Questions about pregnancy and coronavirus (COVID-19)
March 25, 2020
In general, pregnant women are usually at higher risk for more severe illnesses compared to the general population, such as if you get a flu, you're a slightly higher risk from the flu. However, to date, to our knowledge-- so first of all, the knowledge of COVID-19 in pregnancy is a little bit limited. But it does not seem that pregnancy is putting patients at any different risk or higher risk if they were to have COVID-19. The first thing I would say is, as for all people, even non-pregnant people, you should call your doctor right away, but do not come into the hospital. After a series of questions, your doctor will help you decipher whether you need to come into the hospital or you can stay at home.
Many a times patients are not really sick, and you just have some upper-respiratory symptoms. In that case, you doctor may ask you to quarantine yourself and just rest at home. If you stay at home, you should stay away from others as much as possible. What you can do, specifically, you can assign yourself a sick room and stay away from other people in your home. If possible, you can also try to find a separate bathroom for yourself. If you are sick, you should wear a face mask when you're around other people. Of course, if you're feeling worse, you should, again, call doctor right away. And your doctor, again, based on your symptoms, will decide whether you need to come to the hospital or you can further continue your expectant management at home.
This is a very important question. Of course, a lot of patients who are already scheduled for your prenatal appointments are wondering, and people who are trying to get in to see their doctors. Here at the University of Chicago, they're actually currently using telemedicine with all of our patients. What that means is that we are going to give you a call, and currently it's just a telephone call. And then based on your pregnancy history and your needs, we, your doctors, and your care providers, and you, we can decide whether that's all that's needed or whether you need to come in for in-house appointment.
I would say, call your doctor's office and see if it is possible to do a telemedicine visit. Also, if your doctor calls you in and if you are in your doctor's office, you should practice social distancing. What this means is do not give you a doctor or nurse a hug or a handshake, which we typically do, and wash your hands frequently. Your doctor's office should have protocols of cleaning up commonly-used clinical surfaces in between patients visit. Now, similar principles will apply for your ultrasound. If you have an ultrasound appointment coming up, confirm with your doctor if it is even necessary that you get the ultrasound, or perhaps we can delay it by a few weeks.
Contact your doctor immediately if you have any signs of labor of bleeding, or if you feel the baby is not moving. From the evidence that we have, it seems like COVID-19 has not been associated with any kind of complications in pregnancy, but some of the patients in China had a higher risk of preterm birth. However, I would say that this information is really limited, and we will keep you posted as new information comes in. I would say the patients who have proven COVID, so if you're COVID-positive or a person under investigation, you are kept in a separate special isolation room. We are still delivering our patients who are COVID-positive on Labor and Delivery. But they are in a separate area of the unit and separate, obviously, from the patients who do not have COVID.
We have spent a lot of time and effort in developing protocols in coordination with the infectious disease doctors here are the University of Chicago, other specialists who are taking care of our patients. And this includes communication with other large institutions from Boston, New York, and Texas. And we are trying to provide the safest, most evidence-based care during this pandemic. It depends if you actually have COVID or not. If you're COVID-negative, we are allowing one person during your delivery. The hospital has posted the visitor restrictions on the website. But if you look under the Family Birth Center, we are allowing one person on Labor and Delivery and the Postpartum Unit.
I would say that we are saying do not-- this person, the support person should not change. So you have to bring somebody who can stay with you throughout your hospital stay. And also, this visitor cannot be under 18 years of age. I think the decision about home birth has to be discussed with your own provider. But in general, the American College of OBGYN guidelines suggests that it is still safer to deliver in the hospital. I had a personal communication with the SMFM, which is the Society of Maternal and Fetal Medicine, president one email and she suggested that it is still safer to deliver in the hospital.
In the context of the pandemic, if you are actually COVID-positive and you're trying to deliver at home, please think about the ability for you to get an emergency c-section. We have to follow rules of infection control on our labor and delivery, which may delay your care, and you may be at risk for adverse outcomes for your pregnancy and outcomes of your baby. So if you're trying to decide about home birth, I would say talk to your provider. And also consider the fact that if you're delivering at home and you reach the hospital in critical condition, that may not be the best for you and the baby.
So if you actually get tested and you're positive, the hospital and labor and delivery wards have made special arrangements for you. A team of doctors and nurses are prepared to take care of you. And like I said before, we will do our best to provide you the optimal care. I would also say that something more encouraging is that overall, about 80% of the people either did not get sick, do not get sick, or have insignificant sickness, especially if you're young and do not have other co-morbidities. However, it is important to point out that this disease can actually end up-- and some of the patients do go to the ICU.
