Coronavirus (Covid 19) and pregnancy
As the numbers of Covid-19 cases increase globally, everyone is being asked to do their part to slow down the virus.
Depending where in the world you live, you’re likely being asked to avoid non-essential travel, do frequent hand washing, work from home, or stay away from other people (social distancing).
These measures are important to keep health systems from being overwhelmed and to protect vulnerable people who are more likely to experience complications.
But what about pregnant women? How does this current pandemic affect them and their babies?
About 360,000 women give birth globally each day. This means high numbers of healthy women going into hospitals that are very likely already under huge strain. Understandably, many pregnant women are very concerned about their health and their birth options.
We’ve put together the most commonly asked questions about coronavirus and pregnancy to help you navigate these uncertain times.
What Is Covid-19?
First: a quick rundown on the virus, Covid-19. You might notice it’s also called ‘coronavirus’ in the media.
Coronaviruses are a large group of viruses that can cause illness in humans and animals. In humans, some coronaviruses cause respiratory infections such as the common cold or more severe diseases like Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
This current coronavirus, Covid-19, is a novel coronavirus or new, meaning we’ve never seen it before the current outbreak. This is why it is causing a lot of concern worldwide because we don’t have much information about how it spreads, how it affects different groups of people and how to treat it.
We do know the main symptoms of Covid-19 are:
- Dry cough
- Shortness of breath.
Covid-19 is passed on much like other coronaviruses. The virus particles are spread from person to person through droplets that come from their mouth or nose when they cough or breathe out. These droplets can be breathed in, or land on other people or objects – if touched can be transferred to their nose, mouth or eyes.
Are pregnant women more likely to catch Covid-19?
The best current evidence available shows pregnant women aren’t more likely to catch Covid-19 than other people.
However, many health departments around the world now consider pregnant women to be vulnerable. This sounds scary but it’s due to the fact that during pregnancy your immune system naturally lowers, so your body doesn’t react to your baby as an unknown threat.
This can make your immune system a bit distracted and more susceptible to colds and flus. This is why pregnant women usually find they catch colds and flu more easily than others.
This isn’t new knowledge – we have always known this, and you would normally be advised to look after your health and stay away from people with the flu for example. Because Covid-19 is a new virus, health care professionals are urging extra caution for pregnant women.
What effect does Covid-19 have on pregnant women?
So far, the evidence we have from countries worldwide is pregnant women don’t seem to get more unwell if they contract Covid-19. There is also no evidence to show the virus increases the risk of severe complications in pregnant women. This is comparing pregnant women to healthy people.
Keep in mind, this is a new virus so how your immune system responds to it might vary from person to person.
The more severe symptoms that happen with Covid-19 such as pneumonia seem to occur mostly in people with:
- Existing, long-term health conditions such as high blood pressure, type 2 diabetes
- Lowered immune function or are immunocompromised
- Older people, especially those over 80 years of age.
So far research shows pregnant women who are generally healthy will have mild to moderate symptoms and recover well.
According to obstetrician, Doctor Ravi Kashyap, the most significant effects for a pregnant woman is, “The changes to maternity care as a result of social distancing. Large group antenatal classes are likely to be cancelled. Online resources or small midwife run classes may be alternatives. Antenatal visits may be less frequent and some may be replaced with Telehealth consults.”
Does Covid-19 increase the risk of miscarriage or preterm birth if I’m pregnant?
According to the best available information, there isn’t an increased risk of miscarriage or other complications for pregnant women infected with Covid-19.
There have been some babies born prematurely to mothers with symptoms of Covid-19. However it isn’t known at this stage if doctors made the decision for the baby to be born early because the mother was unwell or if the virus triggered preterm birth.
Can my unborn baby become infected if I have Covid-19?
Many pregnant women worry if they become infected with Covid-19 they will pass it onto their baby (vertical transmission).
Health experts are looking at this very carefully and so far the evidence shows this isn’t happening. Researchers tested cord blood, amniotic fluid, swabs and breast milk and found no evidence the virus had passed from mother to baby.
Two cases of possible vertical transmission have been reported but it’s not clear if transmission happened before or after birth.
Is a c-section or vaginal birth the safest option if I have Covid-19?
At this stage, no one can definitely say which birth method is a safer option. The research has focused on babies born via c-section and there hasn’t been any assessment of the risk of vaginal births.
There is no one correct answer and is likely dependent on the health status of the mother and potential complications that could affect the baby if the mother is seriously unwell.
Doctor Kashyap, says there appears to be no benefit for delivery by caesarean section.
Does Covid-19 increase my risk of complications?
Again, we really don’t have enough data to tell for sure. At this time, there appears to be an increased risk of preterm birth but as discussed above, it’s not clear if this is due to the infection or doctor’s decision.
