Cristal Brown thought she would give birth with her mom and boyfriend by her side, and then draw her newborn close to breastfeed.

“That’s how I pictured it,” Brown said. “And it went totally the opposite. I was alone.”

When the time finally arrived to induce labor, Manhattan hospitals were already limiting visitors because of the coronavirus pandemic. After Brown tested positive for Covid-19, her partner was forced to leave.

Pre-eclampsia and a bacterial infection eventually pushed her into having an invasive C-section. After her baby was born, she had to stay 6ft away from him and couldn’t hold him before he was whisked out of the room.

Brown was isolated except when hospital staff checked her vital signs or redressed her incision. The closest she got to her baby boy for 36 hours were photos on her phone.

“I just wanted to take my son and go home,” Brown said.

Maternal care in the US, already flawed compared to similarly well-off countries, has been derailed because of the global coronavirus pandemic. Prenatal visits have transitioned to a combination of telehealth and in-person appointments where only the pregnant person is allowed to be physically present. Maternity units are also limiting visitors, usually to one, though some hospitals in Covid-19 hotspots have not allowed any.

These changes have made deliveries difficult for all expecting mothers, regardless of a Covid-19 diagnosis, race or ethnicity. But even under “normal” circumstances, black mothers face a terrifying prospect as they navigate US hospitals, historically influenced by systemic racism and implicit biases, experts say. Add a global pandemic that’s overwhelming the country’s healthcare institutions, and advocates warn the outcome could be disastrous.

“Black women aren’t trusted. They aren’t trusted to know and understand their own bodies,” said Nia Martin-Robinson, director of black leadership and engagement at Planned Parenthood Federation of America.

“The impact of Covid-19 on a lot of health systems is gonna further exacerbate maternal health complications, especially when it comes to labor and delivery,” said Angela D Aina, interim executive director of Black Mamas Matter Alliance.

Specialists in maternal health fear that women will suffer and die, and that recent strides will regress, as a result of the outbreak. They also recognize the parallels between Covid-19 and maternal mortality, both of which have worse impacts on people of color.

“What you see for both black maternal mortality and for Covid-19 is that difference … in who is seen as valuable shows up so quickly,” said Dr Joia Crear-Perry, president of the National Birth Equity Collaborative.

Black Americans have shouldered a disproportionate burden from coronavirus thus far, representing 34% of fatalities but only around 13% of the population in states that have released racial breakdowns of their data, according to Johns Hopkins University. It’s the continuation of a pernicious trend in healthcare: for years now, black women have carried the lion’s share of pregnancy-related tragedies.

In 2018, black women died of maternal causes at 2.5 times the rate of white women and 3.1 times the rate of Hispanic women, according to the Centers for Disease Control and Prevention (CDC); multi-year reports have shown even wider chasms. These racial inequities exist across socio-economic status and education levels, research suggests.

“We know that black women who are healthy, who have done what the medical community might consider to be all of the right things, are still black women who are dying,” said Martin-Robinson.

Experts told the Guardian how an already lethal situation is devolving even further as expectant mothers have had their agency stripped away and their support systems pushed out of the birthing room in the name of safety. They focused especially on the confusion and fear in New York City, the US’s Covid-19 center, where black women were already nearly eight times more likely than their white counterparts to suffer a pregnancy-related death.

“I think where these two public health crises intersect is that they are impacting the same communities, they are thriving on the same forms of discrimination,” said Pilar Herrero, a senior staff attorney at the Center for Reproductive Rights. “And there are pregnant women of color who … were already at risk of dying from a preventable maternal death, who now might also be exposed to the Covid-19 infection, or might not get the care that they need because resources have been reallocated.”

Mothers are already suffering the consequences. Amber Rose Isaac, a 26-year-old black, Puerto Rican New Yorker, died on 21 April during an emergency C-section. Her platelet counts — which help blood clot — had been falling since February, but the condition went largely unmonitored because her doctor’s visits had been replaced with Zoom conference calls.

“All of this was 100% preventable. All of it,” said Bruce McIntyre III, Isaac’s partner. “I feel like she would have got more attentive care if she was a white mother, to be completely honest with you.”

Denise Bolds, a doula who supports mothers during childbirth, warned that, because hospitals have limited staff and want to cut down exposure to Covid-19, doctors may rush toward operations such as C-sections.

“It’s really changing how women are giving birth,” Bolds said. “It’s becoming more clinical. It’s becoming more controlled. And women are losing their autonomy.”

Preliminary evidence suggests pregnancy does not appear to increase the risk of contracting or getting seriously ill from Covid-19. But the virus has created a tremendous sense of uncertainty around pregnancy.

It has also overwhelmed medical staff who don’t have enough personal protective equipment (PPE) or testing, “placing the human rights of health workers and the human rights of pregnant people in tension with one another in ways that really could have been avoided”, Herrero said.

“Where we see discrimination already pre-Covid, now it’s not only strongly enforced but exacerbated,” said Jennie Joseph, a midwife and health advocate in Florida.

“You’re stressed already, you’re at your wits’ end, you’re tired out, you’re scared as well. You’re gonna go to your kneejerk, which is you’re gonna think about things in the way that is simplest, quickest, easiest.”

There’s no worldwide consensus around whether women who test positive for coronavirus or show related symptoms can safely touch their newborn and breastfeed directly. So far, the virus hasn’t been found in breastmilk or amniotic fluid, but hospitals are still separating mothers such as Brown from their newborns in case they’re contagious.

The World Health Organization has said mothers should be able to hold their babies skin-to-skin, breastfeed with proper hygiene and stay in the same room, regardless of a Covid-19 diagnosis. But the American Academy of Pediatrics has recommended temporary separation between mother and baby, or at least maintaining a 6ft distance.

“We really are building this rocket ship while it’s flying,” said Melissa A Simon, a physician and professor at the Northwestern University Feinberg school of medicine. “So in general, most of us believe we should err on the side of caution and not have that newborn and mom contact when the mom just was diagnosed with Covid.”