Coronavirus (Covid-10) & Pregnancy Webinar with Dr. Ed Coats
The COVID-19 pandemic has left many expectant mums feeling uncertain about the months ahead. Dr Ed Coats, Consultant in Obstetrics and Gynaecology and accredited sub-specialist in Reproductive Medicine and Surgery, talks here about COVID-19 and pregnancy.
Janet Lindsay: Welcome to the first “Wellbeing of Women” webinar. I hope we’ve got a full audience today. I’m Janet Lindsey, and I am the CEO of Wellbeing of Women. Thank you so much for joining us today. And also thank you to our brilliant speaker, Mr. Ed Coats who’s consultant obstetrician and gynaecologist at the Royal United Bath Hospital, and he’s also a specialist in fertility.
Before we start, I would like just to cover a little bit of housekeeping. We are recording this so if you want to turn off your video, now is the time to do so. We are also asking you to add your comments on chat. We did actually ask everybody to submit questions, and Ed will cover these later on in his talk. And we do hope we’ll have time to cover more at the end, too. So, do add your questions if you want, to the chat section.
So without further ado, who are Wellbeing of Women? Well, sadly, most of you will never have heard of us. But we are in fact the UK’s foremost and only Women’s Health Research charity. We’re 56 years old, with some of the country’s brightest and best doctors, researchers, scientists, midwives and nurses. I said many of you won’t have heard about us, but I can absolutely guarantee that you will all have benefitted from our research at some point so far in your lives, because it’s used every day in doctors’ surgeries, in hospitals, antenatal clinics, schools up and down the country and beyond.
Here’s just a few examples of how we’ve had impact. I guess many of you here today are pregnant or hoping to become pregnant and therefore, you’ll be taking folic acid supplements. What you won’t know though, is that the important role of folic acid in pregnancy was one of Wellbeing of Women’s very first research projects. Our research has also led to the use of ultrasound in pregnancy to detect all kinds of things. And we also helped build the foundations for neonatal intensive care. We’ve done a huge amount more. Please go to our website and check if you want to know more about us, and I hope you will.
Until coronavirus struck, we had 30 projects on the go. Two thirds have stopped as of today, and the doctors, scientists, midwives, nurses are all back on the front line fighting the pandemic. We are so proud of all of them and everything that they’re doing. We do want them back because without research, there’s going to be no new breakthrough so badly needed in women’s health, leading new to treatments, cure, tests and preventions. Just a small fact is that less than 2.1% of publicly funded research is in women’s health and reproduction.
Please help us to make sure that our researchers can return to their work by making a donation. There are details on the chat, and you can also go to our website. I’m sure you must be aware that all charities are really suffering. And although the government has given money to charities, most of that is going to frontline work. Now, ours isn’t frontline work yet. But if we don’t raise money in the next few months, then some of our research just simply won’t be able to continue, and we rely on our friends and supporters. So although we’re giving you this talk free of charge, it would really help us if you could go donate. Thank you so much for listening. I’m going to hand over to Ed now. Thank you.
Dr. Ed Coats: Thanks, Janet. That’s a lovely introduction. And I’m very grateful to the charity for allowing me this hour to spend some time talking to people who, during a very challenging time will be, I’m sure very concerned about what COVID-19, the novel new coronavirus, means for their pregnancy, in particular, and also people trying for pregnancy and what the many months ahead will mean.
So I’m an ambassador for the charity as you know, Janet, and I’ve been involved with a charity for over 10 years. And so I’m proud to be part of this very first webinar that I believe we’ve done in what is fairly unusual circumstances, so I hope you find it useful. And please do use the website, the Wellbeing of Women website, which is a great information hub for patients. And we’ll be giving you at the end, some useful places where you might want to look at resources other than the chat today where you can get more information from as well.
But I wanted to start by sort of looking at, I guess, initially at the current situation. I am working in the NHS in what you would call the front line. The front line is often described on television as being the people in intensive care. But I believe anybody working in hospitals today is on the front line, in fact. Whether you’re a hospital porter or a hospital doctor, or an administrator, anybody in the hospitals or working in social care is providing those vital frontline services. And maternity services don’t change really, despite the fact that we have this awful pandemic surrounding us. Maternity still has to keep moving, and as does antenatal care and postnatal care. And so it’s an extremely anxious time for many of you as it is for the staff who are trying to provide excellent care.
We are obviously now in a position where we’re in lockdown now for further three weeks. Many of you would have been isolating for three weeks already. We heard around the 16th of March from the government, that pregnant women were particularly vulnerable and a vulnerable group, and I want to talk a little bit about that today, but let’s just start with the virus. It obviously originated from the Hubei Province and the city of Wuhan, which has a population of around 12 million. It is one of the seventh coronaviruses to have transferred from animals to humans, and it attacks the respiratory system, the lungs particularly. And what we have found out with time is that this has spread around the world and that we’ve had to change our daily lives significantly.
Now for pregnancy, particularly many of you will be very low risk and very normal in your pregnancies and others of you will be more complex and need more detailed care. So the presentation today is going to be difficult to cover everybody’s individual cases, but I wanted to focus really on what we know about COVID-19 so far, and particularly what that means for you, potentially in your lives.
