As March of Dimes’ President and CEO Stacey Stewart put it, “you can’t delay when you’re going to have your baby.” While the world feels like its on an indefinite pause while people across the globe wait out the Coronavirus pandemic in their homes, Stewart is right. For expecting women, your baby is going to come when it’s ready to come, even if your due date is scheduled during this era of social distancing and isolation.
That fact isn’t meant to incite fear or worry. Rather, it’s meant to empower expecting people and birth workers to get informed and share what you know in order to support others and protect not only the health of mom and baby, but the birth experience. Via a virtual panel (the new normal these days), Stewart brought together March of Dimes‘ Chief Medical and Health Officer Rahul Gupta, Mama Glow founder Latham Thomas, and former president of the American College of Obstetricians and Gynecologists (ACOG) Lisa M. Hollier to discuss the risks of COVID-19 for pregnant women and their babies and how the current pandemic can impact prenatal appointments and planned hospital deliveries.
While information about the virus is evolving on a day to day (or sometimes hour by hour) basis, Gupta says it is critical that the health of pregnant women is kept in mind as we develop an understanding of the COVID-19 pandemic, to better understand the extent to which they, specifically, are at risk if they contract Coronavirus. While the age demographic of pregnant women does not put them in a high-risk category and they do not seem to have more severe symptoms than the general public, Hollier agrees that since information that is specific to pregnant women and fetuses is limited at this time (with most data coming from third-trimester pregnancies), we don’t know if pregnancy makes women more or less likely to get sick. Therefore, the best thing a pregnant woman can do is talk to her care provider and birth team in order to get up-to-date information that is specific to her personal situation.
That being said, the panel tackled a number of topics specific to pregnancy and childbirth, considering how we must think of and plan for them differently in the age of COVID-19, and acknowledging that harnessing this information now will only better prepare us for the future.
Latham Thomas explains that “the medical system has been really strained over the course of the past 3 weeks, so it is really important for non-clinical providers to fill in the gaps and support the mental and emotional needs of patients and people. And since the rule for most hospitals has moved from a 2 person maximum in the delivery room to a 1 person maximum, some have ruled out a partner entirely, requiring birthing people to deliver alone. For this reason, it is more important than ever that mothers and partners know how to advocate and ask for what they need, while understanding the limitations that hospitals are currently faced with.
For women who planned to birth with the support of both their partner and a doula, many hospitals are offering digital support and waving rules against in-room video chatting to keep that unit in tact as much as possible. This is so important, as Stewart reminds us that taking support away from a birthing person could result in a traumatic birth experience. It has become the responsibility of doulas around the world to equip themselves with tools they need to support their clients digitally.
With everything we’re hearing in the news about hospitals running short on supplies, it’s understandable for you to wonder if your hospital will be able to care for you through your delivery and keep you as safe as possible. While PPE and medical supplies are dwindling in numbers, resources in the maternity units of some hospitals are being pulled to the COVID-19 treatment units. It’s also important to remember that, should you need a ventilator at any point before, during, or after your delivery, there is not a shortage of ventilators everywhere, and Gupta says that pregnant women should not be afraid of not having access to what they need to give birth safely. He also says that cardiovascular and lung disease can be a significant risk factor for COVID-19 so if you have any of those underlying issues, you need to communicate with your care team so that they can offer a personalized care plan on any changes to your prenatal care that fits your specific needs; however, if you’re a mom that is high-risk, you are likely already planning to deliver somewhere that is prepared to support your specific needs.
Hollier reminds us that a statement was released about continued safety for women to give birth in hospitals during the pandemic, but says to check with your hospital before you plan to deliver to know what their current policies are. On the day of your delivery, be prepared to see a lot more social distancing and a lot more PPE for your team. The check-in process when you arrive may also include screening to make sure you and the support person who’s with you (if you have one) do not show any symptoms of the virus.
Hollier says that, in light of the Coronavirus pandemic, OB/GYNs are adjusting to the current climate and responding to their patients’ needs by shifting to much more use of technology. This includes implementing telemedicine practices
in order to maintain meaningful connection that is patient-centric without having expectant patients come in the office and risk exposure.
Gupta stresses that prenatal visits should not be missed, and pregnant women should continue them essential, for the health of both mom and baby.
Even the most informed person is bound to feel some added stress and fear in this current climate. While you may not be able to combat those very valid feelings, Hollier says that all pregnant people should “know what to expect when you’re expecting in these very challenging times.” Gupta advises that pregnant women can reduce stress so that they are not overburdening their own bodies by staying in close communication with their healthcare providers and putting science to work, continuing their routine safely based on what science has learned about the virus and how it behaves.
Adding to that, Thomas reminds us that while we’re all at home, this is a great time to become more educated to be the best advocate for yourself and for your growing baby. Even if we can’t meet in-person, finding access to a virtual doula will give you non-clinical support that is emotional, spiritual, and comforting, and can also give you the language to advocate for yourself when it is time to give birth. There are people who can help package and digest the information out there so that it doesn’t feel so scary or overwhelming. Use the resources of your people so you can thrive through the process.
