HEALTH PLUS MED­ICAL COR­RE­SPON­DENT

Preg­nan­cy can be an anx­ious time in the best of cir­cum­stances, but the spec­tre of COVID-19 pan­dem­ic and the in­creas­ing re­stric­tions im­posed on our lives as the world grap­ples with this virus, are enough to make any­one feel on edge. You may have planned to a de­tail for this mir­a­cle you ex­pect to de­liv­er, you over­came the hor­rid ex­pul­sions of the first trimester eme­sis(vom­it­ing), the ba­by room is set and ready to wel­come this new joy­ous ad­di­tion in your life. It’s just that no one ex­pect­ed a pan­dem­ic and sud­den­ly you are swarmed with words like spikes, high-risk and ven­ti­la­tion; and re­luc­tant­ly sleep­less nights and neck pains be­come a part of your dai­ly ex­is­tence.

Child­birth is usu­al­ly a time when women feel par­tic­u­lar­ly vul­ner­a­ble but they usu­al­ly find com­fort in hav­ing ca­pa­ble and re­as­sur­ing fig­ures to pro­vide them with sup­port and mo­ti­va­tion, and more so when labour takes a pro­tract­ed time and/or is more com­pli­cat­ed than usu­al. But now with new re­stric­tions aris­ing from the cri­sis, many preg­nant moth­ers are un­able to have any­one oth­er than the mid­wife present un­til the fi­nal stages. For some, it feels that we are go­ing back to the days when fa­thers were not per­mit­ted in the birthing room un­til every­thing was over.

COVID-19 has changed every dy­nam­ic

How we give birth, where we give birth and who is present when we give birth.

The ef­fects of these changes are yet to be ful­ly un­der­stood and da­ta on preg­nan­cy and Covid-19 is still lim­it­ed. Many sce­nar­ios are con­sid­ered but the most both­er­some ques­tion is - “What are my risks?”

HEALTH PLUS deep dived in­to this top­ic, util­is­ing Q&As pub­lished by the Roy­al Col­lege of Ob­ste­tri­cians and Gy­nae­col­o­gists, Roy­al Col­lege of Mid­wives and Roy­al Col­lege of Pae­di­atrics and Child Health, with in­put from the Roy­al Col­lege of Anaes­thetists, the Ob­stet­ric Anaes­thetists’ As­so­ci­a­tion, Pub­lic Health Eng­land and Pub­lic Health Scot­land.

What ef­fect does coro­n­avirus have on preg­nant women?

Preg­nant women have been in­clud­ed in the list of peo­ple at mod­er­ate risk (clin­i­cal­ly vul­ner­a­ble) as a pre­cau­tion. This is be­cause preg­nant women can some­times be more at risk from virus­es like the flu. How­ev­er, all avail­able ev­i­dence sug­gests that preg­nant women are at no greater risk of be­com­ing se­ri­ous­ly un­well than oth­er healthy adults if they de­vel­op coro­n­avirus.

Still, due to changes in their bod­ies and im­mune sys­tems, it is recog­nised that preg­nant women can be af­fect­ed by res­pi­ra­to­ry in­fec­tions. It is there­fore im­por­tant that all pre­cau­tions be tak­en to pro­tect against COVID-19.

A re­cent UK study on 427 preg­nant women ad­mit­ted to hos­pi­tal with coro­n­avirus dur­ing the pan­dem­ic, around one in 10 women re­quired in­ten­sive care. Most women in the study re­quired on­ly ward treat­ment and were dis­charged home, well with well ba­bies.

Preg­nant women over the age of 35, those who were over­weight or obese, and those who had pre-ex­ist­ing med­ical prob­lems, such as high blood pres­sure and di­a­betes, were al­so at high­er risk of de­vel­op­ing se­vere ill­ness and re­quir­ing ad­mis­sion to hos­pi­tal.

What ef­fect will coro­n­avirus have on my ba­by if I am di­ag­nosed with the in­fec­tion?

Emerg­ing ev­i­dence sug­gests that trans­mis­sion from a woman to her ba­by dur­ing preg­nan­cy or birth (ver­ti­cal trans­mis­sion) might be pos­si­ble. It is im­por­tant to em­pha­sise that in all re­port­ed cas­es of new­born ba­bies de­vel­op­ing coro­n­avirus very soon af­ter birth, the ba­bies were well. There is no ev­i­dence to sug­gest an in­creased risk of mis­car­riage if you be­come in­fect­ed with coro­n­avirus while be­ing preg­nant.