But first of all, I want to share with you my first slide, which is to just really reassure you that there are some key priorities for us as a group of doctors providing services, and we’ll start with this first slide. Our goals in the hospital in maternity services are to reduce the transmission of COVID-19 that’s between staff between patients and to ensure that people can continue as normally as possible with their maternity care. And we need to make sure that despite this coronavirus pandemic, we are providing high quality excellent and safe care to all pregnant women throughout the time that we are under these unusual conditions. So that is an absolute priority for us as a group of professionals: midwives, doctors, nurses and all of the staff involved.
Now, what we do know about the virus and its transmission, and many of you may know some of this already, is that it’s transmitted really in two ways, two routes: directly, so that involves being in close contact with somebody, within two meters, where respiratory secretions from the eyes and mouth, the nose could enter into the airways of the other person. And then there’s the indirect route, which you could contaminate yourself with a virus from touching things such as surfaces, objects that carry the virus, other people’s hands, shaking hands, but then yourself infecting yourself with the virus by then touching your nose, your mouth, your eyes and the virus accessing the airways in that route.
So just going back to that slide, can you see that slide? Can everyone see that? I think that should be visible to you. Let me just show you that. So that is the two commonest ways of transmitting the virus. We also think that obviously human to human transmission is key. But we think as well that it’s probable that there can be what’s called vertical transmission in pregnancy. This is really come from a few reports from China, which have suggested that you may be able to transmit the virus in utero to the baby, which means that some people have found that there’s antibodies in the serum of the babies that are born, which means that they will have some immunity to it.
And this, again, is very, very early days. You have to understand with research and with data, and we’ve established evidence, it takes many months sometimes for this to come through. And we’ve been working at an incredible pace to get a lot of this information. And we have to be very cautious about small groups and numbers of studies that are suggesting things. And also, a lot of the data initially has come from China, which has proved challenging in so many ways, not only for the translation side of things, but also the numbers have cases which have been duplicated in cases and published in different journals. And so it’s quite hard to get very, very accurate details. What we do know is that the virus is not being found in amniotic fluid, it’s not being found in vaginal secretions, and it’s not being found in breast milk. But we also have to say this is an evolving landscape. And so these things can change day to day and week by week, and so we will need to obviously keep pace with the changes as they come and try and look around the world at the data and analyse it with caution.
As regards to pregnant patients, you will be wondering, what does it mean for me? Because I’m pregnant, am I more likely to catch it? No, we don’t think so. We don’t think because you’re pregnant, you’re more likely to catch the virus. Absolutely not. The thing that most people will probably get is a very mild flu-like symptoms if they were to get it, maybe moderate flu like symptoms. And some of you may not even know you’ve had it, and that will be the vast majority of people. A few people may develop a cough, a few people may feel feverish, and at the more extreme end of symptoms, people may feel breathless. And if you do feel any of those symptoms and feel unwell, and actually feel unable to cope, then you should obviously urgently contact your maternity services. But the general advice is that if you have a mild flu-like symptoms, is to isolate for seven days and to stay at home. And we don’t know entirely whether the coronavirus has an impact on the fetus in utero. But if you look at SARS and other common viruses, that it seems to be behaving in a very similar way and most of the evidence would suggest that we think babies are not impacted in the uterus, inside the womb while you’re pregnant. If, however, you feel that you yourself are becoming unwell, then you should make sure that you contact your maternity team, and you will have ways of doing that once you’ve booked with your with a midwife.
The reason you have been placed as a vulnerable group or the government is because the immune system in pregnancy, and we’ve known this for years, in general, will work very differently. So it works differently to somebody who’s not pregnant. And that can mean that infections can be harder to find, but not in all cases. And certainly, there’s no suggestion really that because you get coronavirus, you’re going to get it worse than someone else because you’re pregnant. As I said, the vast majority of people will really only ever exhibit mild symptoms. So it’s really quite uncommon to get the severe symptoms that you’re hearing about in the news about pneumonia, for example, really severe breathing difficulties, needing extra oxygen. But in some rare cases, pregnant patients may develop those symptoms, and if you feel that you may not be recovering within that fixed seven day basis allotted to you in terms of isolating if you do have symptoms, it is recommended that you do seek help.
Now, I know there’ll be a lot of fear as well about your babies and what this means for your babies. Now, some people who are not pregnant, but thinking about pregnancy may also be concerned, should you be trying for a pregnancy. As I speak to you today, we don’t really have evidence to suggest that this will create any problems with early fetal loss and early miscarriages, which is great. We don’t believe that this virus harms babies in the uterus, as I’ve already said. And so, for many of you, this is not something which we believe in the first 12 weeks of pregnancy is going to cause huge problems for the vast majority of people. And so, we’re certainly not telling people to not try to get pregnant, that is something as well, and we fully expect in fact, probably to see a baby boom after the lockdown has finished in the months ahead.
There is possibility as I’ve said, of transmission of immunity to babies, although we’re not sure of the significance of this yet. Coronavirus itself we don’t believe precipitates early labor. But if you were to become unwell and to be admitted to hospital and require some additional help, then decisions may be made to make your care improved and at an early labor, maybe something which you’d be advised about but those decisions are individualised around the patient. But we certainly don’t believe it’s going to cause lots of early labours, and that’s not what we’ve seen from the data so far.
