For any woman, pregnancy is a time of change. Physically, significant change is evident as your energy levels change and your baby grows. At the best of times, pregnancy can be a stressful season. Throw in a COIVD-19 pandemic, and change with uncertainty take on a whole new level of intensity.
Here is some information about COVID-19 that will hopefully answer some of the questions which you might have.
How does COVID-19 affect me during pregnancy?
Pregnancy is a state of immune suppression that causes pregnant women to be more susceptible to getting severe viral infections (this is why all pregnant women need to get their flu vaccines). This was seen previously during the SARS and MERS virus pandemics where pregnancy was a risk factor for more severe illness. Since COVID-19 belongs to the same family as these viruses, it would be fair to consider that the same would apply. Initially, studies did not demonstrated this. However as more information becomes available it seems there are risks associated with contracting COVID-19 in pregnancy.
A study of 2130 pregnant women from 18 different countries published recently, found that pregnant women are no more likely to get COVID-19 then the rest of the population. However, when they matched these women against non-pregnant women with COVID-19, they found that pregnancy does seem to be a risk factor for more significant symptoms. Pregnant women with COVID-19 had a three times higher risk of getting more severe illness. They were also one and a half times more likely to have a preterm birth and pre-eclampsia (pregnancy associated high blood pressure).
Like the rest of the population, most pregnant women will be asymptomatic if they contract the infection. Other pregnant women who get COVID-19 will experience only mild flu like symptoms such as a headache, cough, fever, loss of smell, a runny nose and sore throat.
A reassuring finding was that asymptomatic pregnant women had similar outcomes as those that weren’t pregnant.
How does COVID affect my baby prior to birth?
Initial studies did not show any evidence of mother-to-baby transmission of COVID-19 before birth. New information suggests that 13% of babies born to mothers with COVID-19 have antibodies in their blood, which suggest that there was viral transmission to the baby. The exact implications for babies born with COVID-19 is uncertain at this time, but these babies seem to only have mild infections.
While we still have limited information about this virus, understanding that in time we will have greater insight and knowledge, currently there is no evidence showing a risk of medical problems or congenital abnormalities for babies who have been infected in utero.
What about breastfeeding?
COVID-19 is not transmitted in breastmilk and if you contracted COVID-19 around the time of birth, then there is no reason why you should not breastfeed, provided you are not sick enough to warrant specialized care. Standard careful hygiene precautions will be sufficient. The best place for your baby to be is with you. Breastmilk provides complete nutrition as well as other benefits such as antibodies against infections.
What if I get COVID-19 just before my planned birth?
All patients will be required to get a COVID-19 test prior to admission. For maternity patients, this is currently being done 5 days prior to birth and applies to your birth partner too. If you have a negative result, then you will be admitted to the maternity ward where the other patients admitted will all have negative results and standard birth care will be given to you.
If the result is positive, then the pathway is a little different. COVID-19 does not affect your planned mode of delivery unless you are very sick. It also does not prevent you from having an epidural if you are planning a normal birth.
Getting COVID-19 just prior to birth may result in a delay in your planned birth and may make the logistics of your partner being present, a challenge.
Generally, you are no longer infective 10 days after your symptoms are gone or 10 days after a positive test if you were asymptomatic. As a result, your delivery may be delayed by 10 days, if safe to do so, to decrease the risk of spreading the infection. Ultimately, shared decision making with you will be prioritised as to optimise the health and wellbeing of you and your baby.
If delivery cannot be delayed then you will be admitted in a separate labour ward (or use a separate theatre) and care will be offered to you by a midwife (theatre staff if caesarean section was planned) and myself dressed in full Personal Protective Equipment.
If you arrive without a result you will be managed as per COVID-19 precautions. A test will be done, and you would be admitted in a ward as a “Patient Under Investigation.” At the moment, your partner will be able to join you for your birth, however he will not be able to walk around the hospital and will have to stay in the room with you. Thereafter, your care pathway will depend on the status of your result.
How do we negotiate this journey and give you the happiest birthing experience possible?
We know the value of having your partner with you, and we appreciate the stress that their absence could cause. We also know the difficult emotional journey that COVID-19 brings, especially during a time that already seems stressful, such as childbirth. I want to assure you that your fears, concerns and wishes are seen and heard.
Importantly, you and your family need to stay as safe as possible, especially toward the end of pregnancy. Feel no peer pressure to meet up with others or awkwardness in telling others to wear their masks and keep their distance.
Labour is difficult to predict and there are a few factors to consider. We will talk you through the testing protocol and try work out the best plan to help you to have a smooth delivery experience.
A Word on antenatal care
It is vitally important that you attend your antenatal visits. If you are unwell, please call us ahead of your appointment as rescheduling will likely be needed.
If you test positive at any point for COVID-19, please inform us immediately, so that we can carefully plan your antenatal care with you.
If you have any concerns or questions, please don’t hesitate to email or call us. We consider it a privilege to support you through this time.