In the re­cent UK study of 427 preg­nant women, the da­ta re­port­ed out­comes for ba­bies showed that one in 20 ba­bies born (12 ba­bies in to­tal) had a pos­i­tive test for coro­n­avirus, but on­ly half of these ba­bies, six ba­bies, had a pos­i­tive test im­me­di­ate­ly af­ter birth, sug­gest­ing that trans­mis­sion of the coro­n­avirus in­fec­tion from a woman to her ba­by is low. The num­ber of ba­bies born at term (37 weeks or lat­er) to women who had test­ed pos­i­tive for coro­n­avirus that re­quired neona­tal care was sim­i­lar to the num­ber of ba­bies born to women with­out the virus; about one in 10.

I’m preg­nant. How can I pro­tect my­self against COVID-19?

Preg­nant women should take the same pre­cau­tions to avoid COVID-19 in­fec­tion as oth­er peo­ple. You can help pro­tect your­self by:

- Wash­ing your hands fre­quent­ly with an al­co­hol-based hand rub or soap and wa­ter.

- So­cial­ly dis­tanc­ing, main­tain­ing space be­tween your­selves and oth­ers and avoid­ing crowd­ed spaces.

- Avoid­ing touch­ing your eyes, nose and mouth.

- Prac­tic­ing res­pi­ra­to­ry hy­giene. This means cov­er­ing your mouth and nose with your bent el­bow or tis­sue when you cough or sneeze. Then dis­pose of the used tis­sue im­me­di­ate­ly.

- If you have fever, cough or dif­fi­cul­ty breath­ing, seek med­ical care ear­ly and prefer­ably call be­fore go­ing to a health fa­cil­i­ty.

Do preg­nant women with sus­pect­ed or con­firmed COVID-19 need to give birth by Cae­sare­an Sec­tion?

No. Ad­vice from WHO and RCOG is that cae­sare­an sec­tions should on­ly be per­formed when med­ical­ly jus­ti­fied. The mode of birth should be in­di­vid­u­alised and based on a woman’s pref­er­ences along­side ob­stet­ric in­di­ca­tions.

Can I touch and hold my new­born ba­by if I have COVID-19?

YES. Close con­tact and ear­ly, ex­clu­sive breast­feed­ing helps a ba­by to thrive. You should be en­cour­aged to:

- Breast­feed safe­ly, with good res­pi­ra­to­ry hy­giene

- Hold your new­born skin-to-skin, and

- Share a room with your ba­by, once con­di­tions are fea­si­ble

How­ev­er, some cen­tres may ad­vo­cate tem­po­rary sep­a­ra­tion of the new­born from a moth­er who is too ill. The risks and ben­e­fits of tem­po­rary sep­a­ra­tion of the moth­er from her new­born should be dis­cussed with the moth­er by her health­care team. De­ci­sions about tem­po­rary sep­a­ra­tion should be made with re­spect to the moth­er’s wish­es. If the moth­er choos­es a tem­po­rary sep­a­ra­tion to re­duce risk of spread­ing the virus and would like to breast­feed, she should ex­press breast milk and have a healthy care­giv­er, who is not at high-risk from COVID-19, safe­ly feed the new­born the ex­pressed breast milk if pos­si­ble.

Put the "so­cial" back in so­cial dis­tanc­ing safe­ly

Preg­nan­cy is a spe­cial time full of ex­cite­ment and an­tic­i­pa­tion but for ex­pec­tant moth­ers fac­ing the out­break of the COVID-19 pan­dem­ic, fear, anx­i­ety and un­cer­tain­ty are cloud­ing this oth­er­wise hap­py time. Main­tain­ing your nor­mal rou­tines and healthy habits are crit­i­cal dur­ing this stress­ful time. En­cour­age dig­i­tal com­mu­ni­ca­tion with friends and fam­i­ly mem­bers via video calls, or even old-fash­ioned let­ters and jour­nalling. Even though you're apart, you can watch movies or cook the same meal to­geth­er over video chat. Just check­ing in on oth­ers helps keep every­one's spir­its pos­i­tive and nour­ish­es your well­be­ing!

Keep in mind “A healthy mum­my equals a healthy preg­nan­cy and more im­por­tant­ly - a healthy ba­by!”

If you are preg­nant or de­liv­ered dur­ing COVID-19, share with us your sto­ry, “How did you cope with preg­nan­cy and de­liv­ery dur­ing the Pan­dem­ic?”

Email: guardian­health­plus2021@gmail.com