So that’s really where we are at the moment in terms of the pregnancy. Now, from a physical point of view, many of you will be wondering, I suppose, what it means for your bodies if you were to catch the virus. And physically it’s very important you want to remain in as good a health as you can be. And whilst we’re not out and about going to meet people and do to sort of disappear into sort of crowded places where you could become unwell, it’s important to look after yourself. So that means keeping yourself well hydrated, keeping yourself well rested, and also eating well.
So I just want to share a slide with you if I can do that for… let me just see if I can bring that across. Okay, so the important points really are, I think, physical health. It’s important to take your daily exercise. It’s important to do that hour of exercise a day. We know pregnancy physiologically does make patients more susceptible to getting to get a blood clot for example, as opposed to somebody who’s not pregnant. And so it’s always important whenever you’re pregnant, whether we have a coronavirus pandemic or not, to remain mobile to remain active and going about your normal things. Now that’s harder to do when you’re locked in your homes and you can’t go out and do the normal things. So we are by the nature of this pandemic, taking less exercise. We really encourage you to remain active, to take your daily exercise and of course, you will be more sedentary. If you are more sedentary, particularly as we approach the summer with the hot weather, it’s important that you do stay hydrated.
One of the key things for pregnant patients and pregnant women is to make sure that they obviously self-isolate and socially isolate away from any risk. Take those precautions as strictly as you can. The two-meter minimum is around, obviously, the direct route of transmission we’ve talked about. And the indirect route transmission really can be prevented by absolutely strict adherence to hygiene and hand washing.
Monitoring your baby’s movements is an absolutely crucial part of any pregnancy. But even more so during this time to make sure that if you have any concerns that you obviously are keeping very, very close eye on baby’s movements throughout.
If you have any concerns about yourself, your own health or your baby’s health, then please do contact your maternity teams. I’m aware, I’m working in the hospital, there’s a lot of anxiety around coming into hospitals and there’s often a misconception “I think that the hospitals are a place where you are going to be at more risk.” Of course, you will be anxious if you need to come to a hospital, but please do not delay any concerns that you may have regarding your own health or your baby’s health, particularly movement. Contact your maternity team.
We have completely changed the way of working in hospitals. We have different zones so in my hospital, we have a green zone in the red zone. So we have a zone where we have gynaecology services and maternity services for anybody who is healthy and has no symptoms, and we are running routine antenatal clinic appointments, essential scans, essential tests, essential investigations. We’re having to change things dramatically in the way we do that. And that has all been adaptive. And I’ve been incredibly impressed by the resilience of the people in the hospitals working to change things.
I have found that most patients have been quite understanding of the extra delays that sometimes are involved with coming to the hospitals during the times that we have. For example, if you have a routine antenatal clinic appointment that was required in your pregnancy, it may be possible to delay it if you’re self-isolating, but it may be something that you can’t miss and you do need to come to hospital for. And so what I would encourage you is to not miss appointments because you’re worried about going to the hospital. It is a really important part of antenatal care. We know from lots of research over many, many years that good antenatal care, good care in labor and good care after you’ve had your baby are absolutely critical to good outcomes. So it’s really, really important that you don’t miss appointments. And also, don’t delay any assessment if you have concerns about your physical health.
Now, we talk a little bit about physical health. But we’ve also talked about mental health. And I think particularly, pregnancy is a difficult time for many families and many couples and people going through this either on their own or separately and particularly now that you’re isolating yourselves away from friends and family. It can be extremely hard, and there is support out there. I’ve put a website link there for you to look at in terms of supporting yourself. We’re staying in touch with you through this wonderful webinar today. But please do use Zoom and contact friends and family and try and keep the conversation going. It’s all about keeping the conversation going, and I think that will help you stay positive. Because it’s quite easy to think with what’s happening on the news day in day out and hearing the bad news to forget, actually that we’re existing…We are still requiring that normal, very normal human instinct of social interaction. And so I would do it as safely as you can through some of those methods that I’ve mentioned there: Skype, Facebook, FaceTime. You’ll be probably better at it than I am.
And I think financially, this is a difficult time for people at home as well. People have lots of concerns about jobs. I’m very fortunate in that I have a job in the health service. And I’m very, very lucky as well that I’ve got a wife who’s a midwife who’s very supportive with me going to work and having that understanding, but I know for some of you, it won’t be as easy as that and you will be wondering about the future and jobs and income. And so it’s very important if you do suffer with anxiety or depression, or mood disturbances, you need to, I think, engaged as well with your community midwifery teams, if you’re feeling low, feeling despair, not sure where to turn there is support there.
We know and we’ve seen sadly, the amount of abuse does go up with difficult situations, like being confined at home as well as we are, and we have seen an increase in that. So there is help out there if you’re finding your home situation is not good. But please look after your physical and your mental health because they’re both as important as the other. And what can be done, I suppose to reduce your risks? Socially, distance is key. Staying in touch with people to keep yourself mentally upbeat. I think my biggest concern and worry is that people will miss appointments and not trust going to the hospitals. So I do think that’s a really key player thing for you to be thinking about as you go through.
