The COVID-19 pandemic has made in-person home visits impossible in most cases. A survey conducted by the Home Visiting Applied Research Collaborative in early April 2020 found that 88% of agencies implementing home visiting were required to stop in-person visits. Survey respondents reported relying equally on video conferencing and telephone (44% each) to conduct visits during the pandemic. The two most commonly reported major challenges to using interactive video conferencing
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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!