Dr. Mark Hyde discusses the risks and implications of the coronavirus outbreak for pregnant patients
Are pregnant women at greater risk of contracting COVID-19? Can I pass COVID-19 on to my fetus or newborn? How will my delivery be different if I’m COVID-19 positive?
Pregnancy is one of the most exciting and meaningful times of your life. When you are faced with a pandemic at the same time, a whole new list of questions arises. We want to answer your most common questions and recommend precautions to ease your concerns so that you can focus on having a healthy pregnancy and safe delivery.
Are pregnant women more likely to contract COVID-19?
No. Unlike some other viruses, all evidence from China shows that there is no greater risk of pregnant women contracting COVID-19 than the general population in the same age group.
Are pregnant women who contract COVID-19 at higher risk for severe illness or death?
There is also no evidence that pregnant women are at greater risk for severe illness or death after contracting COVID-19 compared to those in their age group. Whereas the influenza virus and some other viruses come with greater risk of severe illness for pregnant women, this has not been the case with this coronavirus.
How can I tell if my symptoms are COVID-19 or normal discomforts of pregnancy?
The most common symptoms of COVID-19 are shortness of breath, dry cough, and fever. These symptoms are also common among pregnant women, which can be cause for confusion during the pandemic.
Shortness of breath
Shortness of breath often occurs in the second and third trimesters as the uterus expands and pushes up into the diaphragm. This pushing can compress the lungs – which can make you feel like you’ve been doing strenuous exercise when you’ve only just walked up the stairs.
Shortness of breath can also be caused by the hormone progesterone, which increases during pregnancy. High levels of progesterone cause pregnant women to breath more deeply and more often. Loss of residual capacity in the lungs also leads to a very common feeling of not being able to get a full breath usually worsening around 25-30 weeks.
If you have severe shortness of breath (causing difficulty to speak in full sentences) or if it is accompanied by a fever of 100.4 and/or a dry cough, please call our office for more instructions and stay isolated to prevent transmission to other people in case you have been infected.
While respiratory symptoms remain the most common, loss of appetite, abdominal pain and diarrhea are newly recognized symptoms of COVID-19. These symptoms can also be confused with normal pregnancy digestive issues caused by hormonal changes. A study from China shows that while we are finding gastrointestinal issues to be more common symptoms of COVID-19, it is rare for COVID-19 patients to have only GI symptoms without respiratory symptoms. (Only 7 out of 204 participants fell into this category.) If you are having both types of symptoms or if your GI symptoms worsen, please self-isolate and call our office.
Take precautions and call us with questions
If you fear that you have symptoms of COVID-19 or that you may have had an exposure to it, please self-isolate and call our office to find out if you should come in for your next appointment or set up a virtual telehealth visit. You can also call if you have questions and want to speak with a phone nurse or reach out to your provider. If your symptoms become unmanageable, call 911 or go to the hospital.
How can pregnant women protect themselves from COVID-19?
Just like the general population, pregnant women should take the following precautions:
- Stay at home when possible and avoid unnecessary human contact
- If you need to leave home, practice social distancing by leaving 6 feet between you and other people to prevent transmission through respiratory droplets
- Avoid people who are sick
- Wash your hands often using soap and water for 20 seconds, especially before eating and after being in a public place
- Use hand sanitizer with 60% alcohol when hand washing is not possible
- Avoid touching your face
- Wipe down and disinfect doorknobs, light switches, countertops, tables, desks, phones, computers, sinks, toilets and other frequently touched surfaces often
I am pregnant and I work outside the home. Should I stop working?
If it is possible to work from home, we encourage you to do so. If you are not able to work from home, please practice social distancing and the other best practices mentioned above in order to minimize your risk of contracting and spreading COVID-19.
During the COVID-19 outbreak, is it safe to have fewer prenatal visits and conduct some prenatal appointments via virtual telehealth options?
Yes. If you are low-risk, some prenatal care can be performed remotely, and your blood pressure can be taken less frequently. You can do fetal kick counts to know that your baby is okay. We can also easily discuss delivery plans via telehealth. We will provide instructions for setting up a telehealth visit as your appointment approaches if it makes sense to do so.
While we are taking every precaution to provide a clean and healthy environment in our offices, reducing the amount of time you are in public places will help protect you and your family from contracting COVID-19.
What should pregnant women do if they have been exposed to COVID-19 or feel symptomatic?
If you believe you have been exposed to COVID-19, please self-isolate to reduce exposure to others. Call our office to let us know so that we can prepare for your upcoming visit and work with you to devise a plan.