I want to talk a little bit about what to expect as you go into hospital because some of you will be in the latter half of your pregnancies. Now, we think COVID-19, coronavirus is probably more of a risk as you as you get further on in your pregnancy than in the early stages of a pregnancy. And so when you’re 28 weeks and beyond, it’s certainly key that you isolate yourself from work. And that’s been certainly clear from government guidance, and that’s absolutely essential. But from point that some of you may be approaching labor and be very concerned about what this means for you in the hospital when you arrive. Well, it’s very different because a month ago, we didn’t have any of these PPE precautions in the way that we’re using them now. But you can be expected to be met by people when you arrive in labor wards and you wearing personal protective equipment. So in the interaction with a patient within a meter we have to wear personal protective gear, which is sad for us because actually I think seeing someone’s face is quite important in terms of interacting but particularly for us, it’s an important safety precaution to make sure that we reduce our key priority, reduce the spread of the virus.
So, when you come in, you will be expected to attend labor with just one birth partner. So we can’t have multiple birth partners. And this has been the general Royal College advice. A lot of the things I’m telling you today have come from Royal College and advice that most hospitals around the UK are adhering to. And you will not be labouring alone. It’s well known from lots of research that good outcomes in labor are related to having your birth partner with you. But you will be met by people wearing a lot of personal protective equipment. I know some of the staff in my department have put pictures of their faces on their aprons to try and make sure that people can see who’s looking after them, which is a really nice thing. I think it started in Italy. Because I think there’s a lot about someone’s face and their interactions which tells you a lot about that person. And it’s quite hard sometimes to communicate the kindness and relieve the anxiety that someone will have when of course they’re approaching an uncertain labor and what it means with a face mask on. So that’s incredibly hard.
But throughout your labor, you’ll be cared for with a midwife, birth attendant who will have a full PPE on, so gowns, gloves and a mask. And if you’re yourself well and normal and healthy, you won’t be expected to wear masks. But if you are yourself unwell, and if you actually in fact have the coronavirus or have been proven to have it, you will be expected to wear a mask, certainly walking in the labor room and around but we would otherwise treat you entirely normal during the delivery. There has been some evidence from a lot of Chinese reports that actually it’s best to monitor the babies in labor. And so the college is recommending that you have continuous electronic fetal monitoring throughout the labor. And that’s simply because there were people who are COVID positive and are symptomatic and unwell are more likely to struggle in labor and that’s why the monitoring of the baby is so important. So that’s a very key thing that you may not know which will change things. But a lot of fetal monitoring nowadays can be done peripherally so you can still remain very mobile. It’s absolutely key that you have the opportunity to do things as normally as possible. We want to keep things as normal as possible for you. We want to still read your birth plans; we want to still understand what you want to do. And people may have questions about water birth; water births are something which our hospital is still currently supporting. And if you are a normal and healthy and your midwife is willing, there are some people that are still support water births. But doing quite locally with your maternity team as to what exactly you are on are not able to do because as I say regionally, this will vary from hospital to hospital very marginally.
In labor, if you’re—Let’s stick with being normal and healthy at the moment—you will literally be careful therefore in a very normal way with just somebody who is unfortunately hiding behind a gown and a mask and some gloves. All precautions will be taken through the labor. And if you deliver your baby and you’re healthy, you should go through the normal things of cord clamping and skin to skin and all of the important things that are essential to bonding with your baby. If you are unfortunately in a position where you need some assistance, which requires you to leave your labor room and actually to end up in theatre, then things may change a little. You may meet more people wearing gowns and gloves and aprons and you will…Certainly, in our hospital, I know this is something which is being rolled out nationally, we’re trying to support the fact that most birth partners want to be able to attend and be in theatre if they can be. And with enough PPE and enough equipment available, that’s something that we’re supporting currently in Bath. But you will need again, to check with your local maternity team if you end up in labor and you can ask that question. There’s no need to ring up in advance; you can ask that on the day.
If your birth partner is well, that is fine. If your birth partner has symptoms or has been unwell, then that he’s not fine and they shouldn’t come to the hospital with you. So you may need to have a backup plan if your partner were to become unwell. And so it’s important to have these conversations in advance. And in theatre, the only time a birth partner wouldn’t be allowed to remain in theatre would be if it was an emergency which required a general anaesthetic or an emergency which we wouldn’t regard as being something that we would want the partner to see or to be part of. So for example, needing to go to sleep is not something which we allow people to stand and watch in any case, but particularly during the coronavirus pandemic, both partners would be asked to leave theatre if that was the case. And that’s the same for any aerosol generating procedure, which is what happens when you have an anaesthetic and you’re off to sleep. But general anaesthetics are really, really rare. I can think in my career, I’ve been doing obstetrics and gynaecology for 15 years, it’s very infrequent that we need to do them. And if we do need to do them, it’s done very calmly.
