If you’re pregnant as coronavirus disease 2019 (COVID-19) spreads rapidly worldwide, you may be worried about what this pandemic means for you and your baby. Brian Brimmage, MD, an obstetrician who delivers babies at UNC REX Healthcare, answers common questions and offers advice on how moms-to-be can take care of themselves and their babies.
What effect could COVID-19 have on a pregnant woman and her baby?
Health care providers and researchers don’t have an answer to this question yet, because the virus is new.
“We don’t yet have enough data to provide clear recommendations for pregnant patients,” Dr. Brimmage says. “So we are, as we often do in pregnancy, encouraging women to be very cautious. Act as if you are a potentially high-risk patient, even though we don’t actually know if you are.”
It’s important to remember that the majority of people who get COVID-19 do not have serious symptoms and will fully recover, and this should apply to pregnant women as well, Dr. Brimmage says.
As for your baby’s health, “as far as we know, it does not appear to be vertically transmitted,” which means transmitted from mother to fetus, Dr. Brimmage says.
In a small study from Wuhan, China, of nine babies born to mothers with COVID-19, all the babies were born healthy. And when infants have become infected with COVID-19 outside the womb, their illnesses have been mild.
What does it mean to behave as if I’m high-risk?
You know those social distancing and hand hygiene guidelines? Follow those to the letter. That means not leaving home unless absolutely necessary, such as for doctor’s appointments, and limiting or outright avoiding exposure to anyone who doesn’t live with you.
“Presume that anyone you might come in contact with may be infected. Keep 6 feet of distance, and wash your hands thoroughly and often,” Dr. Brimmage says.
Unfortunately, baby showers and “babymoon” vacations need to be postponed or canceled, Dr. Brimmage says. “We are absolutely advising against both of those things right now—at least in person.”
Some moms and dads are adapting with virtual baby showers.
Should I still go to my prenatal appointments?
Talk to your health care provider to make a plan, but the answer is yes, Dr. Brimmage says. It’s critical that your care team checks on your health and the health of your baby throughout pregnancy to avoid or manage complications.
Some health care providers are advising women with low-risk pregnancies to come in every six weeks instead of every four, up until the final four weeks of pregnancy, when they will go weekly. This could minimize your potential exposure to people with COVID-19. You also can talk to your provider’s office about waiting for your appointment in your car instead of the waiting room, for example.
If I start experiencing symptoms of COVID-19, what should I do?
If you are coughing and have a fever over 100 degrees, call your health care provider right away, Dr. Brimmage says. But don’t come into the office before you call. The staff will tell you what to do to safely get tested or treated.
If you are experiencing severe shortness of breath, also call your health care provider immediately—you will probably be instructed to go to the nearest emergency department, Dr. Brimmage says. When possible, your health care provider will warn the hospital that you are on your way so staff can prepare to help you and take the necessary precautions to keep others safe from potential infection.
Will my delivery or hospital stay be affected by a potential influx of COVID-19 patients straining the health care system?
It’s impossible to know how many people are going to need COVID-19 treatment in hospitals in the coming months and the toll it will take on doctors, nurses and other health care workers, Dr. Brimmage says. But take solace in the knowledge that unlike elective surgeries and nonessential appointments, pregnant patients remain a top priority.
“We are dedicated to making sure moms and babies come through this healthy and safe and happy,” Dr. Brimmage says. “You don’t go into this profession taking pregnancy and childbirth lightly, and all of us are committed to doing whatever it takes to be there for our moms and their babies and to keep them safe.”
Expect strict limitations on visitors in labor and delivery and postpartum units. For example, some hospitals are permitting women to have only one support person in the delivery room and postpartum unit. At this time, family and friends are not permitted in waiting areas of those hospitals.
If I’m getting close to the 40th week of my pregnancy, should I be induced before the hospitals are overloaded?
There’s no firm recommendation on this, so each woman should ask her health care provider, Dr. Brimmage says.
“There isn’t a clear answer. There is good evidence that we should not induce women before 39 weeks without a good medical reason, and risk of exposure to coronavirus does not fall into that category currently. But we also have evidence that inducing starting at 39 weeks is safe, so if that is something a patient is interested in, it wouldn’t hurt to open that conversation early, starting around 37 weeks,” he says. “Inductions usually need to be scheduled one to two weeks in advance.”
Should I opt for a home birth to avoid hospitals altogether?
Definitely not, Dr. Brimmage says. You have to do a risk analysis: “While labor and delivery go smoothly for the vast majority of women, the time just before, during and after delivering a baby is still statistically one of the most dangerous times of an otherwise healthy woman’s life,” he says. “In the small percentage of women who have a complication, those complications often require rapid intervention. You dramatically increase the risk to mom and baby if you deliver in a place where they can’t get quick help.”
Data is hard to come by, but a sizable percentage of home births—probably about 10 to 30 percent, based on one of the larger reviews published to date—end up requiring hospital transport, Dr. Brimmage says.
“It doesn’t make sense to decrease the small risk of serious illness from COVID by increasing the larger risk of labor and delivery by doing it in a setting where immediate help isn’t available,” he says. “If something goes wrong during delivery, often minutes matter.”
Do I have to limit visitors to my home after we leave the hospital?
While keeping loved ones away in the baby’s early days can be heart-wrenching and hard on new parents who desperately need help, it’s best to limit visitors as much as possible while the pandemic continues, Dr. Brimmage says.
“It’s such a hard thing to tell new parents, but it is critical both to prevent exposure of the mom and baby and also to prevent them from potentially exposing any older family members, like grandparents, who are generally in high-risk groups,” he says.
How do I deal with all this anxiety?
Pregnancy can already be an anxious time for moms-to-be. Add in the uncertainties around COVID-19, and it’s understandable that many pregnant women feel a great deal of additional stress right now, Dr. Brimmage says.
“It is nearly universal,” he says.
He encourages women to talk to their providers about coping with anxiety and adding therapy or medication if needed. There are medicines, including some antidepressants, that have been well-studied and are low-risk in pregnancy.
Is it a bad idea to try to conceive during this pandemic?
Dr. Brimmage is not telling women to avoid getting pregnant if they’re trying to conceive; again, there is not enough information to give a solid recommendation, he says.
But he encourages women who do not want to get pregnant to make sure they have a reliable birth control method. He urges women to call their health care providers if they need a refill of their birth control pills (most providers are not requiring in-person visits for refills at this time, given the pandemic). Depending on the provider, women who want an intrauterine device or Nexplanon placed may still be able to get one during this time of restricted in-person visits.
Health care providers are expecting a “baby boom” in about nine months from people being stuck at home during this pandemic, Dr. Brimmage says; people who don’t want to be among that group of new parents should think about their birth control strategy and call their providers “so we can help,” Dr. Brimmage says.
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