I would say does good to discuss some of the choices that you will make for you and your baby beforehand with the father of the baby or other family member, and covey them to your health care team in case you get critically sick and you are unable to make those choices for yourself. In terms of mode of delivery, whether you will get a vaginal or a c-section if you're COVID-positive and the choice of being control, that should not be different. However, the number of companions that you can have in labor and delivery or during your c-section will depend on the severity of your illness. We are working with the state and local health authorities to develop plans for your care for all our pregnant patients.
At this point it is currently uncertain whether you can transmit the virus to your unborn child. However, data coming from China from pregnancies there, about 38 pregnancies, showed no evidence of vertical transmission with COVID-19 in the late trimester. So that means if you deliver your baby, the chances that the COVID-19 has infected the placenta or the baby is not known, and essentially was not there. If you had tested positive for COVID-19 and you deliver, we are telling our patients to wear a mask. So you will be asked to wear a mask if you are within six feet of your baby or if you're trying to breastfeed. And of course, a team of pediatricians will take care of the baby.
And then, I would like to say thank you so much for listening. I want to assure everybody that we are partnering with each and every one of you, every pregnant patient, to make sure that we have an individualized plan and we will take care of you. I would also, like all of health officials, I would encourage you to practice social distancing. But at the same time, please look out for each other, and everybody stay safe. Thank you.
Sarosh Rana, MD, MPH, Section Chief of Maternal-Fetal Medicine answers common questions about coronavirus (COVID-19) and pregnancy.
What is COVID-19?
The novel coronavirus disease, COVID-19, is an infectious disease caused by coronavirus that has spread around the world. The most common symptoms of COVID-19 are fever, tiredness and dry cough. It also causes respiratory infections ranging from a common cold to more severe breathing problems.
Are pregnant women at higher risk for COVID-19?
Because current knowledge on COVID-19 and pregnancy is limited, it is not clear if just being pregnant will put you at higher risk. In general, pregnant women are at a higher risk for more severe illness when they get infections like the flu. However, to this date, we do not know if people who are pregnant have a greater chance of getting sick from COVID-19 than people who are not pregnant.
As a pregnant person, what should I do if I have symptoms?
If you have symptoms, call your doctor but do not come in for treatment right away. After a series of questions, your doctor will help you decipher whether you need to come to the hospital or stay at home. Your doctor may ask you to quarantine and rest at home. If you stay at home, stay away from others as much as possible. You should remain in a specific “sick room” and away from other people in your home. Use a separate bathroom, if available.
If you are sick, you should wear a face mask when you are around other people. If you feel worse, call your doctor right away and your doctor will decide if you need to come into the hospital.
Should I keep my prenatal appointments?
At the University of Chicago Medicine, we are currently using telemedicine with all our patients for pre-scheduled appointments. After a virtual visit or telephone call, we can decide if you need to come in for an appointment based on your pregnancy history and needs.
Call your doctor’s office and see if it is possible to do a telemedicine visit. When in your doctor’s office, practice social distancing (do not give your doctor or nurse a hug or shake their hand), and wash your hands frequently. Your doctor’s office should follow cleaning protocols commonly used in clinical spaces in between patient visits.
Similar principles apply for your ultrasound. Confirm with your doctor if it is necessary that you get an ultrasound or if it can be delayed. Contact your doctor’s office immediately if you have any signs of labor, bleeding or if your baby is not moving. COVID-19 has not been associated with preterm labor, stillbirth or miscarriage. However, information is limited. We will keep you updated once we have more data.
What if I test positive for COVID-19 while I am pregnant?
For those who experiencing no to light symptoms, self-quarantine for 14 days. If there are other family members in the home, try to isolate yourself to lessen the chance of spreading.
Discuss choices that you will make for you and your baby beforehand with the baby’s co-parent, a family member and your healthcare team in the case that you may become critically sick and unable to make those choices.The mode of delivery (vaginal versus C-section) and choice of pain control should not be different for COVID-19 positive patients. However, the number of companions who can be with you during labor will be limited.
We are continuously working with state and local health authorities to develop plans to care for our pregnant patients who test positive for COVID-19. There have been a small number of problems with pregnancy or delivery (such as preterm birth) in babies born to people who tested positive for COVID-19 during their pregnancy. However, it is not clear that any problems were related to an infection during pregnancy.
Can I transmit the virus to my baby?
We currently do not know if the virus that causes COVID-19 can pass from a pregnant person to the baby during pregnancy or delivery. Still, limited cases have shown no infants born to a person with COVID-19 have tested positive for the COVID-19 virus. In these cases, the virus was also not found in samples of amniotic fluid or breast milk.