So, most of the things will be as normal as they can be. The things that will obviously be important to you as well as what happens afterwards. Now, one of our key priorities, as I said, right at the beginning is to reduce the transmission. And because of the social distancing guidance that we have to follow, that does have an impact for some women. Some women being induced may find that that is different. So if they’re certainly being induced in an open bay—most bay hospitals are four-bedded bays—you may go through a very slow gradual induction process. Unfortunately, birth partners can’t be present on the ward for that. So that is something to be aware of. And also after you’ve had your baby, postnatally as we call it, unfortunately, we can’t have lots of visitors or birth partners on the wards. So those are the two things you might want to put some thought into in terms of making sure you’ve got all your digital devices charged and ready and primed for the hospital and you’ve got everything you need. So really think very carefully about that.
Obviously, we would love for every patient to be able to spend those precious first few days and hours with both partners on the wards if needed, but we just are not allowed to so. It’s heartbreaking for us and it’s very difficult for patients. My understanding is that the support and the hospitals, certainly where I am is still extremely good. You’ll be given support with breastfeeding if that’s what you wish to do, bottle feeding. And at all times, we’re trying to encourage you to remain with your baby as we would do normally.
If you were to contract the coronavirus and become unwell or for your baby to become unwell, then that may have a different impact on the course of events. Really, an hour webinar is not too much to cover every single, I suppose, every single permutation combination of different outcomes of what might be there. But obviously, specialist neonatal care is available alongside every obstetric unit to look after babies if they require it on a daily basis. And there’s no evidence currently to suggest that if you have coronavirus and deliver your baby that your baby will have it or become unwell. But there will be it needs to be some quarantining taking place of yourself until your symptoms have resolved. And to make sure that your baby remains well. Your baby will be observed very closely. Now I’m not a paediatrician so I don’t want to cut across the territory from obstetrician to paediatrician. There are far better people to give you the advice from that point of view, but my understanding is that testing is very difficult as well as we’ve had a lot about testing in recent months. There’s lots of tests done which is create false negatives. So you might have a baby tested and it comes out as negative, but it may be incubating the symptoms of the virus. So, it’s very important to observe your baby closely. And again, if you have any concerns about your baby to obviously, contact the assistants that were looking after you on the ward.
But most babies, as I say born to healthy moms will not contract the virus, but it’s very important after you go home, you still observe the same absolutely stringent measures of hand washing, cleaning bottles, if you’re preparing bottles, and making sure that you reduce any risk of transmission, direct or indirect to your baby. If you do have the coronavirus, there is no suggestion you can’t breastfeed but it depends on how well you are. And as I say many people, many, many people will be very well with this. If you do have it, you would obviously be concerned about transmitting through droplets through the air in close proximity to your baby. So some people with the virus may be advised to wear a mask, one of the fluid resistant masks… but that would be discussed with you.
So we’re trying to keep things as normal as possible, but in literally a matter of weeks we’ve gone from a very normal maternity service to one which has absolutely transformed and is trying every day to change and be resilient and be able to adapt to the new information coming through to us. So I’ve had quite a few questions I think put through over the course of the last week. I will just share with you that slide whilst we look at questions just because there are some useful places to get a lot of your information from. So obviously we can’t. We can only have an hour here to talk about certain things but the Royal College is my college, the college which has a fantastic Information hub for any of you that have any questions. A lot of the information I’ve shared with you today has come from there. They have a brilliant Frequently Asked Questions section there for patients and women and their partners. So hopefully that will be of great help. And the same with the Royal College of Paediatrics and Child Health. If you have questions about the newborn, this is the place I think to look for your information. As well as you’ve got the government websites and the NHS websites and of course, Wellbeing of Women and Total Fertility, which is a website I set up three years ago to help people looking for where to have their fertility treatments. And also, we write a number of useful articles which we hope help patients, and there’s one I’ve written on there, in fact about pregnancy, which you might want to look at.
So let me just move to some of the questions. I can just find these, Janet. My technology doesn’t let me down. So first question is from Sally, “What are your thoughts on pregnant women staying active during this time?’ And I hope I’ve already sort of covered this. Absolutely would be my answer. It’s really, really very important that you remain active, as active as you can, within the realms of the confinement that we’re going to experience. And whether that’s physical exercise, or just making sure that you’re keeping yourself moving and not sitting down for hours and hours on end. Eating well, and sleeping well, those are all really, really important things. And it’s not maybe the time to take up new sports. But just take up things gradually as you can, and do what you can in the home. We’ve had a lot of fun at home here going out with the kids that we have. And it’s been really interesting for us to spend more time with them. So social isolation, in some ways is good, you spend forced family time together, and it’s a great chance to do things like the Joe Wicks workout, although be careful if you’re pregnant sort of see some of the exercises, they do look quite challenging.
Let’s move to the next question, Ashman; quite a specific question on travel. And this is about to ask where…The question is, “I will be going at the end of July and on holiday to Greece, I’ll be 22 to 23 weeks pregnant, should I be looking to cancel if travel companies start up again, should we be going or not?” It’s really impossible situation to predict travel at the moment, I think, and I’ve certainly myself had my last two trips canceled. I can’t really see very much further ahead than next week at the moment in terms of things like that. And we know that we’re going to be in lockdown for three more weeks. The travel companies and certainly our…You have to be very cautious with any trips you are booking now, and insurance as well, check your insurance policy. From the point of view of a pregnancy, our advice with travel generally is to travel at your own risk and be very clear, I guess about where you’re going. I think, as we always say, in my job, plan for the worst and hope for the best. So if you can assume that you’re going somewhere that you know, and you’re familiar with, maybe that’s a safer situation. But traveling when you’re pregnant would be a concern to anybody. But you might want to look at postponing to be completely safe, but I would hate for you to lose money on a trip that you’ve already booked. So it’s a difficult one, I would urge caution. And it’s difficult, as I say, making plans and for anything at the moment.
