Covid 19 and Pregnancy
This is an uncertain time when feelings of panic, anxiety and fear are rising. I aspire to bring you the latest evidence-based information to keep you informed and feeling empowered and I am here to support you, feel free to reach out to me any time if you have any questions. This information will be periodically updated.
WHAT IS COVID _19?
The Virus is called Severe Acute Respiratory Syndrome Corona Virus (SARS COV2)
The infectious respiratory disease caused by this virus is called Corona Virus Disease 2019 (COVID_19)
SARS COV2 is the 7th Corona Virus known to infect humans:
Of these, there are 4 human viruses that cause the common cold. And there are 3 Corona Viruses that cause more severe acute illness viz.
- MERS COV/MERS
- SARS COV – causes Severe Acute Respiratory Syndrome/SARS
- SARS COV2 – causes Covid_19
HOW DOES THE VIRUS SPREAD?
The main way is through person to person contact (respiratory secretions and faeces). But a new study suggests that it can also spread through the air and touching contaminated surfaces/objects.
*A study was conducted by scientists from many organisations including the CDC, The National Institute of Health, UCLA & Princeton and was published in the new England JOurnal of medicine. They found that SARS COV2 was found for up to 3 hrs in aerosols, up to 4 hrs on copper, up to 24 hrs on cardboard, and 2-3 days on plastic and stainless steel.
WHEN DOES AN INFECTED PERSON START BEING CONTAGIOUS?
A study showed that about half of the people who contract SARS COV2 start showing symptoms at 5 days and the other half later – about 11,5 days (John Hopkins – published in the annals of Internal Medicine, 10 March).
It’s possible that the virus is most contagious when the symptoms are most severe, but scientists are concerned that people with mild or no symptoms can spread the virus
*A German-based team showed that some people with COVID_19 had high levels of the virus in throat swabs early in their illness when symptoms were mild
A case was reported of an infected individual who never developed symptoms but shed a similar amount of virus to those who Did have symptoms. (New England Journal of Medicine)
This is why so many Governments are telling people to stay at home and act as if they have the virus. They could be carrying the virus and could be infectious (even though they are not sick) and they don’t know it.
HOW LONG IS AN INFECTED PERSON CONTAGIOUS?
This varies according to the individual. One study showed the median length of viral shedding was 20 days. The other half continued to shed after 20 days. The longest observed duration of viral shedding was 37 days. (Retrospective review of adult patients in China).
HOW DO I KNOW IF WHAT I HAVE IS A COMMON COLD, FLU, OR COVID_19?
The Australian Government recently created a flyer adapted from the CDC and WHO that helps differentiate between a common cold, flu and COVID_19. With COVID_19 it is common to have a fever and a cough and sometimes shortness of breath (which is not a symptom of cold or flu)
Are pregnant women at a higher risk?
The research on Covid_19 and pregnancy, (illness, therapy, birth outcomes etc) is still in its infancy. There is no evidence that pregnant women are at a higher risk of contracting the Corona Virus. They are only considered a “vulnerable group” as a precaution. This is because pregnancy can change the way the body reacts to viral infections. They were placed in the vulnerable group by the chief medical officer on 16 March. “This means you have been advised to reduce social contact through social distancing measures.” (RCOG) So it is very important that you communicate any possible symptoms to your care provider (Fever, cough, difficulty breathing.)
Good news is that to date, (23 March) there have been no reported maternal deaths.
How can I reduce my risk of catching Corona Virus?
- Wash your hands regularly and properly with soap and water, or use an alcohol-based (at least 60%) hand sanitiser if you don’t have water
- Clean and disinfect frequently – touched surfaces
- And avoid touching surfaces in public
- Use a tissue when you sneeze or cough, discard and wash your hands.
- Work from home where possible
- Avoid contact with someone who has symptoms of Corona Virus (incl high temperature and new or continuous cough).
- Avoid non – essential use of public transport
- Avoid large and small gatherings in public spaces
- Avoid gatherings with friend and family
- Use telephone or online services to contact your GP or other essential services
- Avoid exposure to healthcare setting when possible
There is no need to wear a mask if you need to go out unless you are sick yourself or you are caring for someone sick. (25 March CDC – this may have changed since the publishing of this article).
“If you are in your third trimester (more than 28 weeks pregnant) you should be particularly attentive to social distancing and minimising contact with others.” (RCOG). Maintain at least 6 feet /approximately 2 metres distance between people.
What care should be available during pregnancy and childbirth?
All women including those with Covid_19 have a right to high-quality care before, during and after childbirth. ie antenatal, throughout labour and birth, newborn, postnatal, and mental health care. This means being treated with respect and dignity, clear communication by maternity staff, appropriate pain relief, mobility in labour.