In severe cases Covid-19 can cause pneumonia. This is a concern for pregnant women who already have reduced lung capacity. Lower oxygen rates in mothers can mean babies have reduced oxygen.
Fever is another concern, as higher body temperatures during pregnancy can be a problem for developing babies and also may trigger preterm birth.
But remember, these complications occur in a very small number of the general population and even less so in pregnant women. Your care provider will discuss your risk factor for any of these complications and adjust your treatment accordingly.
What can I do to reduce my risk of catching Covid-19 while pregnant?
At the time of publishing, various measures are in place to help slow the spread of Covid-19. Many health experts are advising the most important factor is to keep your distance from others – behave as though you or others already have the virus and don’t want to pass it on.
Most importantly, follow the normal preventative measures for everyone:
- Wash your hands regularly with soap and water, for a minimum of 20 seconds (or use with an alcohol-based hand rub).
- Avoid anyone who is coughing and sneezing (sneezing is unlikely to be a symptom of covid-19 but better to be cautious)
- Avoid touching your eyes, nose and mouth
- Reduce the amount of time you spend in the general community
- Social-distancing (staying 2 metres away from others)
- Cancelling all non-essential travel.
If you feel unwell report your symptoms to your care provider immediately.
Can I boost my immune system while pregnant?
The reality is most of us will have Covid-19 at some point. To lower your risk of severe symptoms, you can take some positive steps now that can help support your immune system while you’re pregnant.
- Eat nutritious food. Nutrition is so important to give you the edge on keeping your immune system primed to deal with viruses. Eat a balanced diet of whole foods and avoid sugar and processed foods as much as possible. Low carb and paleo eating are delicious and healthy options to investigate, where sugar and processed foods and drinks are off the table. See our article for some examples of what a healthy breakfast looks like.
- Keep your weight and blood sugar under control. Studies are showing people most severely affected by Covid-19 are those with metabolic diseases, such as type 2 diabetes, high blood pressure and obesity. Taking steps to manage your health right now will pay off in the future weeks and months. As per above, low carb and paleo eating both can help you achieve this. According to this study, carbohydrate restriction is effective for “a means to achieve weight loss and glycemic control without hypoglycemia.” While pregnancy may not be a time for weight loss, it will help you to control your weight and reduce inflammation for a healthier body, baby and birth. Speak to a nutritionist if you’d like help with a personalised diet.
- Get some exercise. Exercise is still possible, even if you’re in a lockdown situation. Moderate exercise can boost healthy bacteria in your gut, where your body makes a large proportion of antibodies. Check out pregnancy friendly exercise programs online or go for a brisk walk twice a day (if you can safely).
- Get plenty of sleep. Sleep helps your immune system to function at its best – it does lots of repair work overnight. Try for 7-8 hours and if you’re very pregnant and finding sleep is disturbed, take a nap or two during the day.
- Reduce stress as much as you can. Stress reduces your immune system’s ability to fight off infections. Meditation, yoga, exercise, and sleep are great ways to reduce stress. Try to take breaks from social media or constant newsfeeds, or find ways to focus on the positive things happening. Stay in touch with family and friends via phone or online. Bring out neglected hobbies or creative projects and level up the good feelings as much as you can.
- Get some sunshine if you can (else vitamin D3 if your levels are low). For the proper functioning of your immune system, vitamin D is essential. Low levels of vitamin D can leave you susceptible to disease and infections. In fact, it’s associated with an increased risk of respiratory diseases. If you can’t get out in the sunshine or haven’t spent much time outdoors, you might like to ask your healthcare provider about supplementing with vitamin D3.
What about taking medication when I am pregnant and have Covid-19?
Any medication you are currently taking during pregnancy should already be discussed with your care provider. If you have Covid-19 and are pregnant, your care provider will advise you about appropriate and safe treatment.
There have been concerns that it’s dangerous to take ibuprofen if you have covid-19. This has not been confirmed with strong evidence but the UK’s National Health Trust says:
“There is currently no strong evidence that ibuprofen can make coronavirus (Covid-19) worse … until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.”
The World Health Organisation (WHO) also advises to avoid ibuprofen until we know more.
Should I attend my prenatal appointments?
Prenatal appointments are an important part of your health care during pregnancy. Understandably, many women are now unsure if they should attend appointments, especially those in hospitals. This concern has even caused many women to consider having a home birth with a private midwife, to avoid hospitals altogether.
However you chose to give birth to your baby, making sure you can access the care you need is important.
In Australia, RANZCOG is encouraging private and public hospitals and private practitioners to begin creating strategies to reduce the risks of Covid-19 being transmitted to pregnant women and medical staff.
