- It's fair to say covid-19 has quickly reshaped the American social landscape, including people's intimate lives.

This past June, the Guttmacher Institute took a look at data on the emerging impact of the pandemic on women's sexual and reproductive health here in the US.

The report focuses on how the pandemic has changed the social and economic realities of people's lives, factoring in the nearly universal stay at home requirements, which began in mid-March, and the numerous restrictions that remain in place to control the spread of the virus.

How do things shape up for the Latino community?

Well, the institute reported that 34% of women wanted to delay childbearing or have fewer children in response to the covid-19 pandemic.

And of that group, almost 50% were Hispanic, compared to only 28% non Hispanic white women.

This week, we'll dive into sexual and reproductive health and provide some further insight on how covid-19 has affected fertility, pregnancy and motherhood.

Welcome to A Su Salud, Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting inside the PPL Public Media Center in Bethlehem, Pennsylvania.

Let's introduce our medical expert.

Joining us today from St Luke's University Health Network is Dr Zighelboim.

Doctor, thank you so much for being with us today.

- Hi, Genesis, thanks for having me.

- Let me ask you this, because it seems like for me at least, I go to social media and almost everyone is pregnant.

So how accurate, how accurate is this reality that people think that there is going to be a spike or a baby boom?

- Yeah, you know, we all started hearing about this very early in the pandemic, you know, and not only you heard that a baby boom was coming, but people were kind of proposing names for that generation already - the Coroneos, and we all heard of different propositions for what that generation was going to be.

The truth of the matter is that fertility in this country has been decreasing and not increasing over the recent past.

And that's a reflection of multiple factors, one of them being women, delaying childbearing.

Also the economic situation, which fluctuates from year to year.

Here in the Lehigh Valley, the situation is very similar.

So even though we were expecting a potential explosion, reality tended to indicate that perhaps that was not totally founded.

- As women look to delay childbearing, Doctor, how could this affect the population overall?

- Yes, so there are several implications of delaying childbearing.

One of them is evidently the ability of a woman to conceive decreases as years go by.

And that's a reflection of what we call ovarian reserve, the number of eggs that are still viable in the woman's ovary that decreases year after year.

The other one is that there's a lot of illnesses that can affect women in their 30s, 40s and beyond that do not affect or typically not affect women that are younger.

And those are illnesses and conditions that can actually complicate pregnancy and make pregnancy be high risk or be more complicated.

So all of those things really complicate the care that we now have to provide to pregnant women as they have been.

- Does this, as a result, factor into smaller household sizes?

- Well, in general, we have had a decreased rate of fertility in the United States as a country, we estimate, and unfortunately most estimates that we have for fertility lag behind.

All the vital statistics really lags behind by about two years.

But based on statistics from 2018, which is the last set of data we have, there was an ongoing decrease in the number of births in this country.

And the Lehigh Valley, as I mentioned before, really mimics those statistics.

- Let me ask you this, generally speaking, now we're in a time of a pandemic, so what do trends of fertility rates look like during times of uncertainty like this?

- Well, that has varied historically.

You mentioned the Guttmacher Institute survey.

There was another study that was published in June by the Brookings Institute, and pretty much what they tried to do is establish the potential variation of births that could be attributed to a crisis.

And they looked back at the impact that the Spanish flu and other major disasters, such as the Great Recession in 2008, had produced, and both of those scenarios resulted in a decrease in live births in the United States, the Great Recession of about 9%, the Spanish flu about 12 to 13%.

It's interesting because evidently there are other confounding factors.

The Spanish flu occurred at a time when World War I was also occurring.

So the economic impact of the pandemic was less because the war was driving a lot of the economy at that time.

So nowadays we really have the uncertainties as to when and how things will play out.

The pandemic has evidently not only impacted the patient's perceptions or interest in fertility, but also their financial means.

So based on the financial and the economic situation that has been difficult for most American families is that we think that the initial expectation of a baby boom has not occurred.

- I want to end on this question, Doctor.

I don't know if you can talk about this, but what sort of trends are you seeing from a health network perspective or what sort of trends are you bracing yourself for?

Yes, as a network, we at St Luke's have been very, very fortunate.

And again, we don't think that this necessarily represents the demographics of the area, but some of the changes in our service line and how our hospital network has also grown and provided services to patients closer to their communities, attracting new patients to our network.

