BLOG BY Dr. Sarah J. Murphy

Pregnant And Worried About Coronavirus?

Pregnancy can be a worrying and anxious period at the best of time, but especially in the middle of a pandemic. As coronavirus or SARS-CoV-2 spreads further, it is completely understandable to be worried and to have questions surrounding your pregnancy.

One of the worst things about a new strain of virus, is just that – that its new. That means we don’t know exactly how it behaves or who is most at risk of it. All we can do is hypothesise and study case reports of patients who have contracted the virus. This means we don’t have all the information, and it also means that information is evolving rapidly, even everyday.

The RCOG or the Royal College of Obstetricians and Gynaecologists have been amazing at providing up to date information and advice for both health care professionals and patients. They are constantly studying case reports from around the world, to offer the best and most up to date advice. And so below I have tried to summarise their latest advice. Its important to note that this is correct at the time of writing, and certain things may change going forward.

First things first, let's start with some good news. We know that pregnant women can often get sicker with infections than the general public. This is because your immune system changes when pregnant. But so far we have no evidence that women who are pregnant get any sicker than people who aren’t, which is really reassuring. There also has been no case reports of women with COVID-19 passing the infection to their baby while still in the womb – known as ‘vertical transmission’ which is also very reassuring for expectant mothers. And the virus also has not been found in the vaginal secretions or breast milk of women with the infection!

We have seen some cases internationally, of pre-term births. These cases were all ‘iatrogenic’, which means the obstetricians brought on the early delivery of the baby. The reason for this is that some babies did seem to become ‘distressed’ in the womb of women with the infection.  It is for this reason that at this time the RCOG are recommending ‘continuous monitoring’ during labour and are advising against home births. If at any time, you are worried about your baby’s movements outside of this, you should contact your maternity care provider. If you have confirmed infection, your maternity service may also do some extra scans of your baby to ensure he/she is growing well.

In terms of how a baby should be delivered, there is no reason why a woman can’t have a vaginal delivery, as the secretions are not found in vaginal secretions. You can also have an epidural and use Entonox (gas and air) as normal if you wish. Unfortunately, it is not recommended that you have a water birth. The reason for this, is that staff won’t be able to wear proper PPE (personal protective equipment) for this and would be at risk of contracting the virus. If a woman is electing to have a caesarean section, she will go at the end of the list in the theatre, to avoid spreading of the infection.

If you have no symptoms and are well, you should continue to attend all of your antenatal visits as normal, unless otherwise instructed by your hospital. If you do have symptoms or are worried you have the infection, you should contact your hospital immediately and they can offer you advise. If its routine care, they may suggest delaying your appointment for two weeks.

If you have COVID-19, your baby will be tested for the infection afterwards and you will be given advice by paediatricians (baby doctors) about what to look out for. We know that breast feeding has so many amazing benefits, and we have no evidence that the virus is found in breast milk, so at the moment the RCOG finds that the benefits of breast feeding outweigh the risks. If you do wish to breast feed your baby, however, they recommend the following; to wear a mask while doing so, to try to avoid coughing/sneezing while doing so, to practice meticulous hand hygiene and to express breast milk and ask someone else to feed where possible. If you wish to bottle feed, you should also practice these steps and to also follow strict sterilisation guidelines.

At the moment in the UK, the government are recommending that woman who are pregnant practice ‘social distancing’. This is a precautionary measure, but it is possibly a good idea. In Ireland, we are all being advised to practice this in order to slow viral spread or as you may have heard ‘flatten the curve’. The RCOG are also recommending that women over 28weeks gestation who work in the health care sector, to avoid patient contact as much as possible. And where possible, to work from home or in administrative roles.

In summary, this is a worrying and anxious time for us all. All we can do at this time is practice the advice given to us by our governments and by professionals  and protect ourselves and others. While it is important for women who are pregnant to mind themselves, it is also important to focus on the positives mentioned above!

This blog post was written by, Dr. Sarah J. Murphy who is a third year ‘senior house officer’ working  in obstetrics and gynaecology in Ireland’s HSE. She has a special interest in health, fitness and nutrition, which is demonstrated from her instagram @drsarahjmurphy

References:

https://www.rcog.org.uk/

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