Things Pregnant Women Should Know During COVID-19

The spread of COVID-19 and the consequent lockdown has been having the most significant effect on people already dealing with persisting medical conditions - such as pregnant women. Life for them has taken an especially unprecedented swerve, since visits to the doctor, routine checkups, or sanitising surfaces for the baby are not ordinary anymore. Schedules have been disrupted, throwing the work-life-mom nexus off-balance.

Shubhangi Maheshwari, 31, who stays in Gwalior and is in her eighth month of pregnancy, says, “I’m a working woman, and live away from family. So travelling back home was very difficult, even though I needed medical attention. Although I’m now happy to be spending time with family, and have my husband taking care of me, as a pregnant woman, it becomes tough to find credible doctors and good hospitals for special care.”

Also Read: Medical Termination of Pregnancy Amendment Bill, 2020: A Step in the Right Direction?

Thousands of pregnant women like Shubhangi are struggling with such, and other such, issues exclusive to them. The top queries pregnant women have, and should know about, during the COVID-19 pandemic have been addressed below, with medical consultation from Dr Nishita A. Consultant Obstetrics & Gynaecologist Infertility Specialist.

How can a pregnant woman differentiate between COVID-19 symptoms and pregnancy signs?

"The main symptoms of coronavirus are a high temperature, cough, breathlessness, loss or change of sense of smell or taste, muscle pain, etc. Most people with coronavirus have at least one of these symptoms. If a pregnant woman shows these symptoms, she should self-isolate and inform the maternity team."

However, it may also be that symptoms and signs of pregnancy and coronavirus may overlap - since both comprise of conditions like fatigue, chills, nausea, headaches, etc. For this, Dr Nishita says, “Other possible causes of fever/temperature in pregnancy with similar symptoms like common flu, urine infections (cystitis), and waters breaking should be kept in mind. Whatever the symptoms may be, pregnant women should always inform the maternity team who will triage and decide further course of investigation and treatment.”

Q. Can a foetus/baby contract coronavirus from the mother in the womb?

“According to ICMR emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth is probable although its course is yet to be determined. A small number of babies have been diagnosed with coronavirus shortly after birth but it is not certain whether transmission was before or soon after birth,” Dr Nishita says.

Due to varying, distinct incidents, research is still underway on the subject. For instance, in July, HT reported that a Delhi woman who was cured of COVID-19 gave birth to a baby that tested positive for the virus. In the same month, The New York Times reported that a French baby had contracted the virus in his mother’s womb. 

“However, there is no evidence to suggest an increased risk of miscarriage or foetal anomalies in pregnant women who have COVID,” Dr Nishita maintained.

Q. What are the precautions pregnant women must take while visiting the hospitals for their regular check-ups?

Dr Nishita suggests pregnant women follow these measures to reduce health risks when going for check-ups:

• Wash hands frequently at intervals; carry portable soap or sanitiser
• Be sure to wear a mask while visiting the doctor
• Carry own water and some snacks from home (do wash/sanitise hands before eating)
• Respiratory hygiene must be followed
• Antenatal visits should be tailored to a minimum, optimised and timed with prior appointment
• Preferably carry a digital copy of reports and old prescriptions
• Either go alone or only one attendee; attender should preferably be the same in all visits
• Social distancing while waiting for consultation/ultrasound is a must

Also Read: Lockdown: Delhi HC Orders Govt To Prioritize Pregnant Women’s Health

Q. If I am a pregnant lady with COVID, will the virus have severe effects on me more than that on a regular person?

According to WHO, with limited data at present, it appears that pregnant women do not have worse outcomes or consequences of infection with respect to the general population.

Dr Nishita explains further, “However, since during pregnancy there is an altered immune response to viral infections, there are marked symptoms and a worse course of disease, especially for women in the third trimester, and women having co-morbid conditions like heart disease, obesity, GDM, asthma, hypertension, thromboembolism, etc.” This has also been confirmed by Harvard Medical School, that says, “When pregnant women do become infected with COVID-19, they are significantly more likely to need to be admitted to the hospital and to need help with breathing (mechanical ventilation).”

Q. Will there be complications at the time of my delivery if I have coronavirus?

“Pregnant patients with co-morbidities may be at increased risk for severe illness consistent with the general population with similar co-morbidities during antenatal and delivery period,” Dr Nishita says. However, high-quality medical assistance will be provided to women delivering their babies at hospitals, with special attention to any risks she may be susceptible to.

WHO maintains that “All women have the right to a safe and positive childbirth experience, whether or not they have a confirmed COVID-19 infection.” It assures suitable pain relief strategies and birth position of choice for the woman in labour. However, according to ICMR, “There is currently no evidence to favour one mode of birth over another.”