If you test positive for COVID-19, please wear a mask when you are within 6 feet of your infant and when breastfeeding. A team of pediatricians will be available to care for your baby if any medical conditions arise.
Should I think about home birth ?
If you are considering home birth, please discuss this with your doctor. Despite the COVID-19 pandemic, the American College of Obstetricians and Gynecologists (ACOG) guidelines suggest that it is still safer to deliver in a hospital.
If you tested positive for COVID-19 and plan to deliver at home, please consider your ability to get an emergency cesarean section (C-section). As the Labor and Delivery unit continues to follow rules and recommendations from the infection control team, your care may be delayed. This could have adverse effects on your pregnancy outcome and outcomes of your baby if you are delivering at home and reach the hospital in critical condition.
Labor and Delivery Safety Precautions During COVID-19
We know this is a very special time in your life, and these are also difficult times with the current pandemic. You may be wondering what your care will look like and if things will be different. We want you to know that our team is here to care for you and your family.
Some things have changed to keep you and your family safe during this time. We have developed protocols in coordination with the infectious diseases team and other specialists, including from other prestigious healthcare institutions from Boston, New York and Texas, to provide the safest and most evidence-driven care for all our patients during the pandemic.
When you arrive, you and your support person must both wear a mask when in the hospital. This is recommended by the CDC and the hospital has put this in place to keep everyone safe when they are here.
We are testing every patient in Labor and Delivery for COVID-19. This is very important for you and your family to make sure you get the care you need during and after your delivery. If you test positive, the team recommends that you be separated from your baby after delivery. We will talk with you about the next steps and what we recommend for you.
Patients who have tested positive for COVID-19 are treated with special isolation precautions, involving the use of protective equipment to prevent the spread of the virus to other patients and staff.
Your support person is an important member of your care team. This person must also wear a mask in the hospital.
We also want to make sure your support person has meals when at the hospital. We will have three meals a day delivered for them.
Your support person must stay in your hospital room for the entire time you are here. If your support person leaves, they will not be allowed back into the hospital. They will only be allowed to pick you up outside when it is time for you to go home.
Read more important information about guidelines and requirements for your support person during COVID-19.
When your baby arrives, they will stay with you in your room until you go home. Your baby will be cared for by a dedicated pediatrician and care team in the hospital. It is important that when you or your support person hold your baby that you wash your hands really well. This will help keep your baby safe from germs. Your care team will keep providing you with the best care. You will have a doctor and nursing team caring for you during your stay.
If you need any other support, we have resources here to help you. This includes a lactation consultant if you are breastfeeding, emotional or spiritual advisors, and support to help with bonding and developmental resources.
We also have our in-room entertainment (GetWell Network) with a variety of educational videos to support you in caring for your new baby. Ask your nurse to connect you with any of these resources. Everyone is here to help support you.
Breastfeeding and COVID-19
Some people have questions about if COVID-19 can be passed to a baby from breastfeeding.
A lot is still unknown about how COVID-19 is spread. Person-to-person spread is believed to happen mainly from respiratory droplets passed on when an infected person coughs or sneezes. This is like how influenza (the flu) and other respiratory pathogens spread.
In some studies on COVID-19 and another coronavirus infection called Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been found in breast milk. However, we do not know if the COVID-19 virus can be passed in breast milk.
Breast milk gives protection against many illnesses. There are rare times when breastfeeding or feeding expressed breast milk is not recommended.
CDC does not have specific guidelines for breastfeeding when infected with a similar viruses such as SARS-CoV or Middle Eastern Respiratory Syndrome (MERS-CoV).
CDC recommends people with the flu keep breastfeeding or feeding expressed breast milk to their baby while taking precautions not to spread the virus to the infant.
These are CDC Breastfeeding Guidelines for people with COVID-19 or who are being tested for COVID-19.
Breast milk is the best source of nutrition for most babies. A lot is still unknown about COVID-19. The decision to start or if to keep breastfeeding must be made by the person who will be breastfeeding along with their family and doctor.
A person who is positive for COVID-19 or has symptoms of COVID 19 and is being tested for the virus must take all precautions to keep from spreading the virus to their baby. Precautions include washing hands before touching your baby and wearing a face mask if possible, when feeding at the breast.
When expressing breast milk with a manual or electric breast pump:
- Wash hands before touching any pump or bottle parts.
- Follow recommendations for proper pump cleaning after each use.
If you can, have someone who is not sick and is feeling well feed the baby.
Sarosh Rana, MD, MPH
Sarosh Rana, MD, MPH, is Section Chief of Maternal-Fetal Medicine. She is an expert in preeclampsia and performs high-level ultrasounds, which provide a greater assessment of the fetus than traditional ultrasounds.Learn more about Dr. Rana
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