Blog series: COVID-19 Response: What to Expect When You’re Expecting During a Pandemic

COVID-19 blog series

Pregnancy can be one of the most exciting and special times in a
family’s life, but in the current COVID-19 pandemic, expectant families may
find themselves a bundle of nerves when they think of their bundle of joy.

Are pregnant women considered “at-risk” for COVID-19? Early
data from other countries suggested that high
rates of pregnant women were not testing positive for COVID – which
differs from previous viral infections like SARS. However, the U.S. Centers for
Disease Control (CDC) still urges
caution
because so much is still unknown:

“We do not currently know if pregnant women have a greater
chance of getting sick from COVID-19 than the general public nor whether they
are more likely to have serious illness as a result. Pregnant women experience
changes in their bodies that may increase their risk of some infections.”

The CDC says
the best strategy is for pregnant women to attempt to avoid contracting the
virus, through the same steps as the general public, including social isolation
(especially avoiding those who have been sick) and frequent hand washing. The American College of Obstetrics &
Gynecology (ACOG) has now adopted
the CDC’s recommendation
that pregnant women, like all Americans, should
wear a face mask if going outside, but should continue to maintain social
distancing as the best strategy to avoid infection.

What happens
if a woman does contract COVID-19 while pregnant?
ACOG reports that, currently, pregnant
people do not seem to have more severe COVID-19 symptoms than the general
population, though data is not fully available. ACOG also says it is “too early” to know how the virus affects a fetus. Some data in other
countries have found more early births among pregnant women with COVID-19,
though it is not clear that those births were because of the virus. New
research is coming out nearly every day, but the Kaiser Family Foundation says
that “vertical transmission” – transmission to the fetus in utero through the placenta –
is not frequent; several newborns have tested positive but it is unclear if
they contracted the virus during pregnancy or delivery.

How is prenatal care and delivery impacted? All pregnant people may experience changes to their prenatal visits as offices take steps to avoid the spread of COVID-19. This
may include changes in schedule availability, restrictions on other people
attending visits, or a shift, where possible, to telehealth visits. The exact nature of the change will depend on where in a pregnancy a patient
is; patients should talk with their provider.

Those giving birth during our current recommended period of social
isolation may have an experience different than what they envisioned. Hospitals
are restricting the number of support people in the labor ward to generally one
person who shows no symptoms of the virus. Several hospitals in New York, the
epicenter of the U.S. outbreak, made headlines by banning even a support person
from the delivery room, but the state has since issued an Executive
Order
maintaining the right of mothers to have a support person
(symptom-free) as a matter of health and safety. This may still require some
families to reconsider their labor plan – for example, if a family expected to
have both the mother’s partner and a doula for support, they will now be
restricted to just one person.

If a new baby requires a stay in a Neonatal Intensive Care Unit (NICU), these facilities are already well-suited to our current societal challenges. NICU’s follow strict procedures for hygiene, and control the flow of visitors to avoid infection given the health conditions of their patients. Many NICUs are reporting at this time that they are limiting visitors to just one parent, which can be very difficult to another parent or family member who feels separated during this emotional time.

A mother who tests positive for COVID-19 may have additional
regulations put into place to avoid transmission to the baby, such as not
having the baby “room-in” inside the hospital; specific protocol with
transportation to the hospital to avoid spread; and a limiting of mother-baby
physical contact. Specific rules will depend on each situation and health care
facility, and families should speak with their providers to understand these
changes. These can be difficult realities to accept as they differ from the
idea a family may have held for birth for months, but are ultimately to try to
ensure the patients and staff all go home healthy.

What has changed about going home after birth? Families
should expect to go home quickly after delivery, assuming it was an uncomplicated
delivery. ACOG is
recommending
sending families home one day after delivery, as opposed to the
more standard two-day stay, in order to minimize exposure within the hospital.

The American Academy of Pediatrics has released Tips for
Coping with a New Baby During COVID-19
, which provides some guidance for
families making this huge transition during these difficult times, which
includes recommendations for how to stay connected to loved ones and support
groups even while socially isolating, and suggestions for how family members
can still help from afar.

Parents may worry about their infant feeding decisions: is it
still safe to breastfeed? Is it still easy to get formula?

  • So far, researchers believe COVID-19 does
    not pass through breastmilk
    and the CDC
    acknowledges that, in fact, breastmilk provides protection for infants from
    many ailments (this is why mothers with a common cold are told it is still
    healthy to breastfeed). For mothers with a confirmed or suspected case of
    COVID-19, breast milk remains a healthy option for baby, but precautions should
    be taken to avoid spread through other contact. This includes washing hands
    before feeding and, if possible, wearing a facemask to avoid respiratory
    transmission to the baby while in close contact. Some mothers may choose to
    exclusively pump for a period to avoid the chance of transmission, but should
    be sure to wash hands and all pump parts before and after a session for safety.
    Donor milk, which ICS has written before is essential for some NICU babies,
    also continues to be a safe
    option
    for those with a medical need, as milk is pasteurized and test
    before distribution.
  • Families may have seen media coverage of
    “formula shortages” in the early days of the pandemic crisis, as shoppers
    stocked up on essentials and other supplies. However, an AAP
    article reports
    that stock levels in stores should return to normal as production
    continues. They recommend parents purchase no more than a 2-week supply to have
    on hand. They warn that families should never water down formula and not
    try to make “homemade” formula from recipes online. Pediatricians may be able
    to help families access formula through local charities or samples, and should
    be called before any changes are made to a baby’s regular feedings.

For both mom and baby, there are important health care appointments in the weeks after birth to ensure there are no complications. Newborn well-child visits should still be completed as planned unless extreme circumstances are involved; see our previous blog on pediatric health care. ACOG notes that the 12 week postpartum appointment may be delayed or switched to telehealth; however, some Medicaid patients may lose their insurance at 12 weeks postpartum, so those visits should be prioritized to ensure full coverage.

COVID-19 has changed a lot about how families conduct our daily
lives, but families can still have safe and healthy pregnancies and expand
their families!

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