If you have a fever of 100.4 or above and have one or more of the following symptoms—cough, difficulty breathing, shortness of breath—you should self-isolate and call our office.
When you call us, a phone nurse or your provider will ask you questions about your symptoms, possible exposure and risk factors. If your symptoms are mild, risk factors are low and you do not have a pregnancy-related reason to be seen in the office or hospital, they may recommend that you stay home and conduct a telehealth appointment. They may also refer you to an ambulatory COVID-19 test site if you meet specific criteria.
If your symptoms become concerning or unmanageable, your provider may advise you to come into the office or to seek evaluation or treatment at a hospital.
What if I am experiencing COVID-19 symptoms and have pregnancy-related concerns (contractions, fluid leakage, decreased fetal movement, vaginal bleeding, etc.)?
Any time you have pregnancy-related concerns, call our office. Your provider will let you know if your issues require evaluation at the office and/or at a hospital, or if we can attempt to resolve them via telehealth. If you do need to come into our office, we ask that you only bring one additional person who can remain in the lobby of the building or in the car in order to reduce the risk of spreading COVID-19.
Is it safe to give birth at the hospital during the COVID-19 pandemic?
The hospitals where we deliver are taking extensive precautions to provide a safe and healthy environment for the birth of your baby. All rooms and equipment are disinfected after each patient and hospital staff are trained to prevent infection. Our providers and all hospital staff are prepared to respond to any complications that may arise during your delivery. There is substantial evidence that home delivery places mothers and babies at higher risk.
Will I be able to have visitors at the hospital during the COVID-19 pandemic?
Visitor restrictions at the hospitals where we deliver currently allow 1 adult visitor in mother-infant units.
Please refer to the hospital where you plan to deliver for updates:
While it is difficult not to have everyone you want with you at this special time, minimizing visitors will help prevent the spread of COVID-19 to you, your baby, your family, other patients, and healthcare staff.
It’s important to have a plan for childcare as well as a back-up plan if the intended child caretaker becomes sick. We recommend someone under 65 who does not have lung or heart problems and is not immunocompromised.
Can I leave the hospital early to minimize my time there?
Yes. Your baby should receive essential newborn testing around 24 hours of age. Once the testing is completed, you may be discharged from the hospital.
Can I pass COVID-19 to my fetus during pregnancy?
If you do contract COVID-19, the good news is there is no evidence that the virus can be transmitted from pregnant mothers to their fetuses. This is a different kind of virus from Zika, which is especially dangerous for pregnant women because it can be transmitted to the fetus and severely affect fetal development.
If I am COVID-19 positive when I give birth, how will it affect my labor and delivery?
You will have fewer hospital staff members coming into your room during your labor, and some communication may be done over the phone to reduce the risk of transmission to healthcare staff and providers. When healthcare staff and providers are in the room with you, they will be wearing personal protective equipment – masks, eye shields and gloves. We will do everything we can to give you the best care possible while minimizing risk of transmission.
If I am COVID-19 positive when I give birth, will I be separated from my baby?
We recommend separation of COVID-19 positive and suspected COVID-19 positive mothers and their newborns after birth. We discourage skin-to-skin contact to avoid transmission of the virus. Newborns can contract COVID-19 through respiratory droplet transmission both through the air and on surfaces, just as adults can. You should contact your pediatrician for guidance on how to care for your newborn.
Can COVID-19 be passed on to my baby through my breast milk?
Breast milk provides protection against many illnesses. There is no evidence suggesting COVID-19 can be passed to a baby through breast milk. However, because the virus can be transmitted to a baby through respiratory droplets, skin-to-skin contact is discouraged until the COVID-19 infection is cleared. We recommend expressing breast milk with a breast pump and, if possible, having a healthcare provider or someone who is well clean the bottle and feed the baby after washing hands. If this is not possible, you should take all possible precautions to avoid spreading the virus to your baby, including washing your hands before touching your baby and wearing a face mask, if possible, while breastfeeding.
Can I travel while I’m pregnant during the COVID-19 outbreak?
We strongly recommend against traveling while pregnant during the COVID-19 outbreak. You should avoid international travel at all costs and avoid all non-essential domestic travel. You are subject to travel restrictions that could change at any time. Restrictions could affect your return home if you are exposed to COVID-19 or otherwise. If you have pulmonary and cardiovascular co-morbidities or immuno-suppression, you should avoid all travel.