Next question is from Catherine, “My partner and I are actively trying to start a family at the moment. What are your views and advice? And what should we do? And can we get on with life in this respect?” Catherine, it’s incredibly difficult at the moment for lots of people. And the current advice really, is that we don’t think that this virus is having any impact or intent on harming the fetus in early pregnancy. So that means developing babies—the word we use is teratogenic and we don’t believe that virus has any harm to the fetus at that stage. So that’s good. We’re not telling people not to have babies, and I work in fertility. And so it’s always a concern, telling anyone to delay their fertility particularly, I work in IVF, as well. And a lot of patients have not been able to go through with their IVF cycles, which is hard. And we don’t think this has any impact on miscarriage or early pregnancy loss, as I said earlier.
I think you have to look at, I don’t know your situation, but you need to look at your age. If you think about somebody having regular cycles, menstrual cycles, then usually around 80% of couples will conceive within a year. So that’s pretty good odds. So if you’ve never tried before Catherine and you feel that, you know, you think the risk is worth taking, I would say to you absolutely, there’s no harm. I don’t think…We’ve not got any evidence to suggest this is going to be an issue at the moment. Obviously, keep an eye on the data. But I would encourage anyone that’s trying naturally to just continue as normal. Make sure you’re taking your folic acid supplements and vitamins. And most of those things can be bought online. So you don’t need to go out unless you’re popping to the shops to get food things. So yeah, absolutely; no reason not to. And I think if you are older, I would certainly suggest you don’t delay. Particularly because your opportunity to conceive once you get to 39/40, does go down.
Next question. This is from Erin, two questions. “What is the risk of transferring COVID-19 to your newborn if you catch it after giving birth or shortly before?” Well, as I said, the risks of transmission of two routes which we’ve discussed, because it’s a respiratory sort of airborne virus and it comes from the lungs. So the direct routes would be, obviously, I suppose coughing over a baby or being within close proximity and indirect routes. I think if you have active COVID-19, if you actually have it proven that you have the virus, then there is a risk that you could directly spread it to the baby. We think vertical transmission is probable, as I’ve already said, from some of the joint studies that there probably is some immunity being created in the serum of babies after they’ve been born. We’re seeing that immediately there in some cases, but it’s such small amounts of data, it’s really too early to say how significant this is. I think the difficulty is that we haven’t really got an optimal testing system in place yet, particularly for babies. And I think if you’re confirmed to be COVID-19, I would take the advice of the baby specialists to help you minimise the risk of transmission, because if you wear a mask and you want to breastfeed, those two things should still be possible, but it depends on how well you are, I guess, but obviously the transmission of the virus will depend on your stringent attention to hand washing.
So let’s go on. You’ve also asked, “How much at risk are newborns in general, who show severe symptoms compared to children that are a few years older?” We think in general, again, that most babies will get a very mild infection, will have no symptoms and be quite well. And probably the more at-risk babies will be the very preemie babies potentially, and the ones that may be immunosuppressed for some reason. So those are the two potential groups where things may be slightly higher risk but again, if you are in that situation, and you find yourself with COVID and you’re and you have a very preemie baby, those questions will be looked after by your expert paediatrician, neonatologist.
Moving on to Aria’s question, 33 weeks pregnant, and you have a low PAPP-A, and also gestational diabetes. So, currently 33 weeks, I think. And you were given two extra scans to monitor the growth of your baby. But the NHS has said that they would try their best to just give you the 36-week scan. And you’re a bit worried about your baby’s health. “Is there an alternate method to monitor the growth of a baby?” So a low PAPP-A results will require extra monitoring. For those of you watching who…this is quite specific question but low PAPP-A essentially is a marker that we pick up in screening, which, if it’s very low, it can be related to how well a placenta will work during pregnancy. And so for that reason, Aria, you’ve been told that you’ll be monitored. more frequently and have extra growth scans.
Now normally those are three weeklies, and those scans will be done usually, certainly from having a 20-week scan and from 28 weeks onwards, so towards the latter end of your pregnancy. First thing I’d say is I wanted to stress the importance, as I already have, of fetal movement. So fetal movements are crucial, so keeping an eye on your baby’s fetal movements. And if you have any concern about those, you must, must, must, must get in touch with hospital and we would see you as normal in the hospital to assess that issue. But that is one of the first signs in fact, reduced movements of concerns with any fetal growth so that’s why that’s such an important sign to monitor at home.
Three weekly scans if you’re 33 weeks. Now it’s expected your next time would be at 36 weeks so it’s good that they’re going to give you a 36 weeks scan. I don’t know if you were referring to scans after that or not. But I think if your scans are looking good at 33 weeks and 36 weeks, then I think you’ll be absolutely fine. It’s very important when you’ve got a combination of things such as the low PAPP-A and gestational diabetes, that you pay that enormous amount of care to your fetal movements and your sugars, keeping your diets as well controlled as you can, so make sure you avoid high sugar foods. I know you’ll have had all that advice already.
