It's understandable, in this time of uncertainty due to the coronavirus (COVID-19) pandemic, to feel stressed by the news and the rising number of cases. You might be feeling especially anxious if you're pregnant or the parent of a young child, and we hope that Ovia Health is able to provide you with some of the support and advice that you need.
Here's the latest from Dr. Adam Wolfberg — OB-GYN and Chief Medical Officer at Ovia Health — including answers to your questions, practical advice, and a call for how we can all help prevent the spread of coronavirus.
If I’m pregnant and I get COVID-19, will the infection be worse?
The answer is that we really don’t know, but based on our experience with other coronaviruses and with the flu (influenza), it’s possible that the disease could be worse. Public health experts haven’t had time to collect and report information about COVID-19 and pregnancy. One report of 147 pregnant women in Wuhan, China, suggested that the disease was not worse in pregnant women than it was in other infected people. However, influenza tends to be worse in pregnant women, and SARS was worse in pregnant women than in women who weren’t pregnant. My suggestion, based on common sense and not evidence, is that pregnant women consider themselves to be part of a high-risk group and follow guidance from public health experts that applies to the elderly and immunocompromised.
What can I do to prevent infection?
Prevention is no different for pregnant women then it is for others, so follow the advice that you receive from your local health department, from the CDC, and from your healthcare provider. Masks aren’t recommended as a way to avoid catching COVID-19; masks are recommended if you think you have COVID-19 and want to avoid spreading it to others.
Should I work from home?
Working from home is a good way to avoid catching (or spreading) COVID-19, and many businesses that are able to have employees work from home are advocating this approach. If it’s possible for you to work from home, it may be advisable. For many of you, working from home is impossible, so do the best you can to observe infection-reducing practices.
Is hand sanitizer safe in pregnancy?
Yes, Yes, YES. The CDC reports that handwashing with soap and water is more effective than hand sanitizer. However, you can’t take the sink in your car or on a walk or to the grocery, so make sure you use hand sanitizer regularly in addition to handwashing. Furthermore, it’s often much easier to wipe hand sanitizer on your children’s hands than it is to get them properly washed, so consider this regular habit as well.
If I get COVID-19, will I pass it to my fetus?
It’s not yet entirely clear whether COVID-19 crosses the placenta to infect your fetus, and there is very little published research on this topic.Similar viruses (influenza, SARS) do not infect the fetus during pregnancy, and the babies that may have been infected during pregnancy did very well in the recent papers that suggested such an infection is possible. There is no evidence that cesarean delivery reduces the risk of infection, so this is not recommended.
What about during and after delivery?
It is extremely important that you CALL your healthcare provider BEFORE you go to the hospital if you think you have COVID-19 or think you might have been exposed. Once at the hospital, your provider knows what to do to reduce the risk that your baby (and the healthcare professionals who care for you) will become infected.
What is the risk to my baby? And what about the risk to my other children?
The good news is that children seem to be at less risk of becoming really sick if they are infected with COVID-19 than adults are, and the same seems to be true of babies. You should still do everything you can to reduce the risk of exposure.
Is breastfeeding safe if I think I have COVID-19?
There is no evidence that breast milk contains COVID-19, however, we’re concerned that your baby could become infected through droplet exposure (cough, sneeze, etc.) while breastfeeding. Therefore, it’s not clear whether it’s safer to pump and bottle-feed (with breast milk) if you think you may have COVID-19. This is a topic to discuss with your healthcare provider. Either way, hand-washing and use of masks is recommended.
How do I do my part to prevent the spread of COVID-19 to others?
If you have a cough, a fever, a cold, or other respiratory symptoms, OR if you think you might have been exposed to COVID-19, please CALL your healthcare provider or the hospital BEFORE you show up for an appointment or to the emergency room. This way, your healthcare provider will be ready to take great care of you without exposing others. In general, if you have these symptoms or think you might have been exposed to COVID-19, make sure to do your part and practice social distancing: staying six feet away from others, not going to crowded spaces, and paying particular attention to stay away from the elderly, those with compromised immune systems, and yes, other pregnant women. (Obviously, you can’t stay six feet away from your child, as every parent of a sick kid knows, so just do your best and don’t worry too much if "best," isn’t "perfect.")
What about my prenatal visits? Should I still attend all of my visits?
The short answer is yes, particularly for visits that involve an ultrasound, fetal testing, or are in the third trimester. For other visits, the answer is maybe, and depends on how much COVID-19 there is in your community. When in doubt, call your healthcare provider and ask, and consider asking her/him if it would be reasonable to do your prenatal visit by video or telephone. If you go, remember to handwash/sanitize after touching all of those doors/chairs/surfaces.
Should I consider a home birth given the risk of COVID-19 infection during my Labor and Delivery experience?
Your healthcare provider is taking extraordinary precautions to prevent COVID-19 transmission on Labor and Delivery, as well as to take care of women who may have been exposed to COVID-19. Because of this, home birth, which has always been riskier than in-hospital birth, is still not recommended, particularly because there are a host of issues related to the COVID-19 epidemic that may cause laboring at home to be even riskier than it normally is. Because your healthcare provider is doing everything she/he can to reduce the risk of infection, fewer visitors may be allowed during and after delivery than usual, but this is for your protection and your baby’s protection and safety. We know that the hospital may appear to be a scary place these days, and that some women are staying away at all costs. If you are one of them, please consult your healthcare provider to minimize your risks.
Will my partner be able to come with me when I’m in labor and after delivery?
Yes. A few hospitals in New York temporarily banned all visitors including partners, but this decision was reversed. Visitors, including siblings, extended family members, and even doulas may be restricted, but your (healthy) partner will be with you when you deliver.
What if I’m trying to conceive and not yet pregnant?
There’s no evidence that COVID-19 or any similar viruses impact conception or cause birth defects if you are sick when you conceive.
What if I’m receiving fertility treatment, or planning to receive fertility treatment?
The American medical system has essentially canceled all non-urgent medical procedures, and whether you agree with it or not, that includes fertility treatment. This isn’t because pregnancy is fundamentally dangerous, but because a) the risk of COVID-19 infection during the treatment process is too high, and b) because healthcare resources need to be reserved for those people who are really sick. We recognize this may be heartbreaking or incredibly frustrating or disappointing, particularly because your healthcare provider probably can’t give you an answer about when you can start or resume treatment. We appreciate this frustration.
Don’t forget the flu.
At this point, the influenza virus still represents a greater risk to pregnant women than COVID-19, so make sure you received your flu vaccine. The good news is that measures to prevent the spread of COVID-19 also work to reduce the risk of catching any virus or bacterium.