Pregnancy and COVID-19: What We Know (& a Few Things We Don’t)
In a time when virtual hugs are pretty much the only way we hug now, I want to send out a million-billion virtual hugs to all the pregnant ladies out there. I can’t even imagine how scary and uncertain things feel for you right now. HUGS. ALL OF THE HUGS.
I waded through the Google Swamp and tried to pull together a list of reputable sites with the most comprehensive and scientific coverage on COVID-19 and all things pregnancy, childbirth, breastfeeding, and newborn safety. I will update as needed, as so far a lot of the current thinking and recommendations are admittedly based on very limited studies with a small number of patients.
However, I can’t stress this enough: Your doctor is and should continue to be your #1 source of information and guidance. Talk to your doctor, listen to your doctor. Do not listen to that one weird uncle raving about 5G towers or any of the (many, many) MLM shillers preying on people’s fears with false claims about immunity via shakes/supplements/oils/cleaning products. Do not let your mother or mother-in-law work your nerves by questioning your decision to cancel your baby shower or stick with your current birth plan or whatever else She Is Going On About Today. If there’s ever been a time to pull back from the news cycle and go on an unfollowing spree on Facebook, this is it. I AM HEREBY BUILDING UP HEALTHY BOUNDARIES ON YOUR BEHALF FROM AFAR.
Okay, let’s tackle some of the big questions.
Am I Higher Risk for COVID-19 Because I’m Pregnant?
UPDATE 6/26/2020: The CDC has updated their guidance to include pregnancy on their list of conditions that “might be at an increased risk for severe illness” from COVID-19.
The CDC made revisions to their “People of Any Age With Underlying Conditions” page yesterday (on June 25, 2020) to reflect the latest data. There are two tiers to this guidance: Certain underlying conditions that definitely put people of any age at an increased risk of severe illness (heart conditions, chronic kidney disease, etc.), and certain underlying conditions that might. Pregnancy is now listed in the second category, along with a warning that a pregnant woman with COVID-19 may be at risk of preterm birth. So really, all the advice in the next (non-strikethrough-ed) paragraph still stands, which was: Please err on the side of I-might-be-higher-risk caution.
So far, the numbers aren’t pointing to pregnant women getting seriously ill en masse from the coronavirus, despite being considered an immunocompromised/at-risk group in many states and countries. But there’s still a lot we just don’t know for sure yet. What To Expect has a good rundown of anything coming close to an official scientific study here, and the results of all of them are pretty encouraging and suggest that pregnant women are not at a higher risk of developing a more severe illness from the novel coronavirus than the general population. Per the CDC: We do not currently know if pregnant people have a greater chance of getting sick from COVID-19 than the general public nor whether they are more likely to have serious illness as a result. Based on available information, pregnant people seem to have the same risk as adults who are not pregnant. However, we do know that
Pregnant people have changes in their bodies that may increase their risk of some infections. Pregnant people have had a higher risk of severe illness when infected with viruses from the same family as COVID-19 and other viral respiratory infections, such as influenza.
And as we DO know, even out among the general population, it’s a bit of a crapshoot. Plenty of young and otherwise healthy people are getting seriously sick and dying. So focus on what we DO know, which is: Assume community spread is happening where you live, even if the current case numbers are low. Life your life as if pregnancy DOES put you in the higher risk category. Stay at home. Wear a mask. Social distance and avoid crowds/big groups. Wash your hands. (AND CLEAN YOUR PHONE!) Move your baby shower and social life to Zoom/Skype/FaceTime.
(While I don’t want to blur the lines between influenza and coronavirus, let’s not forget that pregnant women are definitely more likely to develop a severe illness and complications if they contract the flu. AND the flu is known to cause problems for developing babies. So while the planet waits on a coronavirus vaccine, please get your flu shot!! It’s the best thing you can do for yourself and your baby, both now and later. Your newborn can’t get a flu shot of their own until six months, but getting vaccinated during pregnancy will let you pass the antibodies along to protect them during that early window.)
What About My Prenatal Appointments?
Even if your appointments happen primarily via telemedicine, that doesn’t mean they’re less important or helpful. Ask your doctor if they recommend at-home blood pressure monitoring. Some appointments will still happen in person (genetic testing, ultrasounds, resting glucose test, etc.), and your OB office has probably made changes to maximize patient safety — lots of disinfecting, spacing out appointments, asking you to wait in your car versus the waiting room, all that stuff. Please don’t skip your prenatal appointments, especially since keeping up regular contact and access to your healthcare provider will be very beneficial for your general mental health right now.
Should I Change My Birth Plan?
I really like this piece by Anna North for VOX. And especially this quote from Denise Jamieson, chair of the Department of Gynecology and Obstetrics at Emory University School of Medicine: “I don’t think Covid should change women’s choices about where the safest and best place to deliver is.”
(Easier quoted than believed, I know.)
A hospital birth right now might not be the same as a hospital birth three months ago, or three months from now. There might be more restrictions on visitors and delivery room attendees. But your hospital (or birth center) hasn’t changed its number-one priority: a safe delivery and a healthy mom and baby.
The overall guidance out there from both doctors and midwives is that women should stick with their existing birth plan, as switching late in the game to a home birth might not be the best choice or even possible. (Qualified, certified midwives are as overloaded as the hospitals in hard-hit areas; and there’s also the risk of needing an emergency transfer to a hospital anyway.) HOWEVER, if you already researched and planned for a home birth, great. You should also stick with your existing plan. Just don’t invite the whole extended family to the house before, during, or afterwards!
What About Breastfeeding?
Again, the “studies” are limited to very small groups of women, but there’s no evidence that the virus passes through breastmilk. If you are able to get tested and you test negative, by all means continue with your plans to breastfeed.
If you test positive, the CDC recommends either 1) wearing a mask and gloves during feedings, or 2) pumping and (if possible) have someone who is not sick feed the baby, and be extra diligent about washing/sanitizing your pump parts. The American Academy of Pediatrics is more conservative, and (as of early April 2020) is recommending that mothers who test positive stay separate from their babies and exclusively pump until they are no longer contagious. The World Health Organization currently disagrees with that guidance, and believes infected mothers can interact safely with their babies as long as other safety and hygiene precautions are taken. Talk to your own doctor.
(Again, if you aren’t sick, there’s no reason to change your plans re: breastfeeding. I’d follow the most draconian recommendations for preventing exposure in the meantime, though. STAY HOMMMMMME.)
If you plan on or need to use formula and are anxious about supply chain/stocking issues in your area, look into an online/delivery subscription service, either direct from the formula manufacturer or Amazon, Target, Walmart, etc. As of this writing, none of the large online retailers or brand-name formula companies are reporting fulfillment or stocking issues for baby formula. (An additional read to answer questions is Should You Breastfeed if You Have the Coronavirus? by The New York Times)
What To Expect
The New York Times full coronavirus coverage for parents (paywall exempt)
Harvard Medical School
The Royal College of Obstetricians and Gynaecologists (RCOG)
Centers for Disease Control & Prevention
American Academy of Pediatrics