Hospitals across the country have canceled elective procedures to conserve space, manpower, and medical supplies during the COVID-19 outbreak. But while grandpa’s knee replacement can wait, pregnant women can’t.

At some point, that baby has to come out. Texas doctors and hospitals are taking steps to make the process of giving birth as safe as possible. They’re spacing out checkups and conducting appointments over the phone to reduce opportunities for women to come into contact with the coronavirus. Hospitals screen patients and visitors for symptoms before they come in and have limited the number of people who can join a pregnant woman in the delivery room. All the while, they’re trying to keep patients calm and informed.

In addition to the regular stress of having a baby, women face the prospect of delivering in the same hospitals where people are being treated for the coronavirus. Some are spending the days and weeks leading up to their due dates trying to emotionally prepare for the possibility that they could have to give birth alone, while others are looking into delivering outside of hospitals entirely.

Because COVID-19 is new, doctors don’t yet know what kind of long-term effects it could have on babies, or if it could cause birth defects. A study published Thursday in JAMA Pediatrics by three doctors from Wuhan, China, found evidence to suggest that infected pregnant women could pass COVID-19 onto their babies. Of 33 babies born to mothers with the novel coronavirus at Wuhan Children’s Hospital, 3 tested positive for the virus. 

Dr. Patrick Ramsey, medical director for maternal transport and outreach at University Health System and UT Health San Antonio, said there don’t appear to be birth defects associated with SARS or MERS, the cousins to this current virus, but it’s something the medical community is monitoring.

“She’s still going to have a normal delivery, but we’re just going to take extra precautions to make sure that she doesn’t get exposed and the providers don’t get exposed,” Ramsey said.

Doctors have started wearing extra protective equipment and regularly sanitizing instruments and spaces. University Hospital in San Antonio is assigning each mom in labor one specific doctor and one specific nurse to cut down on the number of people walking in and out of the room, Ramsey said. They hope the steps they’re taking will protect both patients and medical personnel from infection.

The situation is complicated by the fact that some women in labor might also have COVID-19. At Memorial Hermann in Houston, mothers with coronavirus symptoms are given a mask when they arrive and are put in isolation, according to Dr. Sean Blackwell, a high-risk specialist and chair of the department of obstetrics, gynecology, and reproductive sciences at McGovern Medical School at UTHealth. “The reality is we can’t stop the birth,” he said.

According to the American College of Obstetricians and Gynecologists, the delivery method a woman and her doctor have agreed upon will not need to change in most cases. But doctors are trying to reduce the amount of time women have to spend in hospitals as much as possible. For some hospitals, that means inducing labor for fewer women and letting nature take its course.

Blackwell said he’s not asking his patients to wait any longer than normal to come in to give birth. But with inductions, women aren’t in labor when they arrive at the hospital. Having to jump-start that labor can increase the time women spend in the hospital by twelve to fourteen hours, Blackwell said.

That’s not to say all inductions have stopped—some are medically advisable. Alyssa Leighton, 22, a first-time mom who is planning to be induced on April 1 at Longview Regional Medical Center, said she feels better knowing her birth is planned, “with everything going on.”

“Being able to get her out and home safely is my main concern,” Leighton said. “I already have a weak immune system and newborns have weak immune systems, so I don’t want to chance it.”

While women understand that the new safety protocols are necessary, they’re not always easy to accept. For Dominique Foegelle, 32, the changes mean she has to attend sonogram appointments alone to check on her growing twins, due April 24. Her husband attended every sonogram for their first baby, and she describes the new reality as “sad and disappointing.”

For now, Foegelle’s San Antonio hospital will allow one person to stay with her when she gives birth—her husband. But she’s worried they might ban all visitors by the time her due date rolls around. Several New York City hospitals announced last week that they wouldn’t allow any visitors in the delivery room, including spouses, family, and doulas, but Governor Andrew Cuomo reversed the policies this weekend by executive order. 

“I’ve tried to discuss it with my husband and have a plan just in case, but I get emotional,” Foegelle said of the prospect of having to give birth alone. “I would definitely be sad and overwhelmed after the delivery, especially with two babies in the hospital and figuring out how to manage that.”

Blackwell said there’s a chance Texas hospitals could restrict their visitor policies further if the pandemic worsens, but he hopes it doesn’t come to that.

“These are pretty big changes,” he said. “If you’re a young, healthy person, childbirth is a celebration. It’s a family adventure. Now we’re not able to treat it that way.”

For moms-to-be, the long list of unknowns is cause for concern. Amber Pomeroy, 28, a nurse in Austin, is due April 30. While she isn’t working directly with COVID-19 patients, she worries that her job puts her at higher risk for contracting the disease.

“I would hate to get it and put my baby at risk for getting it,” Pomeroy said. “There is still so much we don’t know about this virus. The policies and procedures are changing daily, so something that could have been best practice the day before could then be wrong the next day.”

Fear surrounding the coronavirus has led some women to look for ways to avoid the hospital altogether. Alexandra Wyatt, the owner and midwife at Heritage Births in Lubbock, said she’s been fielding calls from moms looking into out-of-hospital birth for the first time. Heritage Births has two birthing suites where women can deliver, and Wyatt can also facilitate home births. She only takes on low-risk patients, and said if anyone presented with coronavirus symptoms, she would transfer them straight to the hospital.

“It has been a valid and safe option all along, but I think most people thought that in order to have an out-of-hospital birth you had to be completely hippie or crunchy,” Wyatt said. “I’m glad that midwives are able to step up and help out our fellow physicians so that they’re able to be the most helpful with the cases where they’re actually really and truly needed.”

More stories from our coronavirus coverage:

What You Should Know About the Coronavirus in Texas

“Everything Got Ripped Out From Under Us”—How Texas’s Restaurant and Bar Workers Are Coping

Yogi Adriene Mishler provides advice for managing stress and working from home