But we have had a significant increase year after year for the last three or four years in the number of births that the network manages.

Again, we don't think that this is a reflection of the pandemic itself or a reflection of the natural trends that fertility and new births statistics will have over the next few years for Lehigh Valley.

- Let me ask you this.

Here's a fun question for you, Doctor, about how many births have you assisted in over the course of your career?

- Well, interestingly enough, even though I have the honor of being the chair of OBGYN, I don't deliver babies any more.

I'm focused on gynecologic cancers these days.

But our network delivered north of 4,200 deliveries for the last fiscal year.

And that number has been increasing year after year.

So we're very proud of the strong obstetrical services that St Luke's can offer the community.

- Well, I want to thank you for your work, Dr Zighelboim, and thank you for your time today.

Really, really helpful information.

- Thank you, Genesis.

- Pregnancy is a beautiful experience, but it's not always sunshine and roses.

From trying to conceive, caring for yourself while you're pregnant and even after labor, there are some things you should know.

Let's introduce our medical expert from St Luke's University Health Network, Waleska J. Cancel-Kenyon.

Thanks for being with us today.

- Hi, thank you for having me.

- We mentioned earlier, Doctor, that we're seeing more women looking to delay childbearing.

So can this affect the health and well-being of the mom or the child?

- So we know that extremes of age can have some effect in problems with pregnancy, such as, for example, pre-eclampsia can become more prevalent depending on the extremes of age.

But it does not automatically mean that if you're older that the baby will automatically be affected or that Mom is going to have an adverse outcome with pregnancy.

- That's good news.

You know, speaking to the people right now who are looking to get pregnant, what are some common misconceptions as you start trying for a baby?

- I think one of the most common misconceptions are, one, I don't need to do anything, I'm just going to try and go for it.

But actually, we do recommend starting prenatal vitamins at least three months before conception.

So I usually tell patients within the reproductive age, if you're attempting to conceive or you think you're going to want to become pregnant in the next six, seven months, then please just start a prenatal vitamin.

The other misconception is that if they have preexisting conditions such as diabetes, high blood pressure, thyroid problems, that they are like, "I'll just get pregnant and then deal with it."

Actually, no - prevention is very important.

So actually, if you can get all those problems well controlled before conceiving, your outcomes usually are better.

- So let's talk about prenatal vitamins, because sometimes people aren't planning to have a baby and it just happens.

Or, you know, sometimes, like me, when I was pregnant, I didn't like the taste of prenatal vitamins.

So how important are they?

They are important.

A lot of times we don't consume all the vitamins that we need, though I had a teacher that would always say that, especially in the United States, that our urine was gold because we usually take so many vitamins and extra stuff that we actually don't need anything else.

But no, it is still important in the reproductive age to have extra vitamins, especially the folic acid, which a lot of times we are not taking on a regular basis.

- Now, how can you care for yourself while you're pregnant, especially now, during the midst of a pandemic?

- Yes.

So stay active.

It's very important.

We recommend having exercise at least 30 minutes, five times a week.

It's easier said than done, especially when some gyms are still closed or you don't know where to go.

I would encourage people, listen, there's parks available.

You can go out for a walk.

And the other thing is weight gain in pregnancy, and it's more of a taboo.

Nobody wants to talk about it, but it is important.

It is important to listen to your doctors and see what they're recommending, which we'll tell you at the beginning of the pregnancy.

You know, maybe what we want to keep it at 20, 25 pounds, or sometimes 30, 35 pounds.

It depends on the patient and their other comorbidities they might have.

- Now, should women be concerned about their baby contracting coronavirus while they're pregnant?

- So that's a very heated question that we... that we get a lot right now, and I tell my patients, listen, what's most important for me right now, rather than assuming that the baby would automatically be affected, is for you to try to prevent being infected with the virus.

So I encourage my patients to wear their masks, social distancing, the same things that the experts have been saying for months and months, that has not changed.

And I don't foresee it changing any time soon.

- Now, what are some things to know in the final stretch of labor and delivery?

For someone like me, I didn't do any baby and me classes before I gave birth.

So what can you tell us?

- So I think that having an overview of what to expect is good, and for first time mommies, I tell them, listen, you can get as many classes as you want.

Information is gold.

Knowledge is always good.

But you really don't know until you're actually in the scenario, you know.

