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HEALTH PLUS MEDICAL CORRESPONDENT

Pregnancy can be an anxious time in the best of circumstances, but the spectre of COVID-19 pandemic and the increasing restrictions imposed on our lives as the world grapples with this virus, are enough to make anyone feel on edge. You may have planned to a detail for this miracle you expect to deliver, you overcame the horrid expulsions of the first trimester emesis(vomiting), the baby room is set and ready to welcome this new joyous addition in your life. It’s just that no one expected a pandemic and suddenly you are swarmed with words like spikes, high-risk and ventilation; and reluctantly sleepless nights and neck pains become a part of your daily existence.

Childbirth is usually a time when women feel particularly vulnerable but they usually find comfort in having capable and reassuring figures to provide them with support and motivation, and more so when labour takes a protracted time and/or is more complicated than usual. But now with new restrictions arising from the crisis, many pregnant mothers are unable to have anyone other than the midwife present until the final stages. For some, it feels that we are going back to the days when fathers were not permitted in the birthing room until everything was over.

COVID-19 has changed every dynamic

How we give birth, where we give birth and who is present when we give birth.

The effects of these changes are yet to be fully understood and data on pregnancy and Covid-19 is still limited. Many scenarios are considered but the most bothersome question is – “What are my risks?”

HEALTH PLUS deep dived into this topic, utilising Q&As published by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and Royal College of Paediatrics and Child Health, with input from the Royal College of Anaesthetists, the Obstetric Anaesthetists’ Association, Public Health England and Public Health Scotland.

What effect does coronavirus have on pregnant women?

Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution. This is because pregnant women can sometimes be more at risk from viruses like the flu. However, all available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus.

Still, due to changes in their bodies and immune systems, it is recognised that pregnant women can be affected by respiratory infections. It is therefore important that all precautions be taken to protect against COVID-19.

A recent UK study on 427 pregnant women admitted to hospital with coronavirus during the pandemic, around one in 10 women required intensive care. Most women in the study required only ward treatment and were discharged home, well with well babies.

Pregnant women over the age of 35, those who were overweight or obese, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital.

What effect will coronavirus have on my baby if I am diagnosed with the infection?

Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) might be possible. It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well. There is no evidence to suggest an increased risk of miscarriage if you become infected with coronavirus while being pregnant.

In the recent UK study of 427 pregnant women, the data reported outcomes for babies showed that one in 20 babies born (12 babies in total) had a positive test for coronavirus, but only half of these babies, six babies, had a positive test immediately after birth, suggesting that transmission of the coronavirus infection from a woman to her baby is low. The number of babies born at term (37 weeks or later) to women who had tested positive for coronavirus that required neonatal care was similar to the number of babies born to women without the virus; about one in 10.

I’m pregnant. How can I protect myself against COVID-19?

Pregnant women should take the same precautions to avoid COVID-19 infection as other people. You can help protect yourself by:

– Washing your hands frequently with an alcohol-based hand rub or soap and water.

– Socially distancing, maintaining space between yourselves and others and avoiding crowded spaces.

– Avoiding touching your eyes, nose and mouth.

– Practicing respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

– If you have fever, cough or difficulty breathing, seek medical care early and preferably call before going to a health facility.

Do pregnant women with suspected or confirmed COVID-19 need to give birth by Caesarean Section?

No. Advice from WHO and RCOG is that caesarean sections should only be performed when medically justified. The mode of birth should be individualised and based on a woman’s preferences alongside obstetric indications.

Can I touch and hold my newborn baby if I have COVID-19?

YES. Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be encouraged to:

– Breastfeed safely, with good respiratory hygiene

– Hold your newborn skin-to-skin, and

– Share a room with your baby, once conditions are feasible

However, some centres may advocate temporary separation of the newborn from a mother who is too ill. The risks and benefits of temporary separation of the mother from her newborn should be discussed with the mother by her healthcare team. Decisions about temporary separation should be made with respect to the mother’s wishes. If the mother chooses a temporary separation to reduce risk of spreading the virus and would like to breastfeed, she should express breast milk and have a healthy caregiver, who is not at high-risk from COVID-19, safely feed the newborn the expressed breast milk if possible.

Put the “social” back in social distancing safely

Pregnancy is a special time full of excitement and anticipation but for expectant mothers facing the outbreak of the COVID-19 pandemic, fear, anxiety and uncertainty are clouding this otherwise happy time. Maintaining your normal routines and healthy habits are critical during this stressful time. Encourage digital communication with friends and family members via video calls, or even old-fashioned letters and journalling. Even though you’re apart, you can watch movies or cook the same meal together over video chat. Just checking in on others helps keep everyone’s spirits positive and nourishes your wellbeing!

Keep in mind “A healthy mummy equals a healthy pregnancy and more importantly – a healthy baby!”

If you are pregnant or delivered during COVID-19, share with us your story, “How did you cope with pregnancy and delivery during the Pandemic?”

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