Based on what is known about COVID-19, pregnant women are no more at risk of contracting the virus as adults who are not pregnant, and there currently are no data showing that the virus affects pregnant women differently.
Still, pregnant women need to be mindful about reducing their risk of exposure, said Dr. John McDonald, interim chair of the Department of Obstetrics and Gynecology at The University of Alabama College of Community Health Sciences. McDonald also cares for patients at University Medical Center in Tuscaloosa, which the College operates, and in Carrollton, Alabama.
McDonald said pregnant women should follow the same guidance as everyone else – wear masks when outside of their homes, practice social distancing, engage in frequent handwashing, disinfect frequently used surfaces at home and avoid commonly touched surfaces in public.
“Our recommendations to our patients who are pregnant really mirror the same recommendations that we would give to someone who is not pregnant,” he said.
He said the good news is that there is no evidence that COVID-19 can be transmitted to an unborn baby in utero, although transmission is possible after birth if there is exposure to the baby.
How has COVID-19 changed your practice?
McDonald said the only change is that University Medical Center has spread the timeline of regular visits for pregnant patients from once a month to once every five weeks to reduce the number of times they have to leave home and come into the clinic.
What precautions are being taken by the UMC Ob-Gyn Clinic?
McDonald said there are specific procedures in place to keep patients, and the clinic’s health-care workers, safe. “When you come to UMC, you are screened at the entrance (of the building). Your temperature is taken, you’re asked a series of questions and you may be referred for COVID testing. If not, and you are cleared, you’re asked to remain in your car and one of our nurses calls you when the clinic room is available for you, so you avoid the waiting room. We try to avoid all contact with other patients. You come directly to the room, you have your visit and then you’re able to check out and go.”
Have you had to do anything differently with pregnant patients who may have tested positive for COVID-19?
“Again, the guidelines right now really mirror the general guidelines, McDonald said. “If you test positive for COVID and are pregnant, we still recommend that you stay at home, social distance, wear a mask, quarantine yourself, limit contact and wash your hands frequently.” Because there currently are no treatments for COVID-19, he said pregnant patients are cared for the same way as other patients. “If you develop severe respiratory symptoms – shortness of breath, you feel like you’re suffocating – then we do recommend that you come to the hospital. We will put you on oxygen, we will monitor the baby, we will put you in an isolated room and we will take care of you just as we would for someone who is not pregnant.” He said the good news is that there are currently no cases of congenital transmissions of COVID-19 from mother directly to baby in utero. But, he said, “there have been situations where babies have tested positive for COVID, and they usually get it after birth in the hospital setting.”
Have you noticed any birth defects with COVID-19?
McDonald said there have been no reported birth defects among babies born to mothers who have tested positive for COVID-19.
For deliveries, do you wear personal protective equipment (PPE)?
McDonald said doctors and health-care workers in the delivery room wear PPE that is specific for COVID-19 if women delivering have tested positive for the virus. He said virus-positive women delivering are placed in isolation to try and minimize the spread of COVID-19. While most hospitals have enacted no-visitor policies across the board, McDonald said “in obstetrics, we do value the presence of a patient’s partner in the room at delivery. So DCH (in Tuscaloosa and Northport) has provided a way for a patient’s partner to be in the room for delivery.” He said that one partner, though, is the only visitor that is allowed throughout the patient’s hospital stay.
Are all pregnant patients tested for COVID-19 upon entering the hospital for delivery?
McDonald said patients undergoing elective procedures, including scheduled C-sections, are tested for COVID-19 in a pre-operative appointment with their physician prior to surgery. But he acknowledged that in obstetrics, things don’t always stay on schedule. McDonald said pregnant women arrived at the hospital in labor, or if their water has broken, won’t be tested for COVID-19 because “we would not get the tests back in time to do anything with the results.” But he said if a patient with a scheduled C-section has COVID-19, “we might delay the C-section for the appropriate quarantine time to pass if we have time, to allow for patient safety and employee safety at the hospital.”
Does that cause complications with the baby? Is the baby then post-term, or do you usually schedule a C-section a little bit before 40 weeks?
“We try to schedule our elective C-sections at around 39 weeks. So, if you test positive for COVID, say, at 38 weeks, then two weeks is sufficient time for you to wait and you will not be post-term at the time of your C-section,” McDonald said.
Have you noticed any change in the mental health of your patients because of concerns about COVID-19? An increase, maybe, of post-partum depression?
McDonald said he has seen more anxiety prenatally than depression. “We’ve seen a lot of anxiety, and we try to reassure patients,” he said. “As a general rule, COVID has not been devastating to obstetrics at all. I’m not aware of any maternal deaths locally here from an obstetrical patient having COVID, which is good news.” McDonald said after delivery, or post-partum, is generally when obstetrical patients are more susceptible to depression. He said this offers an opportunity to use telehealth in obstetrics, “to talk with our patients more frequently, to do screening for depression and, hopefully, intervene before it gets severe.”
Do you do telehealth for prenatal visits?
McDonald said obstetricians typically don’t do prenatal visits via telehealth “because there are several physical exams (done at patient visit) that cannot be accomplished over the phone. As far as doing fundal height and a pelvic exam, we’ve not found that telehealth is going to be amenable to those types of things.” He said the doctors are always available by phone if patients need to talk.
What is fundal height?
Fundal height is a tape measurement of the pregnant patient’s belly, and with that measurement doctors can get an idea if the baby is growing appropriately, McDonald said.
Have post-delivery follow-up recommendations changed because of COVID-19?
McDonald said post-delivery patient-care guidelines have not really changed during COVID-19. Doctors still want to see patients two to three weeks after delivery to make sure they are healing and doing well. He also said some patients are going to require additional follow-up care and management of chronic conditions they had before delivery, like diabetes, high blood pressure and heart disease.
What about visitors to the home? Everyone wants to see the baby, but now we have COVID-19.
“The safer-at-home guidelines still apply there,” McDonald said. “Limit folks coming in, wear a mask, wash your hands and keep the baby protected.”
In the old times, they would have no visitors for six weeks after delivery.
“That’s true, but that’s also a two-edge sword,” McDonald said. Having a baby is a life-changing experience and a lot of new moms need assistance, he said, adding that he encourages them to accept help from a parent or grandparent. “Obviously, you don’t want a house full of people going in and out so try to limit the number of exposures if you can. I would advise patients to pick a few close family members that they’re comfortable with, and to plan all that out before (the birth) so that there’s no confusion.”
With COVID-19, if a woman thinks she’s pregnant, is there anything different you would recommend to her than you normally would?
McDonald said even with COVID-19, he would encourage women who think they’re pregnant to “engage with the healthcare system,” especially because of the importance of prenatal care.
Would you recommend flu shots in the fall, for pregnant women, especially since COVID-19 and flu can have similar symptoms?
“A flu shot is always a good idea in the midst of COVID,” McDonald said.