Pregnancy brings different challenges for everyone. For most people these will include new anxieties; worry about the baby, about the birth, how you will cope with a new-born, how your finances or family dynamics will change. But for those that happen to be pregnant right now, you're also faced with a global pandemic due to the spread of coronavirus (COVID 19) across the globe, leading to a lock-down which has thrown everyone's day to day life completely off course. This unprecedented crisis is leading to anxiety for many people, and for pregnant women who are naturally more hyper-vigilant, this could be causing untold stress and worry.
There has been further confusion and concern due to mixed messaging from authorities. On 16 March 2020, the Chief Medical Officer put pregnant women in the vulnerable group, which means that they had to follow strict social distancing measures. This was mainly based on evidence that although pregnant women are no more likely to contract a virus, a small proportion of pregnant women can suffer more severely from viral infections (hence the advise that pregnant women should have a flu jab), and was therefore the most prudent advice to give. However, current evidence shows that pregnant women are not suffering any more severe effects of coronavirus than the general population, and will only experience moderate to mild flu like symptoms.
The information below is the latest RCOG (Royal College of Obstetricians and Gynaecologists) guidance, which is currently based predominantly on large data from China, but will be reviewed and updated as new information arises. The RCOG are constantly monitoring the situation and responding to all available data in near real time surveillance on women who are diagnosed during pregnancy.
What should you do to protect yourself if you are pregnant?
The advice for a pregnant woman is the same as for the general population. Follow government advice to stay in your house with only people that live with you. Limit your trips out to essential food shopping and one form of exercise a day, observing the social distancing rules. And of course, wash your hands well regularly and certainly after any potential exposure.
If you experience symptoms such as a high temperature or a new continuous cough, then you should self isolate for 7 days and those in your home should self isolate for 14 days after your symptoms start. You should advise your midwife or antenatal team that you are experiencing these symptoms but there is no need for further medical assistance unless you are not coping with your symptoms at home or do not recover after 7 days.
Further caution should be taken:
If you are in your third trimester (more than 28 weeks pregnant) you should be particularly attentive to social distancing and minimising any contact with others.
On 24 March, additional measures were announced for people defined on medical grounds to be at very high risk of severe illness from coronavirus, this includes pregnant women with significant heart disease (congenital or acquired).
Will your baby be affected if you are diagnosed with coronavirus?
During pregnancy women will often be analysing all of their actions with a view to how they may impact their baby, so it is natural that you will be concerned about the possibility of exposing yourself to coronavirus infection. However, there is no evidence to suggest an increased risk of miscarriage if you are diagnosed with coronavirus.
Initial reports from China showed no evidence of the virus passing from the mother to the baby during pregnancy or birth. However, on the 26 March it was reported that in one case from Wuhan, there was evidence that this may have occurred. A small number of newborns have been diagnosed with coronavirus, but it is unclear whether transmission occurred in the womb or soon after birth. Your maternity team will maintain strict infection control measures at the time of your birth and closely monitor your baby.
Some babies born to women with symptoms of coronavirus in China were born prematurely but the reason is not yet clear. It is possible that it was recommended that early labour was induced in order to preserve the mother’s health rather than the infection itself causing an early labour.
In all reported cases of newborn babies developing coronavirus very soon after birth, the baby was well and no problems with a babies development have been observed.
How will my care be affected throughout my pregnancy?
As long as you are well then there will be no change to your antenatal or maternity care. You may be feeling anxious about going into hospitals at the moment, but rest assured that the risk of infection will be closely monitored and safeguarded to ensure the safety of all pregnant women. It is important that you receive the same level of care and monitoring as you would at other times. Careful monitoring is there to ensure the safety of you and your baby and to reduce the risk of complications. If you have any concerns you should discuss these with your midwife.
If you are experiencing symptoms of suspected or confirmed coronavirus or you are in self isolation due to a family member experiencing symptoms, then your care will be managed slightly differently. In these circumstances, you should contact your antenatal team and they will advise how to manage your appointments, DO NOT attend a routine clinic. These appointments will be delayed where possible but if the appointment cannot wait until your isolation ends then arrangements will be made for you to attend with precautions taken to avoid exposure to others.
It is important that you help your antenatal team in this situation and if you have had appointments cancelled or delayed then please follow up to ensure these appointments do occur.
You may also be asked to help by minimising visitors that you bring to your appointments as much as possible.
If you have any concerns about your own health or the health of your baby during the period you are self isolating you should contact your out of hours maternity care for advise, you should NOT attend a maternity unit or A&E unless it is urgent.
How will it affect my labour?
As long as you are well, there will be no changes to your plans for giving birth. Maternity care is an essential service and although the pandemic will put extra strain on all areas, the NHS are working hard to ensure the same level of care and access to services that you would receive at any other time.
Note that if you have planned for a home birth then it does require ambulances available to transfer you to hospital in case of an emergency. As ambulance services are under extra pressure at the moment, this may be a consideration within your trust as to whether a home birth will be possible.
As long as your partner is not showing symptoms then they can be with you throughout your labour and in the postnatal ward, but visitors may be restricted at this time.
If you are experiencing symptoms of suspected or confirmed coronavirus or you are in self isolation then precautions will be taken with your admission to hospital. You should contact your maternity team, travel to hospital by private transport, you will be met outside and given a face mask which you must wear until you are isolated in a suitable room. Testing will then be arranged. Your partner will still be able to stay with you but other visitors will be restricted.
If you have confirmed or suspected case then staff would prefer to you to give birth in hospital in an obstetric ward in order to monitor mother and baby more effectively. Otherwise staff would hope to keep your labour as close to your plan as possible, there is no evidence to suggest you cannot have a vaginal birth and no restrictions on the type of intervention or pain relief that you can have.
Women are always advised to have a birth plan ready before their labour, and maternity staff will always do their best to ensure that women are given these choices, but even under normal circumstances you must be prepared to be flexible with your plans as things happen beyond your control. This is true more than ever during this current crisis, be prepared to be flexible in order to help staff best support you, your baby and others.
Will I be able to stay with my baby if I have coronavirus?
If your baby is well, then there is no reason you cannot stay with your baby after you have given birth. In some countries, women with confirmed coronavirus have been advised to separate from their baby for 14 days. This is not the case in the UK as it could negatively affect the feeding and bonding.
With regards to breastfeeding, there is no evidence that the virus can be carried in breastmilk and the well-recognised benefits of breastfeeding are considered to outweigh any potential risks of transmission.
It is up to the individual with their care team and families to decide how they weigh up the risks and benefits of staying with and feeding their baby. Recommendations will be made in order to minimise the risk of infection; keeping your face covered, avoiding droplets from coughing or sneezing reaching the baby, hand washing before you or anyone else feeds your baby
Support is available
At Muma Nurture we are keeping up to date with the latest advice for pregnant women in this rapidly changing situation. If you require any support or advice throughout this difficult time we are available and offering our services online.