Tips for Pregnant Women During Coronavirus

Due to the Corona Pandemic, we have compiled changes in examination, birth organization and new practices that you may encounter. WHAT HAS CHANGED WITH THE COVID-19 PANDEMIC IN PREGNANCY AND BIRTH? INCREASED MEASURES BUT NO DATA TO BE AFRAID

12. Hand in Hand for Birth Association

It’s a fact that there is a panic related to Coronavirus in the world. It is crucial for pregnant women to reach the correct information to protect themselves and their babies in this environment. Nowadays, constant feeling of “Something bad will happen to me and my baby” more harmful than the Coronavirus. Therefore, pregnant women do not need to be overly afraid after taking their precautions. As individuals living in society, we all have to take the classic measures that we often hear for ourselves and our loved ones. These guidelines were compiled from many guidebooks and prepared for informative purposes:

1. To make sure that you take your precautions correctly and to inform you about changing conditions at hospitals.
2. Supporting the protection of our healthcare professionals. Remember, healthcare professionals are at a higher risk than any of us

Information

Coronavirus survives in droplets in the air and on surfaces. Two main routes of transmission are by breathing in the virus; or through the virus on surfaces being transferred to the eyes, nose and mouth by people’s hands. It is known that the transferrence of the virus from the droplet does not exceed 2 meters. Contagion was also reported by asymptomatic individuals. Incubation period is believed to be two to 14 days. In these conditions, everyone can be a potential carrier and the number of asymptomatic carriers will increase in time. According to a theory, virus transmission is less common in pregnant women depending on the suppression of immune system. However, general preventive measures should be taken. The following sources are provided under "Latest Updates". As the data changes, there may be changes in the suggestions.

Findings

• Common symptoms of COVID-19 include fever, dry cough, shortness of breath
• Most people, about 80%, do not show symptoms or recover from mild upper respiratory tract infections. However, those who experience symptoms during their 14 days of isolation continue to carry the virus. Therefore, everyone should avoid close contact with other people, especially in suspicious situations. Pregnant women do not appear to be  at more risk of developing serious symptoms due to COVID-19 infection than the rest of the general population. Like other patients, they do not show symptoms, about 80%, or recover without hospitalization.
• There have been no cases of pregnant women dying because of the coronavirus yet.
• The virus does not get transmitted from mother to baby. Even if the mother is infected, there is no evidence that the baby is infected in the womb. There were no cases of coronavirus detected in the placenta, cord, amniotic water and fetal mouth tests of infected mothers. Moreover, even if the coronavirus is detected in the newborn, it hasn’t been proven whether this transition happened in the womb or at childbirth. It is more likely to be after birth. There is no serious disease reported under 9 years of age, even if the virus was detected later in infants.
• A baby and mother tested positive but both of them recovered after birth.
• Miscarriage and premature birth do not increase risks.
• There is no risk of anomaly in the baby.
• It does not get transmitted to the baby with breastfeeding. Do not stop breastfeeding.

Tips for the Pregnancy Period

• Ministry of Health’s 14 warnings are sufficient for precautions. (Hand washing, not shaking hands, not being in crowded places, carrying alcohol-based cleaning gel or cologne with you…)
• Do not expose your body to excessive chemicals. It is important to wash your hands for at least 20 seconds with soap and water.
• Do not touch your face without washing your hands, especially in outdoor spaces.
• Pay attention to social distance. Do no accept visitors.
• Avoid crowded places, put a distance of 1 meter between you and people.
• Stay at  least 2 meters away from coughing people.
• Learn how to put on or remove masks from videos.
• You can go for a walk with someone who lives at home. It is not necessary to wear a mask as long as you maintain the social distance. Return home without touching anywhere and wash your hands immediately.
• Stay home if you have mild symptoms. If you have symptoms of fever, cough, sore throat and shortness of breath, contact your hospital or doctor.
• In case of a mild upper respiratory tract infection, identify yourself as a suspect and stay at home for 14 days.
• People can work in their workplaces by keeping certain distances, taking classical hygiene measures before the 28^th week of pregnancy. However, if there are any health problems or a pregnancy later than the 28^th week of pregnancy, it is recommended to work from home without close contact.

