Coronavirus: What to know if you’re pregnant now

STATEN ISLAND, N.Y. -- Who will deliver my baby? Will my partner be allowed in the delivery room? Who can come visit me after I give birth?

These are the questions pregnant women are facing during the coronavirus (COVID-19) pandemic.

For this reason, the state Health Department is allowing one support person who is considered essential to patient care throughout labor, delivery, and the immediate postpartum period.

New York ordered all hospitals to allow one support person in delivery rooms despite the coronavirus, after some private hospitals barred partners or another support person in labor and delivery.

This person can be the patient’s spouse, partner, sibling, doula, or another person they choose. This person is the only support person allowed to be present during the pregnant patient’s inpatient care. Individuals ages 60 years or older are not encouraged to be support persons at this time due to the increased risk of morbidity with the coronavirus infection.

According to the state health department, this restriction must be explained to the pregnant patient in plain terms upon arrival, or ideally prior to arriving at the hospital.

The support person must be asymptomatic for COVID-19 and must not be a suspect or recently confirmed case. Hospital staff should screen the support person for symptoms -- including fever, cough, or shortness of breath -- and should check their temperature prior to entering the labor and delivery floor and every 12 hours thereafter. The support person must stay in the room.

After Staten Island University Hospital (SIUH) said medical staff would be the sole source of support last week, it said effective Saturday, March 28, it was relaxing the visitation policy in labor and delivery to one support person.

A spokesman for Richmond University Medical Center (RUMC) said it understands the importance of laboring mothers having a support person with them during their care. Th hospital will continue to allow one support person to be with a patient throughout their care.

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According to the Centers for Disease Control and Prevention (CDC), it is unknown if pregnant women are more susceptible to COVID-19 than the general public. However, due to changes that occur in pregnancy, the state Health Department said pregnant people may be more susceptible to viral respiratory infections.

Dr. Adi Davidov, associate chair of the department of obstetrics at Staten Island University Hospital (SIUH), recently told the Advance/SILive.com that pregnant women aren’t at a higher risk of contracting COVID-19, but they are at higher risk for complications with the pregnancy, like pre-term labor and miscarriage, aside from complications of the virus itself.

It’s important for pregnant women to protect themselves from illness, and for their health care providers to have the most current and updated information to provide the best care.

The state Health Department said it doesn’t know yet the risk COVID-19 may have on pregnancy or potential problems during delivery or post-partum. Small studies suggest the virus doesn’t pass from parent to fetus across the placenta during pregnancy. Other studies suggest that blood-borne transmission of COVID-19 is unlikely. In small studies, the virus hasn’t been detected in amniotic fluid, umbilical cord blood, placental tissue or breastmilk.

The CDC provided guidance for pregnant and postpartum patient care. It includes recommendations for:

Prehospital considerations

Pregnant patients with confirmed or suspected COVID-19 should notify their physician, and the obstetric unit should be informed prior to arrival so that the facility can make appropriate infection control preparations before the patient arrives for care.

During hospitalization

Birthing hospitals must insure labor and delivery staff are correctly trained and capable of implementing recommended infection control interventions. Staff should ensure they can understand and can adhere to infection control requirements.

Birthing hospitals should follow infection control guidance, such as managing visitor access, including essential support persons during labor and delivery.

Parent/baby contact

It’s unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with an infected individual is a concern. To reduce risk of transmission from an infected parent, facilities should consider temporary separation of parent and newborn when the parent has confirmed or suspect COVID-19 until transmission-based precautions are discontinued.

Breastfeeding

Limited research has been conducted on COVID-19 virus and breast milk. Small studies haven’t found the virus in breast milk of infected postpartum patients. Patients with confirmed or suspected COVID-19 with the intent to breastfeed, should be encouraged to express their breast milk to establish and maintain milk supply.

A dedicated breast pump should be provided to the patient. It is important to implement hand hygiene prior to, and thorough washing of the breast pump components follow use, to reduce the risk of infection to the newborn. Bottle feeding should be provided by a healthy caregiver, either the patient’s support person or hospital staff as available.

If direct breastfeeding is preferred by a patient, she should wear a face mask and practice hand hygiene before each feeding.

Lisa Paladino, an international board certified lactation consultant (IBCLC), former resident nurse and midwife, told the Advance/SILive.com that women who are breastfeeding should “proceed as normal.”

COVID-19 is similar to chickenpox, she said, in that is does not transfer into a mother’s milk, but if a breastfeeding mother is sick, precautions should be taken.

Wearing a mask while nursing and wearing gloves will help prevent transfer, as well as basic hand washing procedures.

Pregnant women should take the same precautions as the general public to avoid infection. That includes:

Stay home if you’re sick.
Call your health care provider for advice that can be provided over the phone or using telehealth, before seeking care in the office.
Cover your mouth and nose with a tissue when coughing or sneezing and then discard it in a closed container, or if a tissue is not available, use the inside of your elbow.
Keep your hands clean by washing them often with soap and water for at least 20 seconds. If soap and water are unavailable, use an alcohol-based hand sanitizer containing at least 60% alcohol.
Avoid touching your eyes, nose, or mouth with unwashed hands.
Avoid close contact with others, especially those who are sick.
Get the flu shot (at this time, there is no current vaccination for coronaviruses).