The coronavirus, or COVID-19, seems to be just about the only thing on people’s minds right now, and with good reason. This is unlike anything we’ve seen in our lifetimes. We’re all working hard to find a balance — not panicking, but taking things seriously so we can keep everyone safe. It’s also a rapidly changing situation where we learn more about the virus every day. There are many resources out there to learn general information about the virus and how we can best protect ourselves. But what do we know specifically about coronavirus and pregnancy, birth, breastfeeding, and bonding? Let’s take a look at what we know, as of now.
Note: Please refer to the World Health Organization for any updated information as of the writing of this article.
Coronavirus disease 2019 (COVID-19) is a respiratory illness that can cause fever, cough, shortness of breath, and can sometimes cause pneumonia or other serious complications, even leading to death in some cases (1). It is passed from person to person through respiratory droplets from an infected person’s cough or sneeze, through close contact, or picked up from a surface. As with the flu or other viruses, some people experience mild symptoms, while others’ symptoms are severe. Those at highest risk for severe symptoms are the elderly and those with underlying health conditions. But serious illness and death have been reported in even young, healthy individuals. (Coronavirus in pregnancy may be considered a high risk category.)
The main coronavirus concern we’re dealing with right now is that our healthcare systems won’t be able to help everyone who needs help if too many people get sick at the same time. Because this is a new virus in humans, no one has immunity to it. That, paired with the fact that it’s quite contagious, means that many people will get it. Current efforts at “social distancing” are intended to help slow the spread or “flatten the curve.” Ultimately, many people still may get it, but hopefully not so many at once. If we can spread out the cases over a longer period of time, then those who have serious illness have a better chance of having access to things they might need, like ventilators.
As you read and hear about coronavirus, you may frequently come across some terms you may not be familiar with. Before we discuss the specifics of coronavirus and pregnancy, let’s take a look at some of these buzzwords.
Coronavirus – Many people are referring to the current virus by this name, though it’s not actually what this specific virus is called. Coronavirus is a general term for a family of viruses.
COVID-19 – This is the name for the upper respiratory disease caused by the novel coronavirus. It’s called this because it’s a COronaVIrus Disease that appeared in 2019.
Novel coronavirus – You may hear the word “novel” used to describe the virus. This just means that it’s a new strain that has not been seen in humans until now.
Epidemic/Pandemic – An epidemic is an increase in the number of cases of something in a given area. If an illness that usually affects just a few people per week suddenly affects thousands, it would be an epidemic. When an epidemic spreads over several countries or even continents, it’s considered a pandemic. The World Health Organization (WHO) designated COVID-19 a pandemic on March 11th, 2020 (2).
Social distancing – Keeping people at home, avoiding contact with others as much as possible, helps slow/minimize the spread.
Flattening the curve – Effective social distancing is used in an effort to spread out the number of people who are sick at one time. If many people get sick at once (looking like a tall, narrow curve on a graph,) our healthcare systems would be overwhelmed and unable to care for everyone effectively. If we flatten the curve, as many people may still get sick, but it will be spread out over time. This gives a better chance of there being enough resources available to help those who need it.
Coronavirus and Pregnancy
Because the virus is so new, it’s hard for health officials to know enough to give specific recommendations and guidance for pregnancy. We can stress that pregnant women should follow the same recommendations that all people are urged to follow to minimize the risk of getting the virus. This includes staying home and away from others as much as possible, washing hands or using hand sanitizer frequently. It also includes being careful not to touch your face with unwashed hands (your hands can pick up the virus from surfaces, and it makes its way in through your nose and mouth, so you don’t want to transfer it to your face) and regularly cleaning and disinfecting your home (3). For more detailed information on how you can keep yourself and others safe, check out this resource from the CDC (Centers for Disease Control).
What the CDC says about Coronavirus and Pregnancy
While we haven’t been able to follow it for long enough to know a lot about coronavirus and pregnancy, we can use what we already know about pregnancy and illness.
The CDC states, “We do not currently know if pregnant women 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. Pregnant women experience changes in their bodies that may increase their risk of some infections. With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness. It is always important for pregnant women to protect themselves from illnesses” (4).
Can coronavirus harm an unborn baby?
There haven’t been many studies yet, but a small study seems to show that the virus doesn’t pass from mom to baby during pregnancy (5).
In cases of infection with other related coronaviruses, there have been incidences of pregnancy loss, including miscarriage and stillbirth. We also know that high fevers during the first trimester of pregnancy can increase the risk of certain birth defects. We can use this knowledge to guess that some of the same risks may or could occur in coronavirus during pregnancy (6).
What If Mom Is Positive?
If mom has tested positive for coronavirus, or suspected to be possibly infected, what changes? What are the risks to baby? How does it change breastfeeding, post-birth bonding, and procedures?
Is baby in danger if mom is positive?
As we mentioned above, babies born to mothers who have COVID-19 are not expected to be positive themselves at the moment of birth. That’s great news, as the health of the baby is generally the main concern of new parents. Unfortunately, there may also be really hard news that comes along with it. In order to keep baby safe, healthcare providers may recommend separating mom and baby for a time. Because coronavirus is so contagious and can result in very serious illness, all precautions should be taken to protect the baby. This may be achieved through wearing masks and washing hands frequently, but there is also a very real possibility that the recommendation will be made to keep baby away from mom for a time.