But I always tell my patients, read up, have your partner involved as much as possible because I think that at least some terms are going to become familiar to you during the process of labor.

- That's a recurring theme.

As much as you prepare for pregnancy and being a parent, there is always an unknown.

You can't prepare enough for it.

- What's most important is that you want a healthy mommy, healthy baby, and sometimes we can't achieve it exactly how the patient envisioned it.

But if the physician and the patient have that common goal I think that things usually go well, thank God.

- Now I feel like pregnancy and postpartum education should go hand in hand.

And there are some who label postpartum life as the fourth trimester.

So can you talk to us about some of the hormonal changes that happen after you give birth?

- Yes, so your hormones are completely different during the pregnancy and obviously in the postpartum period, so some women, especially if they have already a predisposition to depression or anxiety, will find that in the postpartum period those things can be heightened, or you have patients that have no previous history, that between sleep deprivation that occurs from having a new baby, the anxiety that comes from, am I my feeding my baby correctly, is everything going well, that the anxiety that a woman goes through and the changes that she goes through is a real thing.

- Now, in terms of postpartum baby blues and depression, would you say that this could present itself more severely now during the pandemic?

- I think that in general, not just in the postpartum women, we are seeing it in the general population, so based on a increase in depression overall, yes, we are seeing more women that feel isolated, feel probably not as supported.

They don't have... The family members might be afraid of coming over to the house to either potentially give them coronavirus, or the baby.

And so I think that it is a very hard time for our postpartum moms and maybe just reaching out or being more... if you have a patient, a patient or a friend or somebody that that is in the postpartum period to at least be able to reach out to them.

- For those who are feeling isolated, what do you recommend?

I mean, do virtual mom groups help, too?

- I absolutely think so.

I think just by the fact of having or listening to other people's story and knowing, "You know what, I'm not alone.

"Other women are going through this," then you feel more comfortable and you don't feel as isolated during that time.

Or even, you know, I encourage my own patients, if you're having a hard time, please feel comfortable reaching out.

If we need to schedule more visits, especially in that postpartum period, I don't mind.

And I'm more than happy to sometimes just hear them out, that's sometimes all you need, so that somebody can just tell you, "Yeah, it's normal," or, "You know what?

"This is actually a little bit out of the ordinary.

"Let's help you further, either with medications or therapy," whatever the scenario is.

- Now, as a Spanish-speaking doctor, you work a lot with the Latino community.

Can barriers in language also prove to be an obstacle when overcoming postpartum depression?

Are there resources for women in this situation?

- Absolutely.

I think it's hard when we communicate better, specifically in Spanish, which obviously is what I speak, I find that patients that come over that speak Spanish, they'll be like, "Oh, you know what?

"I just feel more comfortable, that I can kind of, like, "not be worried about what I'm saying "or if I'm saying it correctly or if it's misunderstood."

So we have obviously physicians in the community that are available.

And not only that, but the Baby and Me Center is very helpful in terms of being able to connect patients to the appropriate resources.

- Wonderful, Doctor Cancel-Kenyon.

(SPEAKING SPANISH) Let's speak with our next guest.

Joining us virtually is new mommy Eva Rivera.

Thanks for joining us today.

- Of course.

Thanks for having me.

- First of all, congratulations.

How are you feeling?

- Exhausted, tired, but happy.

- That is what I expected, too.

So your baby is how old now?

- Two months.

Two months.

W- hat has it been like?

I mean, this is the question I think that most moms are getting - what has it been like welcoming a baby during the pandemic?

- Well, surprisingly, I thought it would be challenging, but it was definitely a gift in disguise, I would say.

From labor and delivery to just, you know, take caring, taking care of her now.

Having only my significant other in the room was a blessing.

I was able to focus throughout the process.

I think, had I had other people in the room, I don't think I would have been a happy camper.

And then, you know, with having a newborn, a lot of people would want to come and visit you so you don't necessarily get to have a chance to rest while they're resting.

So, you know, during the pandemic, believe it or not, has actually been nice because it gives you that excuse.

But it's a valid excuse, right, to not have visitors over, one, of course, because of the virus and two, just because of that time that you need to recover from having the baby.

- You make a really good point.

I mean, I welcomed a baby, as you know, in January, the pandemic hadn't hit yet, but I had back to back to back guests, and I was exhausted.

I didn't realize that I didn't want guests at that time until after I had the baby.

