By: Dr. Ed Coats
As the Coronavirus pandemic surges on, there will be many concerned about the impact that this new virus may have on pregnancy. We wrote about Covid-19 and Fertility Treatment recently with so much uncertainty in the months ahead for those trying to conceive. Those trying to conceive, newly pregnant or perhaps more established in pregnancy will be anxious to understand what lies ahead. We wanted to address the facts and what we know so far about Covid-19 and how to prepare mentally and physically for the months ahead.
The Current Situation
The latest coronavirus (Covid-19) began in Wuhan, Hubei province in late 2019 and since then has spread globally. There has been a massive effort to gather data from those infected to help understand how it affects us all. Pregnancy is a unique state that needs specific attention as the immune system’s response to infection can differ. On 16th March the UK Chief Medical Officer categorised pregnant woman as a ‘vulnerable’ group that may be at increased risk from Covid-19. Since then an enormous amount of data has been collated to provide structured guidance around how best to manage a pregnancy during this global pandemic.
Virus Transmission and Symptoms
Pregnant women do not appear more likely to contract the virus than the general population. Transmission of the virus appears to be by two routes. The first is by ‘direct’ transmission through close contact with an infected person within two metres, and respiratory secretions enter the eyes, mouth, nose and airways. The second route is by ‘indirect’ contact via touching surfaces, objects or hands contaminated by the virus, and then touching the eyes, nose or mouth. The symptoms of the Coronavirus are a persistent cough, fever, shortness of breath, and headaches. The vast majority of pregnant women who contract the virus will remain completely well with only mild cold or flu like symptoms and make a full recovery.
We have known for many years that the immune system in pregnancy may find it harder to deal with infections in general, and it is this information that has led to the very specific government advice to pregnant women. It is clear now that many people in the population infected with the virus will have no symptoms at all. Therefore whilst the advice to socially distance (2 metres minimum) applies to us all it is particularly recommended for all pregnant women, so as to minimise the chance of becoming infected with Covid-19. Although this is not specific to any stage of pregnancy those thought to be more at risk are women above 28 weeks pregnant.
In some severe cases pregnant women might become more critically unwell and develop severe symptoms such as pneumonia and breathing difficulties requiring additional support. Thankfully so far in this crisis these types of cases are less common but if this were to happen then you must contact the NHS on 111 or your local hospital maternity unit immediately.
My Pregnancy Care
We know from many years of research that the care a pregnant woman receives both before (antenatally) and after the birth (postnatally) is essential and prevents complications in women and their babies. We strongly advise that despite the concerns many women may have about travelling to appointments to ensure they don’t miss scheduled appointments. Throughout this pandemic hospitals have adopted new ways of working to minimise any spread of the virus to healthy women during antenatal and postnatal care and importantly during the birth itself.
There is a huge amount of anxiety and fear in the pregnant population currently about travelling to hospital. If you have any concerns about your own health or the movements of your baby it is critically important therefore that you contact your maternity team to arrange further assessment. Any urgent concern you have at all must be communicated to the maternity team without delay. The hospitals have set up ‘safe zones’ to continue with essential hospital visits for healthy pregnant women without symptoms.
If you are self-isolating at home because someone in the household or you yourself has symptoms then it is important that you keep in contact with your maternity team to make a specific plan for your pregnancy care. If you have symptoms of Covid-19 or are self-isolating you should not just attend a routine clinic. Some appointments, scans or tests may be safe to delay until you have completed your period of self-isolation. The best people to organise and make these decisions though are your maternity team. The maternity team will make arrangements for you to attend the hospital safely if required.
What to Expect in NHS Hospitals
In order to reduce the spread of the virus many changes due to social distancing have been strictly applied within the hospital. Therefore be prepared for the fact that you may be asked to attend clinic appointments alone or with only one other. Non-essential antenatal visits may be reduced but this will be communicated to you through your midwife or maternity team. If you have a more complex pregnancy and require more frequent review then an individualised plan will be scheduled by your maternity team.
Restrictions have come into practice since the social distancing guidance was introduced in March. All women should be allowed and encouraged to have one birth partner present during the labour and birth. The presence of a trusted birth partner is known to improve the safety and wellbeing of women in labour. The birth partner should have no Covid-19 symptoms. If they do not meet these criteria or are themselves ‘vulnerable’ due to their own ill health you may wish to consider an alternative birth partner option in advance. Partners and visitors are not permitted onto maternity wards to help reduce the spread of the virus, so this will undoubtedly have implications for induction of labour and after your baby is born.
Labour and Birth
During labour your midwife will wear PPE (Personal Protective Equipment), which involves a gown, gloves and a face mask throughout to minimise the risk of any spread of the virus. As many patients have no symptoms this is essential to protect your midwife during your labour. In addition any other healthcare workers you meet will be similarly protected. Occasionally emergencies happen in labour and sometimes it is necessary to move from the labour room to theatre, perhaps even for the birth itself. In most hospitals maternity teams where possible are encouraging partners to be present at the birth in theatre, but do check this with your local maternity team. If a general anaesthetic is required then as would be case in normal times the birth partner will be asked to leave theatre.
The uncertainty that has engulfed us with the Covid-19 pandemic has added a new level of complexity for all pregnant women. It is inevitable that this unique set of circumstances will lead to anxiety around the impact of the virus on your pregnancy. Having to socially isolate and reduce contact with wider friends and family is an additional burden that we know will be additionally stressful for many as well as the possible financial concerns and loss of loved ones. It is expected that levels of anxiety will increase during this pandemic. Sometimes simply acknowledging this, opening up and talking to your maternity team at your appointments will help relieve some of this tension. If you have concerns about domestic violence at home and need support or advice do not suffer alone and actively seek help.
Where to Find Out More
The key priorities of all staff working in Maternity services is to reduce the transmission of Covid-19 to pregnant women and to continue to provide excellent care that is safe and of the highest standard. This is at the time of writing an evolving pandemic with advice and guidance changing day-to-day. If you have any questions or concerns about what you have read you may wish to read more about “Covid-19 and Pregnancy” and one of the best places to do this is The Royal College of Obstetricians and Gynaecologists where there is a very helpful resource of frequently asked questions that may help.
By: Dr. Ed Coats