Bonding while separated
If mom and baby must be separated, it will undoubtedly feel heartbreaking and traumatic for mom. It’s important to acknowledge these feelings of grief. If mom must be separated from baby, here are some tips for bonding:
- Have dad, or whatever adult is taking care of baby, do lots of skin-to-skin. This can help both baby and caregiver feel more attached.
- Lots of Skype sessions. Perhaps mom can even watch a monitor where she can check in on baby anytime.
- Take tons of pictures.
- Journaling about the experience may help mom feel more connected.
Read more: Benefits of Skin to Skin Contact After Birth
Can a mom who has tested positive breastfeed?
The virus has not been detected in breast milk of women who have coronavirus (4). The CDC does not have specific recommendations at this time about breastfeeding through coronavirus, but says that breast milk is the best source of nutrition for most infants. Women who breastfeed should take all possible precautions to keep baby safe, including wearing a mask while feeding, washing hands before touching baby, etc. (4). If mom and baby are separated, mom can pump (taking precautions when touching equipment) and baby may be fed breast milk by someone who is well.
Restrictions: Community Protection Measures and How they affect care and delivery
Many changes are happening in our communities in an effort to reduce spread, flatten the curve, and protect the most vulnerable. People are practicing social distancing, most states have closed schools, many states have closed non-essential businesses, and some states have even stricter rules in place. How does this affect your prenatal care and birth experience?
Prenatal care is as important as it has always been. With the coronavirus spreading, you just need to proceed with more caution. You should have a doctor or midwife who you trust and with whom you have a comfortable relationship. You should have all the same prenatal screenings as any pregnant woman. However, the way you visit the doctor or midwife may be different. Visits where you don’t need any labs or testing may be able to be conducted through telehealth systems or postponed to a later date.
When you do need to visit the office in person, you may or may not be able to bring a support person. And if so, it will likely only one. Your office may not allow you to bring children with you. You may be asked to answer questions about travel or possible exposure to individuals with COVID-19, or asked not to come in if you’re exhibiting any possible symptoms. These guidelines will vary from one practice to the next, so make sure you know what to expect from yours.
Administrators and healthcare officials are doing their best to make decisions that will keep people safe and healthy, although they may have very challenging repercussions on your delivery experience. Depending on the facility where you give birth, it is likely that you will be allowed only one support person during delivery. (See the next section if you were planning to have a support person and also a doula.) Some hospitals in hard-hit areas are restricting all visitors, including mom’s primary birth partner. And, you may also not be able to have visitors during your recovery and hospital stay.
If you’ve hired a doula and planned to have her/him with you and your partner during delivery, verify your hospital‘s current policy on visitors and birth support. If only one support person is allowed, understandably, most women will choose to have their partner. This may mean they lose the presence of the doula they planned on having for support through delivery.
Be aware that policies may change as the status of the virus changes, so make sure you know what the latest is as you approach your due date. You may even choose to go to the Hospital Administrator about allowing doulas for delivery. DONA International considers doulas an important part of a pregnant woman’s care team, and has published a letter that pregnant women can use to make that case to a Hospital Administrator.
What if my doula is not allowed?
Talk to your doula as your delivery date approaches. Discuss scenarios and back-up plans. Lamaze International addresses how your doula support may change if (s)he is not able to be with you during delivery. “This could look like receiving extra at-home support from your doula until it’s time to go to your hospital; virtual/online/phone support during labor and birth; extra training for your support person; or extra postpartum support in exchange for lost labor support” (7).
Read more: Natural Birth Without a Doula
Fear and excitement
We are living in an incredibly unique time. You are experiencing pregnancy in a way that is different than anything else in modern history. You are likely excited about your pregnancy, but fearful about what could happen to you or your baby. Both are absolutely to be expected.
I would encourage you to practice self care. Talk to loved ones about your concerns. Follow all precautions that you can to keep yourself, your baby, and those around you safe. But as you do your best to be cautious, try not to worry. Lean in to the love of those around you, and know that there are better times ahead. New life brings new hope, and despite the current circumstances, you are still carrying one of the great loves of your life. We at Kopa Birth® celebrate that with you!
2. “WHO Director-General’s Opening Remarks at the Media Briefing on COVID-19 – 11 March 2020.” World Health Organization, World Health Organization, www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020.
3. “Prevention of Coronavirus Disease 2019 (COVID-19).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/prepare/prevention.html.
4. “Pregnancy & Breastfeeding.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Mar. 2020, www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html.
5. Chen, Huijun, et al. “Clinical Characteristics and Intrauterine Vertical Transmission Potential of COVID-19 Infection in Nine Pregnant Women: a Retrospective Review of Medical Records.” The Lancet, vol. 395, no. 10226, 2020, pp. 809–815., doi:10.1016/s0140-6736(20)30360-3.
6. Terreri, Cara. “What to Know About COVID-19, Pregnancy, Birth, and Breastfeeding.” Lamaze International, Lamaze International, 13 Mar. 2020, www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/what-to-know-about-covid-19-pregnancy-birth-and-breastfeeding-1.
7. Terreri, Cara. “How the Coronavirus Can Affect Having a Doula During Birth.” Lamaze International, Lamaze International, 16 Mar. 2020, www.lamaze.org/Giving-Birth-with-Confidence/GBWC-Post/how-the-coronavirus-can-affect-having-a-doula-during-birth-1.