If suspected or confirmed, healthcare workers should take precaution to reduce risk of infection; hand hygiene, protective clothing, gloves, gown, medical mask.
Depending on which country you are in and whether you are in Lockdown or not, you should contact your primary healthcare provider to find out what the current hospital policies are for birth.
Currently, hospitals are starting to ban any support partners including the husband. If you are expecting right now, consider finding out the policies at all the possible places of birth, for you, so that you can consider all your options and don’t feel unprepared.
Remember that you are allowed to have options and change providers or place of birth if need be.
Can Covid_19 be passed onto my unborn or newborn baby?
Research is still in its early stages as this is a new virus but no evidence of mother to baby transmission has been published as yet.
There is at least 1 case under investigation, but it is not confirmed. The baby could have contracted the virus from a healthcare worker after birth or from the infected mother immediately after birth not necessarily through birth. To date, the virus has not been found when testing samples of amniotic fluid and breastmilk, so there is no evidence to support this currently. “A small number of babies have been diagnosed with coronavirus shortly after birth but it remains unclear whether the transmission was prior to or soon after birth. Expert opinion is that the baby is unlikely to be exposed during pregnancy.” (RCOG)
Can I have a doula with me during birth?
Currently, 26/03 hospitals Globally are banning doulas.
Private hospitals in Port Elizabeth are not allowing doulas inside the hospital.
In South Africa, Doulas are not considered an essential service and are not trained in pathogens and prevention of infectious disease. Even if you are having a home birth in South Africa. At this time of International Public Health Emergency, it is a risk upon clients, the doulas themselves and humanity for doulas to attend the birth.
We are now pivoting our businesses and are starting to offer our services virtually so that you still have someone to support you and your partner with education and emotional support through this time of uncertainty.
Should I attend my antenatal appointments?
Please contact your Clinic or Primary Healthcare Provider to find out what their current hospital policies are.
I have been informed that some pregnant women in Port Elizabeth visiting their doctor before South Africas 21 – Day Lockdown were told they are not allowed to bring anyone with them for their appointment.
Would you feel comfortable escorting yourself?
If your partner escorts you do you need to sign some type of document?
If you fear being exposed to infection by coming to a healthcare facility, call your clinic or healthcare provider to discuss your options.
Consider using telephone or online services to contact your GP or other essential services. I am in the process of gathering some contacts who offer this service.
This topic will continue to be updated as I find out more, sign up at the bottom of this post to keep updated.
Should pregnant women be tested for Covid_19?
Eligibility to be tested varies from country to country.
Currently, in South Africa and especially in the Eastern Cape Province, resources are limited. So testing will only be done if you are a highly probable suspected COVID positive.
The World Health Organisation recommends that women with Covid_19 symptoms should be prioritised for testing. If they are positive, they may need specialised care.
Taking the above information into consideration, if you are pregnant, it is very important that you communicate any possible symptoms to your care provider (Fever, cough, difficulty breathing.) If you are having trouble distinguishing whether you have a common cold, flu or COVID_19, have a look at this infographic. If you are still in doubt and you live in Port Elizabeth, Uitenhage or Despatch, the Islamic Medical Association South Africa, PE is offering a FREE Whatsapp service to help you.
How will I be tested for Covid_19?
Processes are rapidly changing. If you require and are eligible for testing, you will be tested the same as anyone else. Swabs will be taken from your nose and mouth. You may also be asked to cough up sputum (saliva and mucous).
Do pregnant women with suspected or confirmed Covid_19 need to give birth via Caesarian?
No, The World Health Organisation advises that caesarian sections only be performed when medically justified. The mode of birth should be based on the woman’s individual preferences
Can I have a water birth if I have Covid_19?
Pools should be avoided for the safety of the health professionals delivering your baby.
Can a woman with suspected or confirmed Covid_19 Breastfeed?
Yes. She should if she wishes. She should start breastfeeding within 1 hour after birth.
If she is showing respiratory symptoms, she should wear a mask.
She should practice hand hygiene – washing her hands before and after touching the baby and regularly clean and disinfect any surfaces they have touched
Can a woman with Covid_19 touch and hold her baby?
Yes, she should be encouraged to room in, maintain early and close contact.
Exclusive breastfeeding helps a baby to thrive.
You should hold your newborn skin – to – skin.
Have you got any valuable feedback you would like to add to this resource? Have you got any questions? Please feel free to reach out to me.
Reading this post doesn’t mean that we have entered into a doula – client relationship
Nothing in this post should be construed as medical advice
Talk with a care provider before putting this information into practice
Content is not guaranteed to be 100% accurate or up-to-date
This is an emerging topic and research and guidelines may change!!
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www.evidencebasedbirth.com – webinar