With Maternal-Fetal Medicine Specialist Dr. Washington Hill
With pregnancy comes inevitable uncertainty — and questions … so, so many questions. Both are normal and completely understandable, even under the best circumstances. But for those navigating pregnancy during a global pandemic, that anxiety is heightened and that list of questions unending.
To help ease those fears and to get answers to questions about pregnancy, hospital delivery and coronavirus (COVID-19), please read the below Ask An Expert FAQ penned by Maternal-Fetal Medicine specialist Washington Hill, MD, an obstetrician-gynecologist (OB-GYN) with 55 years’ experience.
FAQ for Expectant Parents Worried about COVID-19
Am I at more risk for COVID-19 because I'm pregnant?
No. There has been no evidence that is the case.
Just like everyone else, pregnant women should take preventive actions to avoid infection, such as properly and frequently washing hands or using alcohol-based hand sanitizer, avoiding people who are sick and practicing social (physical) distancing. Click here for the “6 Simple Rules for Combating COVID-19.
How does COVID-19 infection affect pregnancy?
At this time, there is limited data about how the virus and disease might affect pregnancy, because the novel coronavirus and COVID-19 are relatively new and there have not been many confirmed cases in pregnant women.
While we are still learning about COVID-19, we do know that other coronaviruses have not caused higher rates of miscarriage or stillbirth in infected pregnant women, when compared to the general population. However, a high fever early in pregnancy may increase the risk of certain birth defects, and influenza (flu) has been associated with complications like low birth weight and preterm birth.
Could I transmit COVID-19 to my baby during pregnancy or delivery?
Again, there is limited data on this.
There are not many published case studies of infants born to mothers with coronavirus, and those studies show few infants tested positive for the virus. Further, there have been no reports of mother-to-baby transmission for other coronaviruses, and there was no virus detected in samples of amniotic fluid or breast milk of infected mothers. (Mothers who test positive for COVID-19 typically can still breastfeed but they should wear a mask.)
There have been a few reports of newborns (as young as a few days old) with infection, suggesting that a mother can transmit the infection to her infant through close contact AFTER delivery. (See below for more on this.)
Is it safe for me to deliver at SMH, where there have been patients with confirmed COVID-19 infection?
Absolutely — whether delivering vaginally or by Cesarean.
Sarasota Memorial Hospital (SMH) is taking great precautions and following stringent infection-prevention protocols in order to keep patients, families and healthcare providers safe. These include stricter visitation policies that help make it possible for you to deliver at the hospital without otherwise putting yourself or your baby at risk.
Currently, visitors are not allowed at SMH, with limited exceptions. These exceptions include allowing for one support person for women who are giving birth (Labor-Delivery / Mother-Baby) and two designated visitors for infant patients in the Neonatal Intensive Care Unit (NICU).
If you’re planning to deliver your baby at SMH in the near future and have questions about how the new visitor policy may impact your birth experience, please call 941-313-0943 to speak with a clinical nursing leader. If you’re planning to deliver at another hospital, we recommend calling ahead to find out whether there are restrictions on visitors.
I am scheduled for an induction of labor. Is that still safe?
Yes. Be sure to discuss when and whether to come in ahead of time with your doctor or midwife, as situations and patient load fluctuate in the Labor-Delivery Unit.
What plans should I make now in case the hospital system is overwhelmed when it's time for me to deliver?
SMH has been preparing for months to manage the impacts of COVID-19. The hospital and its community partners have plans in place to deal with any potential patient surge related to novel coronavirus. Be sure to talk with your doctor or midwife once you're at least 34 weeks pregnant about your concerns.
By following recommendations for social distancing from the U.S. Centers for Disease Control & Prevention (CDC) and the National Institutes of Health (NIH), we can reduce the chance that will ever happen. But this requires a community effort and commitment to social distancing.
Will the hospital separate me from my newborn and keep the baby in quarantine?
Unless you have COVID-19 or have been exposed to the virus, SMH will not separate you from your newborn.
If you do test positive for COVID-19 or have been exposed but have no symptoms, your interdisciplinary care team (your OB provider and pediatrician) will collaborate and will make the determination based on the recommendations of the CDC, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine to decrease the risk of transmission. Wearing a mask while breastfeeding would be recommended.
In some cases, women who are COVID-19 positive and symptomatic when giving birth may have to be separated from their newborns and quarantined for 14 days.
If you are pregnant and have COVID-19, talk to the hospital care team, your baby's pediatrician and your family about how to plan for care of your baby in the event that you have to be separated after delivery. Make sure you have the emotional support you would need to endure the stress of being separated from your infant and quarantined. And look into options for using technology (video chat apps, etc.) to connect with your loved ones and newborn during that time.
