Pregnancy is a time of great expectation and joy for most women and their families. But with the declaration of the COVID-19 (coronavirus) pandemic, it’s understandable that some pregnant women will be feeling a little anxious about their health and that of their unborn or newborn baby.
It is somewhat difficult to give definitive advice because information differs between locations and the situation is rapidly evolving. However, women have every reason to feel confident about a good outcome, but they do need to heed the advice of health professionals. So what are the risks to pregnant women from coronavirus?
According to the Royal Australian College and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), pregnant women are considered an ‘at-risk’ or ‘vulnerable’ group. It is recommended that they avoid all non-essential travel, avoid public spaces and stay at home where possible – including working from home if they can.
If they do contract COVID-19, it is expected that the large majority of pregnant women will experience only mild or moderate symptoms, much like most of the general population. However, because health professionals are yet to understand the true nature of the virus, this advice is based on learnings from influenza infections and also the medical response to the SARS epidemic in 2003. In the case of influenza, it was noted that pregnant women have an increased risk of severe complications, so the general advice is, err on the side of caution.
Risks To Your Baby
In terms of COVID-19 and pregnancy and given RANZCOG’s extensive knowledge of the impact of the effect of other respiratory viruses, women should remain reassured that there is currently no evidence that COVID-19 will harm your baby or cause abnormalities. Newborn babies and infants also don’t appear to be at increased risk of complications from the virus.
There has also been no confirmed data that a mother who has COVID-19 can transmit the virus to her unborn child, and no risk of miscarriage to women diagnosed with the virus who are trying to conceive or are in early pregnancy.
Some babies born to women with COVID-19 symptoms in China have been born prematurely. However, it is unclear whether the virus was the cause or whether their doctors made the decision that the baby should be born early because the mother was unwell.
It is highly recommended by RANZCOG that pregnant women continue to attend ultrasounds, blood tests, routine antenatal visits and maternal and fetal assessments. And while it won’t influence your response to a COVID-19 infection, you should also have your routine influenza vaccination and a whooping cough vaccination after twenty weeks.
Breastfeeding With COVID-19
At the present time, there is no evident that the virus is carried in breastmilk, so women should be still encouraged and supported to do so. This is because the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of COVID-19. However, if you are diagnosed with the virus, it is recommended that you take enhanced precautions with general hygiene and consider using a facemask.
Hospital And Medical Clinic Strategies
The safest place to give birth to your baby is in a hospital where you have access to emergency facilities and highly trained staff. Pain relief while in labour is also available as normal, including morphine, an epidural and nitrous oxide. In terms of the latter, there is currently insufficient data about the administering of it in a COVID-19 setting, so this advice is under review and may change in the future.
In terms of the coronavirus and pregnancy, there is also no evidence that a caesarean or labour inducement is necessary to reduce the risk of transmission if a woman has COVID-19 infection or has been significantly exposed to it.
Medical intervention, other than that specifically related to infection control, will also not differ significantly from usual practice. RANZCOG has encouraged private practitioners and both public and private hospitals to proactively implement strategies to reduce the risk of exposure for both patients and medical staff. Hospitals must also ensure that Personal Protective Equipment (PPE) and training in its use is available to all staff.
When it comes to pregnant women and the coronavirus, there is no vaccination currently available for COVID-19, so RANZCOG recommends the following preventative measures:
- Washing your hands regularly and thoroughly with an alcohol-based rub or soap and water
- Avoiding people who are coughing, sneezing or have a sore throat, fevers or chills
- Avoiding touching your face, including your nose, mouth and eyes
- Reducing community exposure by staying at home, including working from home if possible
- If you need to go out (unless you are in isolation), avoid public places and public transport
- When out, practice social distancing (maintaining a distance of 1.5 to 2 metres from other people)
- If you feel unwell, seek treatment urgently via your GP or hospital Emergency Department
- Have only one support person in the hospital or birthday suite when the time comes. Obviously this should not be your partner if they are symptomatic or have been diagnosed with COVID-19.
If You Become Unwell
If you develop symptoms (which can be similar to a cold or flu) like a cough, fever, sore throat, nausea, vomiting, diarrhoea, fatigue or difficulty breathing) you should arrange for an urgent medical review through your GP practice, fever clinic or hospital Emergency Department so that you can be considered for COVID-19 testing.
If you are required to self-isolate or are diagnosed with COVID-19, you should notify your healthcare provider and delay and/or reschedule your appointment. This will enable you to continue to receive antenatal or postnatal care without putting other patients or health workers at risk.
Mental Health Support
Pregnancy and parenting are associated with anxiety and depression and unfortunately the current environment may exacerbate this risk for women, their partners and families. The screening, diagnosis and management of perinatal anxiety and depression must continue and services must be supported.
At the present time, the risk to you and your baby is small, and the medical system and its dedicated staff are committed and equipped to care for you. It is important that you continue to rest, exercise, keep your fluid intake up and maintain your interests and normal hobbies. Our staff are also here to support you during this difficult time. Changes around our pregnancy care include:
- Reducing, postponing and/or increasing the time between antenatal visits
- Limiting visit times to less than 15 minutes
- Offering telehealth and phone consultations where appropriate
- Requesting you wait in your car until called for your consultation. When you are called, you can proceed directly to my consulting room to avoid the waiting room and reduce your exposure to the virus
- Providing antenatal advice by phone or video conferencing (as these have been ceased by the hospitals)
- Visiting alone (without children or partners) to reduce disease transmission
- Abiding by hospital rules which limit visiting to partners only during hospital admission
- Encouraging an early discharge from the hospital if possible
If you have any questions or would like to discuss this topic further, please call us on (07) 3353 3100.