The only real way to measure growth is to measure your bump which would be done by your community midwife in routine appointments. But of course, we know great scans are not infallible either. So it’s important, as I go back, I don’t want to go back to the same thing but your movements are actually the key during this period. If you have any concern, then do contact your maternity team.
Next question is from Sarah, “If I should contract COVID-19 whilst pregnant, does that naturally give the baby immunity? Or will I still be classed as vulnerable?” Sarah, I think the evidence is evolving here. It’s a fairly dynamic landscape. We’re getting new information all the time. I think obviously, if you have had COVID-19, you should be immune. That’s the first thing to say. So you asked, “Will I still be vulnerable?” You should be immune. Probably, we think, there’s some vertical transmission to the baby. But again, this is something we still don’t have all the information on. So that’s a very difficult question to answer. I don’t really have all the answers to that one, I’m afraid, Sarah, but I think if you’ve had COVID-19 whilst pregnant, you will likely be immune and there’s also a possibility that your baby will have got some immunity, from some of the studies we’re seeing, but again, the significance of that still needs further investigation.
This is a question from Mira, “Can COVID-19 adversely impact on the baby? And what happens if I go into labor but have COVID-19?” Well, we don’t think, because as I’ve said, that having COVID-19 while you’re pregnant adversely affects the baby or compromises your baby in the womb. It depends very much on how sick you become; I think I would stay on that point. If you do have COVID-19 and go into labor, you’re very likely to be looked after and cared for in an isolation labor room. Most labor rooms are by nature, sort of single rooms, you’re not labouring…And thankfully, we don’t have rooms open with many women labouring within the same room, so you’ll have your own room. So you will be isolated usually, and it’s essential that there are toilet facilities for you so you will be minimising the amount of movement that you might have from that room. You would be continuously monitored; and certainly, that’s the advice that we would regard as important. And you’ll be given regular observations throughout if your oxygenation levels in your lungs, your pulse, your blood pressure, and your temperature throughout your labor.
You will need to expect to be met by people in PPE, and your midwife throughout the whole course of your labor and any contact you have with her in that room will involve full PPE. So if you go into labor and you have COVID-19, you can be reassured you’ll be very, very closely monitored. And we will have patients who are suspected as COVID-19 as well but not proven, and you will also be cared for in a similar way.
The next question is from Helen, “Do we have any data to support the impact of contracting COVID-19 on newborns and babies? There have been cases reported in the press of babies contacting it, including a newborn whose mother had it during labor, but there wasn’t much information shared on the internet to the child.” What I would say is there are four registries around the world which are collecting data. There’s one in the UK, the UK Obstetric Surveillance System, which is collecting cases. And there’s one in the Netherlands, there’s one in the US. And these are all the time collating cases of COVID-19 in pregnancy and taking the data from that and then trying to put that into understanding what’s going on.
The only one to really have reported actually is the Netherlands system. And that’s given us as we know…The stuff in the press you see, unfortunately, isn’t the published evidence press that the doctors will go by, and of course, you’ll see in the media, very sadly, cases where people have had bad outcomes. But actually, the way we can change practice is by focusing on the data, and the data is coming through these registries are showing really that the data is limited, but we think most people babies will be, again ,quite well, and if anything, only have a mild illness. So I hope that answers your question. I think, as I say, the most susceptible newborn babies are probably the premature babies or those that may be immunosuppressed.
Two more questions. “I’ve got two doctors questioning during four weeks, my husband will be working on the front line and exposed to COVID from the very beginning. We’re keen to know what evidence shows so far, regarding the effects of COVID-19 on newborns.” As I say, the registries are collating the data, and very few actual formal reports coming through. There’s lots of case reports but they’re always quite difficult. A lot of them from China, so difficult to interpret. It’s possible, I think, but not proven that COVID-19 can be transmitted vertically in utero and some immunity there. The proportion of pregnancies affected by this, we don’t know. The significance for the baby, we don’t really know. I think what I would go back however, to answer your question is that we know that this RNA virus, this coronavirus has not been found in amniotic fluid, breast milk or vaginal secretion but obviously vertical transmission is possible. So it’s one of those difficult situations to know exactly what the data is telling us. Except if you have COVID-19, it doesn’t necessarily mean your baby’s going to have it.
I suppose you have to consider when you are looking after your baby, if you’ve had COVID-19 that potentially newborns, maybe incubating the virus again, that’s where it’s really key to keep a close eye on them. And we would obviously expect small babies to be susceptible, but not necessarily the ones that will get really sick. So yes, your newborn may become infected after birth. But we think that most babies will remain quite well with that and not become sick unless they have other issues or complex problems. So, in general, I think the data is telling us that it’s a fairly minor illness.