SMH is only allowing one support person. If my support person leaves after the delivery, will they be allowed to come back?
Every hospital has different policies, and they can change rapidly. At SMH, women who are giving birth may have one support person in Labor-Delivery / Mother-Baby. Two designated visitors are allowed for infant patients in the Neonatal Intensive Care Unit (NICU). At this time, these visitors/support people may come and go as needed, but he/she will be screened for COVID-19 symptoms upon each re-entry.
Contact your hospital, ask your OB, midwife or Labor-Delivery Unit a week or so before delivery to get the most up-to-date visitor info. If you’re delivering at SMH, click here for the latest visitor policy, or call 941-313-0943 to speak with a clinical nursing leader.
Loved ones who cannot be present are encouraged to connect via video calling apps like FaceTime and WhatsApp. Click here for guidance on how to use these.
I have an appointment with my OB or midwife soon. Can I just skip that appointment and come in when in labor?
No. Do not skip appointments, unless your doctor advises you to. If you’re concerned about keeping appointments, ask your OB whether you could spread out your appointments or use telehealth options.
I work in healthcare. Should I ask my doctor to excuse me from work until the baby is born? What if I work in some other high-risk setting?
Healthcare facilities take care to limit pregnant employees’ exposure to patients with confirmed or suspected COVID-19, just as they would with other infectious diseases. If you continue working, be sure to follow the CDC's risk assessment and infection control guidelines, as everyone else should.
If you work in a school, travel industry or other high-risk setting, talk with your employer about what it is doing to protect employees and minimize infection risks.
What if my OB or midwife is infected with COVID-19?
If your midwife or doctor tests positive for COVID-19, he/she will need to be quarantined until they recover and are no longer at risk of transmitting the virus. In this case, your care would be transitioned to another OB in your doctor's practice group, or you may choose another care provider yourself. You would also need to ask your doctor's office whether you should self-quarantine or be tested for the virus; this would depend on when you last saw your provider and when that person tested positive.
Should we hold off on trying to conceive because of COVID-19?
At this time, there is no data that suggests you should hold off on trying to get pregnant. But again, the data we have is really limited. As mentioned, the data does not show that the coronavirus causes birth defects or increases miscarriage risk. However, we don't know for sure whether a mother could transmit COVID-19 to her baby before or during delivery, and we don't know whether the virus lives in semen or can be sexually transmitted. We just don’t know.
We have a ‘babymoon’ scheduled in the next few months. Should we cancel?
This is an easy one. Yes. Absolutely, you should cancel travel plans. Stay home, and be safe.
At this time, the virus has reached more than 140 countries. This is not the time for travel.
Places where large numbers of people gather are at highest risk, especially airports and cruise ships. If you were planning travel in the U.S., note that any travel setting increases your risk of exposure, and there are already many places where everyone is being asked to stay home.
For the most current advice to help you avoid exposure, check out the CDC's COVID-19 travel page. And then cancel that babymoon.
My family member was planning to fly here to help me care for my new baby. Should I tell her not to come?
Yes. Any travel setting increases a person's risk of exposure to coronavirus, so it may be risky to have him/her around the baby after traveling. If your loved one is older than 60 or has any serious chronic medical conditions (such as heart disease, lung disease or diabetes), he/she is at higher risk of serious illness from COVID-19 and should avoid air travel. Opt for virtual support instead.
I have a hair / pedicure / manicure appointment. Should I still go?
No. This is not the time to do that, even if a facility was open. It is time to practice social distancing.
I am really afraid and feeling very anxious. What should I do?
That is normal and understandable. Don’t worry alone. Talk to you OB or midwife.
This is going to be a marathon not a sprint. The coronavirus pandemic is an evolving story. Specific guidance changes every day. Your questions will also change over time.
Getting accurate facts will help reduce your fear and that of your friends and colleagues. For reliable information, check out websites for the American College of Obstetricians and Gynecologists, and the Society of Maternal-Fetal Medicine. And turn to your expert SMH health care providers; follow this blog, stay tuned to our social media platforms, and visit our COVID-19 updates webpage.
Advice that many of us healthcare providers share — and follow ourselves — is to turn off the news alerts. Give yourself a budget of 30 to 60 minutes per day to catch up on the latest news and health recommendations. Take a walk. Call someone you haven’t talked to in a while.
Remember the sun will come up tomorrow, and you are going to experience the joy of having a BABY!!
“Ask an Expert” is a Q&A series with Sarasota Memorial’s health and medical experts, where you can get thorough answers to your health queries from a local source you can trust. Have question that you’d like to “Ask an Expert”? Email them to AskAnExpert@smh.com.