Measures During Examinations and Follow-up Visits

(For healthcare workers and pregnant people)

• Healthcare workers are at a greater risk than us during the pandemic. It is important that all non-urgent pregnancy follow-ups are reduced to minimum with the decision of the doctor. Even routine pregnancy examinations were removed in some areas where COVID-19 is widespread. Therefore, be prepared for changes that can be made by healthcare professionals.
• Wear a mask and galosh while entering the hospital.
• Always wash your hands before and after the examination.
• If the examination is in the hospital, go alone, keep it short and never take children.
• Leave 1 meter distance from other people.

Implementation and Measures During Birth

(Pregnant women without coronavirus suspicion)

• Coronavirus can be transmitted without any symptoms (30%), both families and healthcare professionals should take precautions very well.
• Put 6-8 pieces of N95 / FFP2 / FFP3 masks in your birth bag. Give them to the birth team.
• Simple measures will be sufficient for pregnant women without coronavirus suspicion. (Mask, gloves, glasses, protective clothes)
• Do not go to birth with your relatives, they will not be taken into the hospital.
• It is recommended that only one birth attendant accompanies birth. Photographer, room decoration staff, additional family members will not be taken into the hospital.
• Additional support such as private midwife, doula, birth psychologist is important for providing psychological support for the pregnant person. We are in extraordinary times and the initiative is in the hands of the hospital management. Investigate this issue before going for labor.
• Stay in your room as much as possible. It can be recommended even if the expectant mother does not need to wear a mask all the time.
• All hospital personnel can wear gloves, glasses, masks, protective clothes. Do not be surprised and afraid. These are for protection.
• There will be no additional changes in the baby care after birth. Routine hospital practices will continue. The baby can stay on your lap for physical contact.
• When cesarean is required, there is no risk difference between the general or epidural anesthesia. Nobody other than the pregnant person will be allowed to the operation room during cesarean section.

Pregnant Women With Covid-19

The main goal is the full protection of the healthcare professionals and pregnant women. All pregnant women should fulfill their responsibilities.

• If the expectant mother had contact with a suspicious patient recently, she should warn the healthcare staff and wear a mask.
• Family members should not be taken into the hospital if pregnant women are known to be infected or symptomatic.
• During the follow-up period, all health professionals will wear N95 medical masks and help the parent with full protection measures.
• Pregnant person wears a mask during childbirth, health personnels take high level of protection measures. (Mask, glasses, gloves, protective clothes)
• If labor takes a longer time, the risk of infection may increase. Therefore, Cesarean Delivery indications may be more healthy.
• There is no restriction in the date for late cutting of navel cord and skin to skin contact at that time.
• While some of the Chinese healthcare professionals recommend keeping the mother and baby seperate for 14 days after birth, RCOG suggests the opposite because of the bond’s benefits. There is no risk difference between the general or epidural anesthesia when cesarean delivery is required.
• It is still not clear whether the virus can or cannot be transmitted though breast milk. The possibility of coronavirus transformation from mother to infant may have occurred through the upper respiratory tract after birth. For this reason, all protection measures should be taken during close contact and breastfeeding.
• If the formula is given to the baby, families should pay attention to the sterilization conditions. Mothers should prefer breast pumps for human milk.
• If there are no symptoms after labor, the 14 days quarantine rule is applied at home.

As Hand in Hand for Birth Association, we are aware that we are in a challenging period that affects whole world. Our association continue to support babies, expectant parents, families, birth teams as always. It is our greatest wish to have births with full of health, love, respect and welcome new generations no matter what. We wish to give hand in hand and spread this unity to humanity.

Best Regards,

This was prepared by Hand in Hand for Birth Board Members MD. Hakan Çoker, MD. Selçuk Somer and updated on March 30, 2020.

Resources

1. Türkiye Maternal Fetal Tıp ve Perinatoloji Derneği-Gebelikte Coronavirüs Enfeksiyonu (COVID-19) Hakkında Görüş
2. RCOG - Coronavirus (COVID-19) Infection in Pregnancy 
3. Yeni Koronavirüs Hastalığı (COVID-19) Sağlık Bakanlığı
4. ACOG - Novel Coronavirus 2019 (COVID-19)