Over the past few days, all of us have been faced with the stark reality of what it means to survive in the midst of a pandemic. While stress levels are understandably through the roof, among the highest are those of expectant parents. As a former labor and delivery nurse, a certified nurse midwife, and a professor at Rush University Medical Center in Chicago, I have heard some recurring themes in the questions surrounding pregnancy and delivery during the Covid-19 crisis and can offer some advice.
First and foremost — don’t panic. Mothers have been having babies since the dawn of time, through wars and famines and natural catastrophes. You have the creative power within you to have formed your perfect little person; you have the power within you to usher her or him safely into the world – even in the middle of a pandemic.
What we know today about the coronavirus and pregnancy:
Of the case reports coming out from around the world of women who tested positive for the virus, and were ill at the time they gave birth, the babies born to those women have been born healthy, without any signs of infection. The babies have also largely tested negative for the virus. There has been at least one newborn who tested positive, after being born to a woman who was positive at the time of the birth.
Pregnant women are assumed to be at a higher risk because pregnancy puts women into an immunocompromised state. That means that the immune system, which is what fights off illness, is purposely suppressed during pregnancy. That said, from what we are hearing, the virus does not seem to be affecting pregnant women as severely as may have been suspected that it would.
What to expect if giving birth during this time:
Your provider may stretch your prenatal visits out a little further than you had planned. That’s okay; the traditional schedule of every four weeks up to 28 weeks, every two weeks up to 36 weeks, and weekly after that is really outdated. Research has shown that prenatal visits can actually be scheduled further apart, with no adverse effect on mothers and babies — and with the benefit of enhanced patient satisfaction
Many hospitals have implemented a restriction on visitors for all hospital patients in the midst of this health crisis. This is important for the safety of all hospitalized patients, many of whom are at significant risk if exposed to the virus. Though women having babies are healthy upon arrival, it is important to keep vulnerable newborns away from potential visitors who could be infected. One area exceptions have been made is in the labor and delivery units, where visitors may be limited to one support person only. Note that non-hospital employed doulas may well be considered visitors. To be mentally prepared, you may want to check with the facility where you plan on giving birth as to their visitor policy at this point. If you were planning on having a doula at your birth, one good strategy is to have your doula review some of the basic comfort techniques that she/he uses with your partner, so that she/he can have some “tools” in their bag to assist you.
If you were planning on an “elective” induction of labor on a given date (meaning a labor induction that is not done for any medical reason), know that depending on the hospital’s census on the labor unit – particularly if they have a heavier patient census of laboring women infected with the virus – elective inductions may need to be put off for some time, or rescheduled to a different day.
While many of the babies born to mothers ill with the virus have had no untoward effects, at this point it really isn’t known whether these babies have a higher risk of severe complications. There is still concern that babies may be infected via their mothers after birth. For that reason, the Centers for Disease Control and Prevention (CDC) is recommending temporary separation of mothers (who have the confirmed illness) and babies until the mother’s transmission-based precautions are completed. Of course, the CDC notes that this should be done after a discussion of risks and benefits with the baby’s mother.
Current figures show that the virus is not transmitted from mother to baby in breastmilk. If mothers test positive for the virus, they can express breastmilk during separation from their baby to establish their milk supply. If a test positive mother and baby are rooming together, mothers should wear a facemask and wash hands well prior to putting baby to breast.
What you can do to help yourself:
If you had been planning on attending an in-person childbirth education class that will likely be cancelled (if not already), don’t despair; there are great online options. Rather than risk seeming to endorse any particular one, I recommend just Googling it; you will find a plethora! And don’t forget there are plenty of great books to get you into the mindset.
Be flexible… you have planned and looked forward to the big day for months; no doubt about that. That said, birth is a test for the rest of parenthood. Our mind’s eye pictures ourselves in a flowing white gown serenely rocking a cherubic faced angel to sleep while reality ends up with us stumbling around the room at 4am to find a diaper, exhausted after the fifth feeding of the night, wearing the same nightshirt we put on after a shower three (or was it four?) days ago, now nicely primed with the smell of baby poop and spit-up. Parenthood is full of unexpected twists and turns; this is the first of many.
Have confidence in your chosen provider to look out for your best interests. I know of home birth practices suddenly being inundated with transfer of care requests from women who are now afraid to give birth in hospitals because of the virus. Although I support home birth for many low risk women, not all who may want to change their care to a home birth practice will be appropriate candidates. Do your homework, make sure it’s right for you, and find a homebirth provider with whom you feel you can mesh.
One option I would steer anyone away from is making a plan to give birth at home without the attendance of a qualified midwife or physician (often called “freebirthing”). Labor and birth follow a normal course the vast majority of the time, but every woman needs — and deserves — a qualified birth professional to watch over and guide her through the journey, and to know what to do if problems do arise.
If you give birth in a hospital, think about asking for an early discharge home at 24 hours (if 48 hours is the standard where you are). The appropriate candidate for early discharge will have had an uncomplicated labor and birth, be nursing well, and have support at home. Having said that, many women are great candidates to be discharged at 24 hours.
If you are the partner of someone who is expecting, know that she has enough on her hands just gestating. Be as supportive as you can; if you have to have a meltdown do it – maybe just not in front of her. Reassure her by participating in the labor and birth planning whenever possible; go to any provider appointments that you are able to; read what she is reading about the birthing process, and join in activities like the online childbirth classes. In short, walk as closely as possible next to her as she travels this path. This is scary for everyone, but less so with someone holding your hand through it.
Give handwashing its due diligence; it’s a simple message that can’t be said enough. At least 20 seconds (preferably 30) is needed to rid your hands of what may have found a home on them.
Keep yourself (and baby, once the little one arrives) out of the limelight. In some cultures, there is a tradition for new mammas and babies to be isolated from visitors for a period of time. That’s not a bad idea in general, and especially in the midst of a pandemic. Thank goodness for instant photos, phones that instantly transmit pictures and videos, and Facetime. Loved ones can track baby’s every move via technology; they can wait to hold baby. Your job as a new parent is to protect your baby… and no better time to start than at birth!
Breastfeed, breastfeed…and oh yes, breastfeed! The antibodies (virus and bacteria fighting proteins in your blood) are plentiful in breastmilk. Via breastfeeding you pass those super germ fighting properties along to your baby, enhancing their resilience to illness in a huge way.
One more time… don’t panic, parents; you got this!
Michelle Collins, PhD, is a professor of nursing at Rush University Medical Center in Chicago, and a certified nurse-midwife with over 30 years of experience in the field of maternal-child health. She is also a Public Voices Fellow with the OpEd Project.