Our most recent Healthe-Matters blog post addressing pregnancy and birth amid the COVID-19 pandemic (“Pregnancy & Coronavirus ~ Ask An Expert Q&A”) was published a little more than 3 months ago. Since then, healthcare experts have learned more about novel coronavirus transmission and trends. Below, we revisit the March 2020 Q&A and offer updated responses from Maternal-Fetal Medicine specialist Washington Hill, MD, that reflect the latest information known about this evolving public health threat.
Am I at more risk for COVID-19 infection since I'm pregnant?
No. There is still no evidence that pregnant women have a higher risk for infection, even though their altered immune systems make them more susceptible to viral infections in general.
However, pregnant women with COVID-19 may be more likely to develop severe illness, compared to non-pregnant women with the virus. Because of this, the Centers for Disease Control and Prevention (CDC) recently added pregnant women to its list of people who are high risk for severe COVID-19.
For those at higher risk, we recommend limiting contact with others as much as possible, or restricting contacts to a small number of people who are willing to take measures to reduce the risk of (you) becoming infected," said CDC Director Dr. Robert Redfield.
Having COVID-19 during pregnancy may also bring an increased risk of adverse pregnancy outcomes, such as preterm birth.
Pregnant women and their families — like everyone — should take preventive steps to avoid COVID-19 infection:
- Stay home as much as possible, avoid crowds and remind your friends and family to stay home as well.
- Practice physical distancing, staying at least 6 feet away from those who are not in your household.
- Wear a mask when you’re out and when you may not be able to physical distance.
- Wash your hands frequently with soap and water, or use alcohol-based hand sanitizer.
- Avoid people who are sick and not in your “bubble.”
How might coronavirus infection affect my pregnancy?
While data on COVID-19’s impacts on pregnancy and long-term health is still limited at this time, it does appear that pregnant women are at higher risk for developing severe cases of COVID-19 (especially among black and Hispanic women) — serious enough to require hospitalization and potentially ICU admission — so taking those preventive measures mentioned above is really important.
Some COVID-19 patients’ pregnancies have been associated with problems like low birth weight and preterm birth. To date, there is inadequate available data on COVID-19 and miscarriage or birth defects.
A high fever early in pregnancy may increase the risk of certain birth defects, but further data is needed (and coming). We do know that women with infections of other coronaviruses do NOT have miscarriages or stillbirth at higher rates than the general population.
Could I transmit COVID-19 to my baby during pregnancy or delivery?
We really don’t know for sure yet. The bottom line is that there is very limited data, and further studies are needed to answer that question conclusively. There have been no clear reports of mother-to-baby transmission for other coronaviruses.
What we know right now: Of the published case studies of infants born to mothers with COVID-19, few of the newborns tested positive for the virus and there was no virus detected in amniotic fluid or breast milk samples. But there have been a few reports of newborns (as young as a few days old) with infection; this suggests — but does not prove — that a mother can transmit COVID-19 to her infant through close contact after delivery. Studies are ongoing.
Is it safe for me to deliver at SMH or a hospital where there have been COVID-19 cases?
Absolutely. Whether delivering vaginally or by Cesarean, hospital births are safe.
We know that COVID-19 is a very scary virus for you — and for many of us. But know that Sarasota Memorial Hospital (SMH) and many other hospitals are taking every precaution and following stringent infection-prevention protocols in order to keep patients, families and healthcare providers safe.
These include testing pregnant women for COVID-19 when they are admitted for delivery, as well as enforcing visitation policies that help make it possible for you to deliver at the hospital — along with your support person — without putting yourself or your baby at risk.
At the time of this post’s publication, visitors are not allowed at SMH. There are limited exceptions to the no-visitor policy, which allow for 1 support person for women who are giving birth (Labor-Delivery / Mother-Baby), along with a certified doula or a licensed community midwife, and 2 designated visitors for infant patients in the Neonatal Intensive Care Unit (NICU).
If you’re planning to deliver your baby at SMH in the near future and have questions about how the visitor policy may impact your birth experience, please call 941-313-0943 to speak with a clinical nursing leader. If you’re planning to deliver at another hospital, we recommend calling ahead to find out whether there are restrictions on visitors.
I work in healthcare. Should I ask my doctor to excuse me from work until the baby is born? What if I work in some other high-risk setting?
Healthcare facilities take care to limit the exposure of pregnant employees to patients with confirmed or suspected COVID-19, just as they would with other infectious cases.
If you work in another high-risk setting, talk with your employer about what it is doing to protect employees and minimize infection risks.
Regardless of where or if you work, be sure to follow the CDC's guidelines for prevention and reducing community spread.
What if my OB or midwife gets COVID-19?
