone she works with directly tested positive for coronavirus.

“That’s a scary position to be putting yourself in, but it’s a position I have to put myself in,” Aiken said. “If money gets tight, I have to go back to work, because I can’t not pay my bills.”

Aiken, who has a 10-year-old daughter, feels pulled in two directions: wanting to support her co-workers and to protect her family. She worries about what happens to babies whose mothers had been infected with the coronavirus.

“I want to be excited, and I wanted to jump for joy and say, ‘Yay, I’m having a baby, guys!’ ” Aiken said. “But at the same time, I don’t want to be too excited, because at any given moment, that can be taken from me.”