But then you can't really, you know, turn people away.

So I'm glad that you see that as a silver lining as well.

I mean, what was labor and delivery like for you?

I mean, was it difficult having a mask on?

Did they do they have you wearing a mask?

- Yes.

And I asked, I said, "Do I have to have this on the whole time?"

And they said, yes, you do.

But, you know, they're not, they weren't strict about keeping it on because, of course, you know, you get to a point while you're going through your contractions where you just can't breathe, you know, you're kind of breathing the mask in and out of your mouth and that gets, you know, dangerous and uncomfortable.

But eventually I just kind of ripped the mask off and they didn't say anything.

And actually I've had the mask off throughout the whole process, even until they've they moved me into recovery.

So... - Are you working from home now too?

I am.

I actually was supposed to be returning from maternity leave in November, but I had to return unexpectedly sooner.

- So what has that been like?

I mean, has it been challenging, working and having a newborn at home?

- Absolutely, because, you know, with a newborn, and like I mentioned, she's only two months as of last Thursday, and so, you know, she's still too, too young to begin sleep training.

And it's really all on them.

It's their timing at this point.

And so working from home has its perks and its challenges.

I would say that the challenge to start off with that is when she's not sleeping, and of course, breastfeeding.

And so that makes it even more of a challenge in that situation.

The perks, however, is that you do get to stay at home and you're able to watch your baby grow and you're able to witness all of those milestones, development milestones.

And you save money on child care.

So I would say those would be the perks.

- I found that to be a silver lining as well.

How else have you adjusted during this time?

What else have you found yourself doing?

- Well, I've been doing a lot, a lot of bottle washing because I am supplementing as well, you know, I would say just I've been staying at home not so much because of the pandemic, but just because caring for a newborn is a full time job.

And so I haven't really been doing much other than staying home and taking care of my baby and figuring out ways to get things done, because although I'm not a single mother, my significant other does work long hours.

And so sometimes you feel alone in situations like that.

You have to figure out, how do I go food shopping with a baby in a stroller, how do I move another cart plus my stroller?

So those are some challenges there.

- I bet.

How are you handling visitors now?

Are you allowing friends and family, parents to come over?

- Yes, it took me a few weeks before I accepted visitors, but what's been nice is that family and friends have been very understanding, again, because of this pandemic, they're even more understanding why I didn't allow visitors at the beginning.

But now, you know, they voluntarily let me know whether they've been tested.

You know, they... You know, they have asked, you know, they've asked me permission to come over.

And when they do come over, they come wearing masks, even though with some, you know, if they've told me they've been tested, I'm like, OK, great.

You know, that's fine.

You know, no mask needed.

However, I... I can't complain at all because everyone's been really great with their visits, either wearing masks or taking the necessary precautions that would be necessary to be around a newborn at this time.

- With an eight week old baby, I think you're the best person to ask this question.

What advice do you have for mommies who are expecting babies in the coming weeks of the... And we're still in the pandemic?

- Yeah, you know, I could name or I could share a ton of advice, but if I had to give a few, the first one would be when given, or when offered help, take it, when offered food, take it, because you don't always have that opportunity to prepare meals or, you know, I went to my last visit with the pediatrician and I said, you know, "There's times where I don't get to eat.

"And I understand it's important "because I'm breastfeeding.

And I was giving the advice to meal prep.

And then I go home and I attempt it and I don't always have the time to meal prep because I have to attend the baby!

So any time family members offer to bring you meals, I would take that offer, that would be my number one advice, I would say.

I mean, I can go on, but I don't want to take up too much time.

But that would be my number one advice.

- I would say the same thing, take all the help that you can get.

I was a little bit stubborn with that.

And looking back, I was like, I should have taken that extra help.

- I would say, put your pride to the side and take the help.

- Yeah, well, thanks for speaking with us today.

Hang in there.

Enjoy that new baby.

- I am, thank you so much.

I want to thank our St Luke's University Health Network experts and Eva Rivera for speaking with us today.

And thank you for tuning in.

We look forward to seeing you again soon.

If you have a suggestion for a medical topic you'd like for us to cover, send me a message on Facebook.

You can find me on social media, Facebook and Instagram.

Plus, you can tune in to hear more of my reporting on 91.3 FM, WRVA News, your local NPR news source.

For all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers.

To your health.