Changes that are suggested for maternity care providers to consider:
- Reducing, postponing and/or increasing the interval between antenatal visits
- Shortening the duration of antenatal visits
- Using telehealth consultations as a replacement, or in addition, to routine visits
- Avoiding face to face antenatal classes
- Limiting visitors (partner only) while in hospital
- Earlier discharge from hospital than would otherwise be planned.
These strategies must take into consideration your health and that of your baby.
Should I go to my antenatal classes?
Birth education classes help you be informed about birth choices and connect with your baby during this really exciting time. Unfortunately, many birth educators are making the tough choice to not hold face-to-face classes to ensure the safety of pregnant families and their staff.
It’s very likely your birth education class will shift to an online or web based format. If not, there are plenty available if you search ‘online birth education + your region’. You can also watch BellyBelly’s amazing birth program, The Truth About Natural Birth.
What do I do if I think I have coronavirus or have been exposed during pregnancy?
If you are pregnant and develop any of the symptoms listed for Covid-19 you should isolate yourself and seek medical advice as quickly as possible. If you suspect you’ve been exposed or someone you have close contact with has a positive test result, you need to isolate yourself while you seek medical advice.
In Australia and other countries pregnant women who are concerned they have Covid-19 can contact a health professional via a telehealth call (search for the details online for the service available in your area). This helps you to avoid having to attend a clinic or emergency department where you may be at risk of infection.
If I have Covid-19 what happens when I give birth?
There should be little change to how you actually give birth. In many cases, if you are otherwise healthy, your birth should be no different to if you weren’t Covid-19 positive.
However, the reality may be very different on the day you give birth. Hospitals have to be careful about infectious disease control and this may put some limitations on what you can expect. This is to protect you, your baby and staff from infection.
Some hospitals are already putting measures in place to reduce unnecessary visitors and even support people, other than your partner. This is to try and reduce the risk of transmission in the community, as well as protect medical staff. Discuss this with your care provider if you are concerned about this having a negative impact.
It’s also likely your hospital will be busy and you will be encouraged to go home as soon as you and your baby are doing well. This may mean your postpartum period will be more isolating than normal.
Will I be separated from my baby after birth if I have Covid-19?
At the time of publishing, we’re aware in some countries hospitals are separating babies from mothers infected with Covid-19. This is not in line with the recommendations of the WHO:
“Mothers and infants should be enabled to remain together and practice skin-to-skin contact, kangaroo mother care and to remain together and to practice rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”
Skin-to-skin contact and early breastfeeding immediately after birth should be supported as usual if baby is well. As the virus is spread through respiratory droplets, WHO recommends mothers with Covid-19 should:
- Wash hands before and after holding their baby)
- Use a face mask to minimise their baby’s exposure to the virus
- Clean and disinfect all surfaces they touch to reduce potential transmission.
Can I breastfeed my baby if I have Covid-19?
Doctor Kashyap says, “There’s good evidence the virus is not excreted in breast milk and does not cross the placenta. So there is no need to deliver the baby early, and breast feeding should be encouraged.”
There has been no evidence of the virus in breast milk. The benefits of breastfeeding are well known and in normal circumstances should be encouraged and supported soon after birth.
The protective effect of breastfeeding is extremely beneficial against infectious diseases. It directly transfers antibodies and immune factors to your baby, to help them fight off infection while their immune systems are still immature. Even if you were not planning to breastfeed, it may be wise to consider doing so until after the Covid-19 pandemic has ended.
If you are too unwell, your midwife or nurse can help with expressing, so your baby gets the benefits of your breast milk.
What about visitors after birth?
In normal situations, new parents are often delighted to show off their new baby to immediate family and close friends. Some parents prefer to wait until their baby is a few weeks old, to give themselves time to bond and adjust to life as a family.
The covid-19 pandemic is an unprecedented event and it’s very likely your hospital won’t allow visitors to the hospital after you give birth. While this may or may not align with your personal decision to allow visitors, it’s to protect everyone including other mothers and babies, and essential medical staff.
Whether you decide to have visitors once you are home is going to depend on where you live and what conditions are in place. Many women won’t have the option to introduce their new baby in person to family and friends. Other new parents might have the choice but should exercise caution in all cases.
Person to person transmission appears to be most likely when you have symptoms of Covid-19, however you may only have no or very mild symptoms and still be contagious. Researchers have detected the virus for up to three hours in aerosols, up to four hours on copper, up to 24 hours on cardboard and up to 2-3 days on plastic and stainless steel.
Newborn babies have immature immune systems and should be protected from infectious diseases as much as possible. New mothers are depleted after pregnancy and birth and may find fighting an infection more difficult. Visiting your new baby may have to wait but in the meantime, send plenty of pictures and videos to keep your family and friends updated.
Being pregnant during a pandemic can be worrying. There is uncertainty and constant negative news. Try to focus on caring for yourself, both emotionally and physically, which in turn gives your baby the best protection.