Coronavirus and pregnancy: your questions answered
This post has been written on 31st March 2020, and it reflects the advice contained in RCOG, ACOG and CDC guidelines. The date is mentioned intentionally, because evidence is coming to light all the time regarding coronavirus and pregnancy, and the advice is changing frequently.
The risks of coronavirus infection during pregnancy
What are the risks to mom?
Pregnant women do not appear to be more likely to contract coronavirus or develop complications as a result than the general population.
However, pregnant women experience changes in their bodies that may increase their risk of some infections. Other viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, cause pregnant women to have a higher risk of developing severe illness. It is always important for pregnant women to protect themselves from illnesses. As this is a new virus, how it may affect you is not yet clear.
It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms. The main complication is pneumonia and respiratory distress, although this is extremely rare.
Will mom having Covid-19 effect baby?
There is currently no evidence to suggest an increased risk of miscarriage or abnormalities in your baby. There have been reports of pre-term birth in China, but it is not clear why this happened yet.
Could I pass coronavirus to my baby?
Emerging evidence now suggests that vertical transmission is probable, which is where the virus passes from mother to baby whilst still in utero. The proportion of pregnancies affected and the significance to the baby is unclear.
When my baby is born, are they at risk of catching coronavirus?
Whilst babies and children can contract coronavirus, the disease tends to be much milder than in adults. It is not yet known if newborns are at increased risk than other children.
What if I have Covid-19 during labor/birth?
If you go into labor, and have mild symptoms of suspected or confirmed coronavirus, you will be encouraged to remain at home (self-isolating) in early labor, as per standard practice.
When you and your maternity team decide you need to attend the maternity unit, extra precautions will be taken:
• You will be advised to attend hospital via private transport where possible
• You should be met at the maternity unit entrance and provided extra protective measures such as a mask to wear.
• During labor you will need extra monitoring in the form of a CTG, so should be on a labor ward/delivery suite rather than a birth center. This is because there have been some cases of babies being distressed in labor when their mother has coronavirus.
• There is currently no evidence to suggest C-section or vaginal delivery are better. Therefore, decisions should be taken based on your birth preferences. There is also no reason you cannot have an epidural for pain relief.
• If you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus.
New recent guidance from The Centers for Disease Control and Prevention (CDC in the US) has advised, “to reduce the risk of transmission of the virus that causes Covid-19 from the mother to the newborn, facilities should consider temporarily separating (e.g. separate rooms) the mother who has confirmed Covid-19.”
According to the new hospital guidelines infants born to mothers with coronavirus should be considered persons under investigation (PUIs) and should be isolated in accordance with infection prevention guidance.
It is important to note that this advice differs to the RCPCH stance in the UK, where mothers and babies are not advised to be separated.
Will I be able to breastfeed my baby if I have coronavirus?
At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognized benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.
The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.
If you choose to breastfeed your baby, the following precautions are recommended:
• Wash your hands before touching your baby, breast pump or bottles
• Wear a face mask for feeding at the breast if available
• Follow recommendations for pump cleaning after each use
• Consider asking someone who is well to feed expressed breast milk to your baby.
If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilization guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.
What are the
symptoms of Covid-19?
The symptoms are mainly cough, fever above 37.8°C and shortness of breath.
Other symptoms include fatigue, lack of appetite, muscle aches and a loss of the sense of smell/ taste
You do not need to seek specialist advice or testing if able to manage symptoms at home. If you have severe symptoms you should attend hospital, but please call ahead before turning up.
Whether or not you will be tested if you don’t require admission to hospital will depend on your hospital and which country you are in.
What if I have symptoms of coronavirus?
It is likely that your routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. That may be a different time, or in a different clinic, to protect other patients. If you need to self-isolate, follow usual government advice.
If you live alone, the appointments will be delayed for at least 7 days. If you live with others, the self-isolation applies to the whole household so appointments will be delayed by 14 days.
If you need to come to the maternity unit or hospital you should arrange for your own travel, if possible, and call ahead so they can take precautions for your arrival.
How can I reduce the risk of contracting the infection?
Pregnant women should do the same things as the general public to avoid infection. In the UK and most parts of the world, this now includes social distancing, and avoid leaving home wherever possible.
The main way to stop the spread of COVID-19 is by covering any time you cough (using your elbow is a good technique) and clean your hands often using soap and water or alcohol-based hand sanitizer for at least 20 seconds.
How this pandemic may affect the care you receive in pregnancy & birth
It is worth noting that during this time, there may be some disruption to maternity services for everyone. Pregnancy care is considered an essential service (like A&E) which means operations such as planned caesarean sections cannot be cancelled entirely.
However, the increased volume of patients, and risk of virus transmission affecting healthcare professionals and patients means that the system will not run as normal.
There may be longer response times when calling or being referred for services. There may be a need to reduce the number of antenatal visits you have, or your appointments will be combined to reduce the number of times you have to attend the hospital.
This will be communicated with you, and will be done as safely as possible, taking into account available evidence on the safe number of visits required. Do not reduce your number of visits without agreeing first with your maternity team.
You will be asked to keep the number of people with you to a minimum. This will usually include being asked to not bring children with you to maternity appointments.
Will my birth partner be allowed in?
Across the medical services, visitors are being reduced or prevented to reduce risk to uninfected patients and also staff. However, all organizations recognize the important role that birth partners play in supporting mothers, and therefore labor and delivery is often an area with special rules.
In the UK, the RCOG have advised that a single, asymptomatic birth partner should be permitted to stay with the woman during active labor but may need to leave once the baby is born. Other countries haven’t specifically advised about number of birth partners, meaning hospitals need to determine their own rules.
There may be situations where the hospital does not allow birth partners to join you in labor or birth. This is a very difficult situation but is only done in extreme circumstances because the hospital believes that their staff or other patients are at high risk. Although your partner may have no symptoms of coronavirus, they could be carrying the virus and transmit it unknowingly.
It is worth planning in advance what you can do to have a positive experience during this pandemic, even if you aren’t able to have the people around you that you had planned.
The Birth Collective have launched a free course to help prepare you called ‘Having a positive birth during a pandemic’ which can be found here: https://www.thebirthcollective.org/courses/