And the last question we’ve got from Tamara, “Are hospitals resorting to cesarean sections far quicker than normal?” A friend of ours had a cesarean section last week, and she was the fourth member of our NCT group to have one. No other intervention was tried. Well, I can’t speak for your specific situation. But I would say to you as an obstetrician working in a maternity unit in the southwest of England, we are doing our absolute best to minimise intervention unless it’s absolutely required. The normal rules of engagement are therefore for all of us to observe…And just because we have a coronavirus pandemic, we’re not suddenly doing loads more sections, if anything, we’re trying to reduce the number of interventions that we’re doing simply because we know the best way to go into labor is to labor normally without lots of interference and actually, interference or intervention only when required.
So, certainly not in our hospital. There’s no guidance from the college that we should be performing cesarean sections certainly more. All of it say is cesarean sections, there’s always a risk, you may need to go to sleep during a cesarean section and that’s absolutely what we’re trying to avoid. So, what we are seeing in our hospitals is a very much consultant led service. Certainly, our usual ways of working with registrars and consultants on call often from home overnights is changing and what patients are noticing and I think liking, is you’re seeing a very senior level of senior registrars and senior consultants in the hospitals making sure that every single detail is managed as quickly as possible to make sure that we’re not ending up in situations where lots of people are going to theatre. So certainly, that’s my experience. And that has been my experience so far. Now, let me just look if there are any other questions coming in.
Janet Lindsay: Ed, we’ve got a lot of questions, actually. Should I read some out to you?
Dr. Ed Coats: Yes, that’d be great. Thanks, Janet.
Janet Lindsay: So the first one that came in was, its, “I am asthmatic and epileptic and 33 weeks pregnant, I have a constant cough but no fever. Should I be worried?”
Dr. Ed Coats: I think if you’re generally well and you feel you have got a cough, I would keep an eye on it. The general advice is that if within seven days that hasn’t cleared up, or you feel like you’re getting worse, then you would obviously want to contact someone. But you shouldn’t be rushing to hospital if you have just a cough. Keep an eye on things. If you’re finding your breathing is becoming laboured or your breathing is becoming difficult, or you feel like you develop a fever in addition and start to feel that you’re more laboured in your breathing, then absolutely, you should be seeking extra urgent help. But currently, just from that two lines there, I can see, I would stay at home, isolate and stick to all the guidance that we’ve talked about today.
Janet Lindsay: Okay, and then from Beatrice. “Hi, may I please ask that once there is a vaccine, would it be recommended for pregnant women to have it?”
Dr. Ed Coats: I absolutely hope the vaccine becomes available to everybody. I think it’s going to be absolutely key. I think the question of will the vaccine be safe in pregnancy itself, is still to be answered. None of us know that. It will depend on whether the virus is a live virus that’s being used in the vaccine, and as I’m not going to be able to answer that. I’m afraid I’m not a virologist experts so my knowledge of vaccines is ..But there are some vaccines which are safe to have in pregnancy and some that are not and it generally depends on the antigen that’s used in the virus, but I think we’ll have to wait and see.
Janet Lindsay: Okay, all right. From Stuart, “Hi, my wife as a medic, and pregnant too, should she still be going to work as normal?”
Dr. Ed Coats: Well, the general advice is it depends on how pregnant she is. So if you are over 28 weeks pregnant, certainly that seems to be the time where potentially if you were to get COVID, you’re slightly more at risk. And therefore, if you’re over 28 weeks, certainly our guidance has been that if you’re over 28 weeks, you should be trying to socially distance and so that can be quite difficult if you’re working on the front line in the hospital. And so I’d say if she’s over 28 weeks, then probably needs, I think, some contents needs to be applied and probably that would be wise to discuss it with your occupational health team and in fact, the direct team that she’s working with. Before 28 weeks, again, it’s less likely that you’d become unwell so it may be absolutely fine to go to work. And I suppose it depends on what her role is as well within the hospital. You know, an anaesthetist for example, incubating patients during the covert crisis would be extremely high risk and in a much more risky position. So I guess it depends on her exact roster.
Janet Lindsay: I think if you don’t mind Ed, we will have to stop there. We’ve got more questions. What we’re going to try and do is answer those over emails for people if we can, with your help.
Dr. Ed Coats: Certainly.
Janet Lindsay: Yeah, but I think we ought to stop because we have an hour. So it just remains for me to say thank you to Ed for taking time out of his work at the hospital in Bath to give everybody this talk. It was really fascinating. I’m sorry we haven’t got through all the questions, but we really will try. And it just remains for me to say thank you for coming to us. And also, please, please do go on and donate to Wellbeing of Women. Because the research that we do that you might help fund may well be, if it’s not helping you, it’ll certainly be helping the next generation of girls, women and families. So please do go and donate. Its wellbeingofwomen.org.uk and it is still in the chat line as well. It really remains for me to say, thank you very much. Stay well, stay safe, everybody, and we’ll let you know of our next one. Thank you so much.
Dr. Ed Coats: Thank you. Bye-bye.
Janet Lindsay: Bye.
About Dr. Ed Coats
Dr Ed Coats, Consultant in Obstetrics and Gynaecology and accredited sub-specialist in Reproductive Medicine and Surgery, talks here about COVID-19 and pregnancy. As well as being a Wellbeing of Women ambassador, Dr Coats is currently working as a consultant at the Royal United Hospital in Bath and is co-Founder of Total Fertility, which helps patients understand the fertility marketplace.