Healthcare Workers Who Are Pregnant
If you’re an expectant healthcare worker, currently working at a hospital or medical center where you may be coming in contact with COVID-19, you’re likely wondering if going to work is safe for you and your baby for you. While being in those environments does increase your risk of exposure, Hollier explains that a lot of institutions have very specific guidance for their employees and staff to keep everyone safe during the pandemic, including pregnant people.
Gupta encourages pregnant healthcare workers that if you’re worried and you’re coming to work, talk to your employer about your specific risk and your status as a pregnant women. He says you may be surprised by how many options open up, but you need to advocate for yourself because they may not be thinking about it on their own.
Thomas adds that it’s an incredibly stressful environment already, so when you’re in that space and you’re pregnant, you could expose yourself to higher risk of preterm labor, becoming immunosuppressed, etc. For all healthcare providers who are on the front lines caring for COVID-19 patients, mental health is an important piece that must be taken into consideration.
Bringing Your Newborn Baby Home
When you’ve have your baby and are ready to take them home, Hollier says it is important to maintain social distancing and limit who is coming into the home to visit that infant. The home visits from friends and family that would normally be commonplace once you’ve brought your baby home do not follow the rules of social distancing. Since babies do not have robust immune systems when they are born, they could be at greater risk of contracting COVID-19 if they come into contact with someone who has it.
Gupta adds that if the child has older siblings who are living in the house with them, that child could have COVID-19 but be asymptomatic. The panel suggests managing expectations around holding and touching the baby, maintaining good hand washing and personal hygiene, and wearing masks and gloves as appropriate. Furthermore, you should ensure (to the best of your ability) that anyone who is coming into the house is healthy, by doing temperature checks, respiratory checks, etc.
In place of at-home visit, Thomas recommends using technology and live chat to keep extended family connected to and meeting the baby. A group chat can keep everyone in the family in-the-loop with photos and updates, while limiting the strain and pressure on the parents to maintain contact. If someone you know has just had a baby and you’re wondering what you can do to support them, consider sending a gift card in place of in-person care and support.
For a mother who has or thinks she might have COVID-19, breastfeeding could feel scary. While Gupta and Hollier say that research hasn’t seen COVID-19 come up through breast milk or in amniotic fluid, we don’t have robust data yet and cannot be sure if that information will change.
Thomas reminds us that, in most cases, we know that breastfeeding and breast milk is the safest and healthiest option for developing infants. Breastmilk has important antibodies which will help build your babies immune system, so she recommends doing it safely if you are able.
If you are unable to breastfeed your child due to COVID-19, there are ways to get breastmilk to the baby if the mother has to be separated for any length of time. The mother could pump, or make use of a milk bank (which pre-screens its milk).
Neonatal Intensive Care Unit
If your newborn needs to spend time in the NICU, that can already feel like a stressful time, even without factoring in the COVID-19 pandemic and its presence in hospitals. The experience does not have to be a negative one, however, as there are ample support measures in place to keep NICU patients as safe as possible. One expectation to prepare for is that visitors and other providers may be limited during the pandemic.
Make sure your questions are being addressed, and go into the NICU with all of the information you need to advocate for your baby – March of Dimes’ “My NICU Baby” application can help support you. Under the current circumstance, it is important that you understand why your baby is in the NICU and how those conditions could relate to COVID-19 risks and recovery – underlying lung and heart conditions could make your baby at higher risk of longterm issues if they contract COVID-19. Furthermore, work proactively to understand the technology and other aspects of what you’ll be using at home, empowering yourself to have all those answers ahead of time and know who you can turn to.
People who have had a baby in the NICU are already well-versed in the precautions that are being asked of all of us to prevent COVID-19 spread, so know that there is power in your experience.
For women who are not currently pregnant but were thinking about becoming pregnant — COVID-19 presents the question “Should I be delaying my plans to get pregnant?”
Thomas says it’s a challenge for anyone who was hopeful about starting a family to now have to face this pandemic and what it looks like for our society, recognizing that in addition to the medical constraints, there are economic changes that may also need to be considered.
It’s really hard to tell someone “don’t do this now” because it’s a personal choice, but if you have the ability to put it off, you may want to consider waiting until later in the year. Stress is something that could overcome a family at a time like this. To prevent family planning from becoming and added stressor, there are resources and tools that can help you find care providers and come up with a best course of action, including community groups online with people who are going through similar challenges.
If you’re already in the middle of fertility treatments, Hollier cites that ASRM studies suggest that ongoing cycles can be continued, while new cycles might not be started.
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We're here to support you and your family with the information you need to know during this global pandemic. For more resources, please visit marchofdimes.org/covid19.
Posted by March of Dimes on Wednesday, April 1, 2020