COVID-19 and pregnancy: Local doctors offer guidance

By Susan Geier and Kristen Senz

Even though her due date is months away,  Kristin Lindemann, of Pittsfield, can’t help but worry about her baby and going into labor.

“My hope is that things will calm down by then,” she said. “I mostly try not to think about it too much and try not to stress about it too much.”

Lindeman plans to give birth at Elliot Hospital in Manchester, however childbirth classes have been cancelled. She’s heard stories about women having to give birth alone without a partner at hospitals in different parts of the country, and that’s something she cannot imagine.

Lindemann

Kristin Lindemann gets fresh air on her porch in Pittsfield on March 27, 2020. Credit: Jessica Arnold / Arnold Imaging LLC

“That’s just awful,” she said.

Pregnant women heading to the delivery room amid the COVID-19 outbreak are understandably anxious, and although they might encounter some procedural changes at New Hampshire hospitals, maternal health professionals say pregnancy is not a risk factor for this virus.

Generally, pregnant women are more susceptible to respiratory viruses, but according to a February report by the World Health Organization-China Joint Mission on Coronavirus Disease 2019, that does not appear to be the case with the virus causing this outbreak.

Lindeman, 29, lives in Pittsfield with her husband Chris Alexandre, 32, who was laid off last week when his company shut down. The uncertainty over finances has only added to her anxiety.

“I haven’t bought any baby items,” she said. “I’m worried I won’t be able to have a proper baby shower. “It’s our first child so I don’t have any baby things.”

Fortunately, she has been able to work from home and maintain social distancing while her husband runs errands.

“We do go out for a walk every day,” she said.

Although pregnancy itself does not increase the risk for contracting the virus, like with the general population, pregnant women with hypertension, diabetes (including gestational diabetes), asthma, or other underlying conditions are at an elevated risk.

Because the coronavirus that causes COVID-19 is so new, it remains unknown whether contracting the disease causes problems during pregnancy or affects the health of the baby after birth, according to the Centers for Disease Control and Prevention, which has issued guidance for pregnant women. Early studies suggest that the virus is not transferred through the walls of the uterus or through breastmilk, according to the CDC.

Dr. Julie Braga, director of general obstetrics and gynecology at Dartmouth Hitchcock Medical Center, posted a video message on the Lebanon, New Hampshire, hospital’s website this past week to reassure local pregnant patients.

“It appears that while the baby is still inside, that the baby is protected from infection,” Braga said. “In other words, there have not been any reported cases of congenital infection of the virus. This is true of other coronaviruses as well and seems to be true for this particular coronavirus. We know this from studies that have been done on the placenta and the amniotic fluid of mothers who have the coronavirus around the time of delivery.”

 

Newborns, however, are susceptible to catching the virus from a mother during and after delivery, if the mother tests positive. For that reason, the CDC is recommending that hospitals treat women who are showing symptoms of COVID-19 as if they have the disease. That means separating and isolating mother and baby immediately after birth, until the mother’s test results come back. The mothers use breast pumps to express breast milk for their newborns to drink from a bottle during the separation.

This policy is in effect at DHMC, according to Braga’s statement, and at Catholic Medical Center, according to Nicole Pendenza, director of Maternal and Children Services at CMC. Pendenza said there is no shortage of COVID-19 testing kits and that test results are usually returned within 48 hours.

“It’s getting a little better,” she said. “It was taking between four and six days, and now it’s about 48 hours, and I think it will keep getting better as things ramp up.”

To prevent this potential separation, leading up to delivery, pregnant women should heed guidelines issued by the CDC, including staying at home as much as possible and finding a friend or relative to help with errands and shopping. “If I was a woman who was pregnant right now,” Pendenza said, “I would honestly try to get someone else to go get groceries for me. I don’t go to the grocery store right now, either, because I work in healthcare.”

 

Expecting women should also remain in close contact with their doctors and report any fever or upper respiratory symptoms, especially as the due date approaches.

At CMC, and most other hospitals in the country, women in labor are no longer offered the option of inhaled nitrous oxide to manage pain. “When you’re inhaling gas, you release small droplets, which can get in the air and increase the risk of the virus getting into the air, so most hospitals are eliminating any aerosol treatments,” Pendenza said.

To comply with social-distancing restrictions, many obstetricians are offering virtual visits for their pregnant patients, which is the safest option when there are no complications, Pendenza said. “If you need to actually come see your doctor, then we can make arrangements,” she added, explaining that human contact upon entering the hospital and waiting for appointments would be minimized.

Holly Zurer is a doula and childbirth educator in the Seacoast area. A staff doula at Portsmouth Regional Hospital, she also has private clients who deliver at hospitals around the region. She has talked to many pregnant women who are concerned about what may happen when their due date arrives. “I’m not hesitant to take on new patients,” she said, “but the patients may be hesitant, because they don’t know if they can have a doula present during labor and delivery.”

At Portsmouth Regional Hospital, doulas do not have to be affiliated with the hospital to be in the delivery room, but they must follow the current guidance.

“Doulas with professional certification are considered part of the (mother’s) care team, and they will be screened appropriately for COVID-19,” said Lynn Robbins, spokesperson for Portsmouth Regional Hospital.

Each hospital has its own rules for who can be present during delivery, and in some cases may only allow a woman in labor to have one support person in the delivery room. Some hospitals outside of New Hampshire, such as in New York City, prohibit outside guests, even partners or family members, from being with the mom.

Following delivery, new moms are allowed one adult visitor during their stay at PRH.

“Birth workers are trying to keep up with the changes, but it is difficult,” Zurer said. “Ideally, you get to be there for labor and delivery, but part of what you do as a doula is to prepare them for birth and possibly birth without extra support. I also help with childbirth education, so pregnant mammas recognize their own strength, and we prepare their partners, especially if a doula is not present.”

Zurer is a member of Evidence Based Birth, an online childbirth resource that seeks to inform expecting parents and maternal health practitioners globally on research-based practices. Zurer and other members have put themselves on a list to be available for virtual childbirth support services for expectant moms.

“It’s not ideal,” she said, “but we don’t know how (COVID-19) will play out.”

Worldwide, a small number of newborns have tested positive for COVID-19, but there is no evidence of intrauterine transfer of the virus. It is more likely that those babies contracted the virus during delivery.

The vast majority of babies and children who have contracted the virus exhibit mild or moderate symptoms; some are asymptomatic. Of the children who have experienced severe cases, most were age 5 or younger.

The best thing people can do to prevent contracting or spreading the virus is to stay home.

“I don’t think people are doing it enough,” Pendenza said. “People need to stay home, and that includes with their baby. Take a walk outside; I’ve gone on more walks lately than I ever have.”

These stories are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org. 

 

Categories: COVID-19