As coronavirus and our efforts to contain it reshape public life, it is also dramatically impacting expecting and new parents everywhere. Although there is a lot of uncertainty about the direct impact of coronavirus on pregnancy, birth and postpartum experiences, and women’s attempts to conceive, we’ve put together these coronavirus pregnancy FAQs, which will be updated as information becomes available.
COVID-19 and TTC: Should I stop trying to conceive?
In mid-March, the American Society for Reproductive Medicine recommended that most non-emergency fertility treatments be suspended, dealing a devastating blow to many couples who have been trying to conceive without success and who have sought the support of reproductive medicine specialists.
These guidelines persisted for several months, and included the suspension of new treatment cycles, the cancelation of embryo transfers, and minimized in-person appointments for care of patients currently “in-cycle” or with urgent needs.
In explaining its decisions, the organization cited the limited information around COVID-19’s impact on pregnancy and reproduction, as well as the looming threat to our healthcare system overall. “Until more is known about the virus, and while we remain in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients,” ASRM wrote in its announcement.
As of early May, ASRM’s Task Force stated it supported “the measured resumption of care.” Practically speaking, this means that much is being left to the discretion of particular clinics and their local and state government guidelines.
If you are considering initiating fertility treatment, consider reaching out to an infertility doula and therapist for support during this time.
So what does COVID-19 mean for TTC in general?
Even as our world begins to reopen, social distancing measures are likely to remain in place for some time, in an ongoing effort to prevent healthcare systems from being overwhelmed.
One lingering consequence of this is that, even as more routine activities resume, it will remain harder to access routine medical care, and prenatal and postpartum care will look different should you conceive.
Many practices are moving to telehealth, canceling routine visits, or limiting the number of support persons who can come to appointments.
Pregnant people tend to need more healthcare than the average, and we know that good prenatal care impacts outcomes when it comes to the health of mothers and babies. So that may be something to bear in mind if you are trying to conceive.
What is the impact of coronavirus on pregnant women?
Currently available data on COVID-19 does not indicate that pregnant women are at increased risk for COVID specifically — but pregnancy impacts the immune system, and pregnant women are immunocompromised. Pregnant women are also at greater risk from other respiratory infections, including the flu and SARS, which means pregnant women are considered an at-risk population for COVID-19. If you are pregnant or trying to get pregnant, you should be taking more precautions around getting sick anyway, but especially now.
COVID-19 and fetal development
We have very little information about the impact of coronavirus on pregnancy and fetal development. So far, there is no evidence of vertical transmission — which means that if the mom has the virus while pregnant, there is no evidence that she passes it to the baby in utero.
There is currently no data on women infected with COVID-19 during their first trimester, according to a review of studies on pregnant women who were affected by the new coronavirus, published on March 17.
Some adverse infant outcomes have been reported among infants born to mothers positive for COVID-19 during pregnancy, but it’s not clear that these outcomes were related to maternal infection. And while fever is a common symptom of coronavirus, the coronavirus-related fever holds the same risks as any other fever for pregnant women and can usually be treated with Tylenol, which is safe during pregnancy.
COVID-19 and giving birth in a pandemic
According to a review published on March 17, nearly half of 32 women who were infected with COVID-19 delivered prematurely, or before 37 weeks. (That compares to a general preterm rate of about 1 in 10 in the United States.) It’s not clear, however, that it was coronavirus that caused the preterm delivery.
COVID-19 is impacting birth even for noninfected people. Many low-risk women in late pregnancy are being told to skip prenatal appointments or do them over the phone or video.
In mid-March, many hospitals began restricting visitors to one person, meaning that many families could not be joined by their doulas personally. Some doulas began providing support virtually.
Beginning March 23, one hospital system in New York City banned all visitors, including the partners of people giving birth, citing the lack of personal protective equipment. Many have decried this policy as inhumane, and medical professionals have lamented what they describe as a wrenching choice given there aren’t enough resources to test partners of birthing people or PPE for them.
If you are in a position where you may need to labor alone, consider employing the services of a satellite doula, who can help you virtually. If you can, take a birthing class focused on strategies for coping with labor. And draw on the wisdom of others who have been in extraordinary separated positions, like deployed military personnel, who recommend Skyping in to the birth. You are strong, and you can do this.
Policies are fluid and changing every day, so it’s best to be in contact with your healthcare provider to understand your options.
Should I induce early now?
This depends on how far along you are and what your hospital situation looks like.
In general, not related to COVID-19, early elective induction has been shown to lead to adverse outcomes for both mom and baby, usually at 37 or 38 weeks, and is not recommended.
Things change a bit at 39 weeks, at least according to results from the ARRIVE trial, published in 2018, which found that 39 weeks may be a sweet spot for early elective induction. That study found no difference in neonatal adverse outcomes, and it also showed a reduction in C-section rates and maternal hypertensive disorders. So if you are at 39 weeks, this may be something your healthcare provider has broached with you.
But if you’re 37 or 38 weeks, or less, inducing may increase your baby’s risk of needing respiratory support, which means inducing now would be ill-advised.
Should I have a home birth if I wasn’t planning one already?
Probably not. We found this statement from the New York Homebirth Collective compelling in explaining why, so we are excerpting it here:
“Most of the homebirth midwives in NYC have full practices and do not have the ability to take on a meaningful amount of new clients at this time. We are not an institution that can absorb a large influx of birthing people. We also do not have access to the protective equipment that institutions provide to their providers. We are reliant on the market to order supplies—a supply chain that is rapidly dwindling.
In order to keep providing high quality, safe care, our own health and ability to serve one another in times of need are also resources we need to prioritize. Midwives, like any health care provider, put their own health and the health of their families in jeopardy every day to take care of clients no matter the circumstance. The nature of our jobs is that we cannot socially distance. The reality is that some of us will become ill during this time. Without an institution behind us to take care of our clients if we are ill, we need to rely on each other. Therefore, we have a responsibility to maintain a manageable client load so that we may support each other and keep homebirth accessible to those who have been planning for it.