Q. Is it safe to deliver in a hospital right now? Or should I have a home birth?

Dr Nishita maintains that hospitals are ideal even in the current scenario for birth-giving, since they continue to be safe with strict infection control. “Hospitals and accredited birth centres remain the safest settings for birth even during COVID-19. New data analysis from the CDC suggesting increased risk of ICU admission and mechanical ventilations for pregnant patients with COVID highlight the importance of delivering at a hospital or accredited birth centre,” she says.

She specifies, “Delivery should be at a tertiary care centre, with the facility of an isolation room, dedicated labour room, and an OT (operation theatre) with a multidisciplinary team approach, and intense maternal and foetal monitoring.”

Also Read: I Don’t Fear The Disease, Says 23-Year-Old Pregnant Coronavirus Patient

Q. If I have coronavirus, can I continue to breastfeed my newborn?

WHO has confirmed, as does Dr Nishita, that new mothers can continue to breastfeed their infants, since there is no evidence that suggests transfer of the virus from a COVID+ mother to her baby.

She says, “Yes. you can breastfeed your baby as per advice from your obstetrician and neonatologist since it will help your baby to get proper nutrition and antibodies to protect it from other illnesses. However, all the principles of nursing such as respiratory hygiene and hand hygiene when handling the baby should be followed.”

WHO suggests, “A woman with COVID-19 should be supported to breastfeed safely, hold her newborn skin-to-skin, and share a room with her baby.” However, if the mother is too unwell to breastfeed, she can feed her baby by expressing milk, relactation, or via donor human milk.

Q. What other precautions should I take around my baby to maintain immunity?

“The best you can do to prevent COVID is by socially distancing yourself and the baby from other people as much as possible. You should also eat a healthy diet, do yoga and breathing exercises, and maintain good hygiene. If you’re healthy, it will protect your baby from illness too,” she says.

Q. What to do if someone at home has COVID and a baby has just arrived?

Dr Nishita suggests for the COVID+ person at home to isolate completely, especially away from the baby. Everyone else must wear face masks, and surfaces should be frequently cleaned and disinfected. She mentions, “The infected person should wear a face mask (ideally a FFP3 or FFP2 - N95 mask) when s/he is in the same room as the baby, or other people.”

Q. What should I tell relatives/friends who want to come home and meet my newborn?

This is a common doubt, especially in a country like India where the birth of a baby automatically guarantees a large number of visitors. Dr Nishita says, “Having a baby is the most memorable and significant life milestones for any person. Amid the coronavirus pandemic, however, this experience is accompanied by a unique set of challenges.”

“Parents should restrict all visits during the first 6 weeks, when the newborn’s immune system is developing. They can cite the reason of the baby’s health to relatives who insist on visiting. Later on, the key idea should be cohorting of visitors with all COVID precautions. It’s better to visit with a small cohort for a long time than a large cohort for a short time.”

Q. Which is the safest soap to bathe my baby with? Which disinfectants and detergents should I use to clean surfaces when there’s a baby around?

Dr Nishita suggests that parents should know certain essential parameters while choosing the correct baby soap for their little one. “The soap should contain pH Value (near 7), without parabens, hypoallergenic, tear-free, and a gentle lather.”

As for the detergents to be used on surfaces, parents can use soap-water or detergents, followed by a disinfectant. “In non-healthcare settings, sodium hypochlorite (bleach) may be used at a recommended concentration of 0.1% (1000ppm). Alternatively, alcohol with 70-90% concentration may be used for surface disinfection,” she says.

Q. Should I get tested for COVID before getting admitted to the hospital for my delivery date?

Recently, per Delhi HC orders, COVID testing for pregnant women visiting hospitals was deemed not mandatory. Dr Nishita also says that “There are no recommendations of testing all pregnant women.”

However, “Pregnant women residing in cluster/containment areas or in large migration gatherings/evacuees centre from hotspot districts presenting in labour or likely to deliver in the next 5 days should be tested even if asymptomatic,” she says. “During admission for labour and delivery with suspected COVID-19 or who develop symptoms suggestive of COVID-19 should be prioritised for testing (as per CDC, ACOG advisory).”

Also Read: COVID-19 Test Not Mandatory for Pregnant Women: Delhi Govt. To HC

Q. What about the mental health of pregnant mothers?

ICMR has noted the importance of a pregnant woman’s mental health during COVID, saying, “The coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact.” Dr Nishita suggests that the pregnant woman be given full mental support by those at home, who can drop her an encouraging word or two from time to time.

Views expressed and information shared is the doctor's not that of SheThePeople.