If your doctor or midwife tests positive for COVID-19, he/she will need to be quarantined until they are no longer at risk of transmitting the virus. You would be assigned to another OB in your doctor's practice group, or you may choose another practitioner yourself. Ask your new OB or your doctor's office whether you should self-quarantine or be tested for the virus; the guidance will depend on when you last saw your provider and when he/she tested positive.
Will the hospital separate me even temporarily from my newborn and keep the baby in quarantine?
If you don't have COVID-19 and have not been exposed to the virus, the hospital will not separate you from your newborn.
If you do test positive for COVID-19 or have been exposed but have no symptoms, your OB provider and your pediatrician will collaborate on how to best decrease the risk of transmission, following current recommendations of the CDC, American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. Wearing a mask while breastfeeding is recommended for moms with COVID-19 and should be done.
As your due date approaches, talk with the hospital, your baby's pediatrician and your family about how to care for your baby, should you test COVID-19 positive and must be separated after delivery and for how long. Be sure you have the emotional support you would need to endure the sadness and stress of having to potentially delay really meeting your newborn. Use the technology we all have available to us (video chat apps, etc.) to connect with your loved ones and newborn during that time.
Can I just skip my next appointment with my OB/midwife, and wait to go in when in labor?
No, no and no. If you have a concern, speak to him/her about spreading out your appointments, seeing you less often or having virtual appointments via your smartphone, computer or tablet. More and more doctors are using telehealth.
When can I have my baby shower?
Any time you like — as long as it’s a virtual baby shower.
Seriously, we advise against any in-person gatherings right now. Too risky.
A Zoom or FaceTime baby shower may not be the celebration you dreamed of, but with a little creativity, a virtual shower can be just as fun and special. There are lots of great suggestions online (hello, Pinterest). Use an online registry, organize a drive-by baby shower, etc. Ask invitees to mail or drop off the gifts ahead of time and send games out via email; then enjoy the activities and open gifts when the group is on the video chat.
Another bonus of Zoom baby showers is that you can have as many as you like. Schedule separate showers with different groups: one with family, another with co-workers and one with your friends.
This is definitely a time for you and your loved ones to practice physical distancing and to stay at home, so if a virtual baby shower isn’t for you, then plan to postpone the celebration until it’s safe to hold in-person gatherings again.
Can I visit a salon to get my hair done or a manicure/pedicure?
The more you are out and about, the higher your risk of exposure. But now that these businesses are open again, it’s up to each of us to decide when it’s worth the risk. Wear a mask if you go, and call ahead see what they’re doing to protect you. If you feel uncomfortable, leave.
Should we cancel our planned babymoon?
That’s still an easy one: Yes. The virus has reached more than 140 countries; this is not the time for travel. Stay home, and be safe.
Places where large numbers of people gather put you and your baby at highest risk, including airports and cruise ships. If you were planning travel in the U.S., note that any travel setting increases your risk of exposure, and there are many places — abroad and in the US — where everyone is being asked to stay at home, face masks are mandated or tourism services are closed.
For the most current travel restrictions and advice to help you avoid exposure, check the CDC's COVID-19 travel page. But please, just cancel.
I’m really scared and worried about the virus. What should I do?
That’s normal. Don’t worry alone. Talk to you OB or midwife. This is going to be a marathon, not a sprint.
Advice many of us share and have been given ourselves is to turn off the news and news alerts. You don’t need them. Give yourself a daily news budget of 30 to 60 minutes.
Read a book. Take a walk (we can still do that outside, just remember to physical distance); the morning is the best time. Walk on the beach if you need it.
Ask someone in your “bubble” for a hug. Call or have a virtual visit with someone you haven’t talked to in a while.
Remember, the beautiful, Florida sun will rise again tomorrow, and you are going to experience the joy of having a BABY!!
Stay Informed, Stay Healthy
The COVID-19 pandemic is an evolving story. Stay informed and stay connected with your care team. Talk with your doctor or midwife frequently. Specific guidance changes rapidly, and your questions will also change over time.
Be selective about where you get your information. For reliable information, visit the SMH COVID-19 webpage and check out websites for the CDC, American College of Obstetricians and Gynecologists, the Society of Maternal-Fetal Medicine, and your expert SMH healthcare providers.
Be safe, stay well and mask up!
{Bonus update: The original Q&A was borne out of questions from a then-anxious mother-to-be. Good news! She reports that her delivery at SMH went well, with the support of her partner; and the new mom says the new baby is healthy and doing fine.}
Washington Hill, MD, a Maternal-Fetal Medicine specialist with CenterPlace Health and Sarasota Memorial Hospital, has been an obstetrician-gynecologist for 55 years, almost 30 in Sarasota.