The Science of COVID-19: COVID-19 and Pregnancy (Part II)

Dr. Narine Singh
Chief Medical Officer
Ministry of Health

COVID-19 and Pregnancy (Part II)
In Part I last week, we covered the latest research into COVID-19 and pregnancy, as well as looked at mother-to-child transmission and the need for remote appointments, if necessary. In case you missed it, here is the link: https://guyanachronicle.com/2020/11/29/covid-19-and-pregnancy-part-i/.

Labour and delivery
If you are healthy as you approach the end of pregnancy, some aspects of your labour and delivery might proceed as usual. But be prepared to be flexible. Whether you deliver your baby vaginally or via cesarean will depend on a lot of factors, and not just whether you have COVID-19.
If you are scheduled for labour induction or a C-section, you might be screened for COVID-19 symptoms 24 to 48 hours before your arrival at the hospital. You might be screened again before entering the labour and delivery unit. If you have symptoms or the virus that causes COVID-19, your induction or C-section might be rescheduled.
To protect the health of you and your baby, the hospital might limit the number of people you can have in the room during labour and delivery. Visits after delivery might be affected too.
Also, during your hospitalisation, if you have COVID-19, or are waiting for test results due to symptoms, it’s recommended during hospitalisation after childbirth that you wear a cloth face mask and have clean hands when caring for your newborn.
Keeping your newborn’s crib by your bed while you are in the hospital is fine, but it’s also recommended that you maintain a reasonable distance from your baby when possible. When these steps are taken, the risk of a newborn becoming infected with the COVID-19 virus is low.
Research suggests that only about 2-5 percent of infants born to women with COVID-19 near the time of delivery test positive for the virus in the days after birth. However, if you are severely ill with COVID-19, you might need to be temporarily separated from your newborn.

Postpartum guidance
It’s recommended that postpartum care after childbirth be an ongoing process. Talk to your healthcare provider about virtual visit options for checking in after delivery, as well as your need for an office visit.
During this stressful time, you might have more anxiety about your health and the health of your family. Pay attention to your mental health. Reach out to family and friends for support, while taking precautions to reduce your risk of infection with the COVID-19 virus.
If you experience severe mood swings, loss of appetite, overwhelming fatigue, and lack of joy in life shortly after childbirth, you might have postpartum depression.
Contact your health-care provider if you think you might be depressed; especially if your symptoms don’t fade on their own, you have trouble caring for your baby or completing daily tasks, or you have thoughts of harming yourself or your baby.

Breast-feeding
It isn’t yet known if the COVID-19 virus can be transmitted through breast milk. Limited research has shown no evidence of the virus in the breast milk of women with COVID-19. But experts caution that more research needs to be done before they can definitively say there’s no risk.
The bigger concern is whether an infected mother can transmit the virus to the baby through respiratory droplets during breast-feeding. If you have COVID-19, or are an asymptomatic person under investigation for having the virus, take steps to avoid spreading the virus to your baby.

These include:
• wearing a face mask
• washing your hands thoroughly before touching your baby (be sure to get under your nails and into the webbing of your fingers)
• washing your hands thoroughly before handling a breast pump or bottle
• considering having someone who is well give the baby a bottle of expressed breast milk

What you can do
A vaccine to prevent infection with the COVID-19 virus is still not available in Guyana at this time.
To reduce your risk of infection, the World Health Organization (WHO) advises pregnant women to do the same things as the general public does to avoid infection, such as avoiding close contact with anyone who is sick or has symptoms, and keeping about six feet of distance between yourself and others beyond your household. Wear a cloth face mask in public and at work. Limit contact with others as much as possible.
Instead, consider sharing moments with friends and family via photos, videos or videoconferencing. Wash your hands often with soap and water for at least 20 seconds, or use an alcohol-based hand sanitiser that contains at least 60 percent alcohol. And skip the baby wipes — they don’t disinfect.
Above all, focus on taking care of yourself and your baby. Contact your health-care provider to discuss any concerns. If you’re having trouble managing stress or anxiety, talk to your health-care provider or a mental health counselor about coping strategies.

Safe Medical Treatments
Treatment for COVID-19 is similar to the treatment of other respiratory illnesses. Whether you’re pregnant or not, doctors advise:
• taking acetaminophen (Tylenol) for a fever of 100.4°F (38°C) or higher
• staying well hydrated with water or low-sugar drinks
• rest

If Tylenol doesn’t bring down your fever, you have difficulty breathing, or you start vomiting, call your doctor for further guidance, or call the COVID-19 Hotline immediately.
Like swollen ankles and constipation, worry is a constant companion when you’re pregnant. But it’s important to keep perspective. This new coronavirus is serious business, but, pregnant or not, you’re not a sitting duck.
While much still needs to be learned about the virus, the little research that’s out shows that pregnant women with COVID-19 are no more likely than others to have severe disease. And the virus is not likely to be passed along to their babies during pregnancy or childbirth, according to limited data we have so far.
As the saying goes, it pays to be prepared, not scared. Simple steps like thorough hand washing and limiting your time in crowds can go a long way in protecting you and your baby.

Article submitted as part of the Ministry of Health’s COVID-19 public information and education programme. For questions, email [email protected]