That planning is in fact a significant factor in the safety of homebirth. The careful screening of clients before and during their care, as well as the developing of a relationship of trust over time, helps ensure the best outcomes for parent and baby. This not only involves medical screening in order to make sure the birthing person remains low risk throughout their pregnancy. It not only involves partnering with the birthing person to promote well being through nutrition and lifestyle. It also, importantly, involves facilitating emotional preparedness. Throughout pregnancy, we process fears and anxieties about giving birth. We develop strategies for coping with the intensity of labor and birth without analgesic medication. Clients are advised to take childbirth education classes to fully understand the physiology of normal birth. Many secure a doula. All of this work and emotional preparation make homebirth safe.
People choose to have a homebirth because they seek autonomy in their pregnancy and birth, because they believe home is the safest place to give birth, or because they desire to experience all that homebirth offers, from the intense and challenging to the joyful and transcendent. Fear and panic do not lend themselves to an empowering homebirth. This is true generally and it is true now during what is unequivocally a scary time for so many of us. If a pregnant person originally chose a hospital because they believed it to be the safest location in which to give birth, that belief continues to make the hospital the safest place for that person to give birth. Birth is a physiologic process that is greatly impacted by one’s environment and one’s emotional state. For most people, the two are inextricably linked. Homebirth with a client who does not fundamentally trust their location of birth place is unsafe for both client and midwife.”
Should I switch to a birth center?
This depends on where you are in your pregnancy, whether it is low risk, and whether there is a birth center near you. Freestanding birth centers are founded on the midwifery and wellness model, guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost-effectiveness. Many birth centers are currently accepting late transfers, including in the third trimester, as long as the client has a low-risk pregnancy, regular prenatal care, and complete records. But they, too, are limiting support people at the birth to two and taking other precautions. If you meet these criteria, you could certainly consider switching. But remember that things may change — for better or worse — rapidly. We cannot predict what eventual restrictions birth centers may need to implement, and it is still important that you trust your provider and place you are giving birth. Though the risk of an emergency transfer to a hospital is low, at around 1 percent, an emergency transfer would be less safe for both mom and baby. Most transfers happen due to a mother’s desire for pain medication. Birth centers do not generally offer narcotics and do not use epidurals.
You can find birth centers near you on the Motherlode at motherfigure.com/directory.
What does labor look like now?
Different birth locations have different policies for labor. Currently, many hospitals are permitting one support person (like a partner or family member or friend) but are restricting in-person support like doulas. The support person will not be permitted to go in and out, either, and you cannot “swap in” another support person.
In triage, most hospitals will take your temperature and that of your support person, and you will both be given tests for coronavirus and PPE. These tests range in terms of the amount of time they take to get results; generally, the longer they take, the more accurate, and so many L&D wards are using a 2-hour test.
You will have to labor with a mask on until your results come back. That will be uncomfortable.
If you or your support person tests positive, more precautions will be taken — you’ll likely be in a separate covid unit, and your support person may need to leave.
COVID-19 and breastfeeding
Breastfeeding in general has powerful immune-boosting properties. No evidence of coronavirus has been found in the breast milk of women infected with COVID-19; however, it is not yet known if COVID-19 can be transmitted through breast milk (i.e., infectious virus in the breast milk). The CDC is more concerned about transmission via droplets, such as from a cough or from touching.
At the time of this writing, there are rare exceptions when breastfeeding or feeding expressed breast milk is not recommended.
A mother with confirmed COVID-19 should avoid spreading the virus to her infant by washing her hands before touching him and wearing a face mask, if possible, while breastfeeding. If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use.
COVID-19 and children: How worried should I be about my baby?
In general, non-immunocompromised children are becoming very sick at a much lower rate than adults; according to the CDC, adults make up most of the known cases to date. And if children do get infected, their illness is usually much less severe: In a study of 2,143 pediatric cases in China, most cases — including 90 percent of infants — are asymptomatic, mild, or moderate. Some infants did get very sick, but this was not the majority. There was one death in the data, a 14-year-old boy. But in general, this virus seems to be sparing children, though, of course, children should also be taking all normal precautions such as handwashing and social distancing.
What does COVID-19 look like in children?
One bright spot, until very recently, seemed to be that children were for the most part spared from the worst of coronavirus. According to the research available to date, children with confirmed cases of coronavirus generally have mild, cold-like symptoms, like fever, runny nose, and cough. In some cases, vomiting and diarrhea have also been observed.
That said, a new inflammatory syndrome is being investigated as separate but linked to the immunoresponse to covid-19, which seems to infect children and teenagers (but not infants and toddlers).
Can I let other people see the baby?
Given guidelines around social distancing, it’s important that we maintain our distance from friends and family. But a lack of social support is a risk factor in the postpartum period, too. You should consider that babies should be pretty isolated for the first few weeks, pandemic or no, and the risk of coronavirus makes this recommendation more acute. It is a good idea, regardless of what you decide, to limit interaction to a very small group.
That said, this ultimately is a decision that needs to be made with the risks and benefits specific to your family. For visits with grandparents, for example, you may be able to mitigate risks by driving to meet, and doing so outside with masks on (the baby won’t wear one). You may also be able to quarantine for two weeks, and your visitors may also be able to do so, before you actually meet. Example: You are considering having your parents drive from their home two hours away to meet your newborn. Given the incubation period of the virus, this would mitigate risk, too.
For more insight, economist Emily Oster offers a good framework for evaluating risk to each person and considering mitigation strategies.
Disclaimer: The information herein is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.