What to expect when you're expecting during COVID-19

The information provided on the show is for general information purposes only. If you have a health problem, medical emergency, or a general health question, you should contact a physician or other qualified health care provider for consultation, diagnosis and/or treatment. Under no circumstances should you attempt self-diagnosis or treatment based on anything you have seen on the show.Navigating pregnancy and life as a new mom is tough, and it’s even more challenging when the world is dealing with COVID-19. So, what can you expect when you're expecting during a global pandemic? Family physician Dr. Shelia Wijayasinghe shares some insight.

AM I MORE VULNERABLE IF I'M PREGNANT?

At this time, based on the information we know (from data from other countries like China) pregnant individuals who contract COVID-19 do not appear to have a worse prognosis, or worse illness or are at worse risk than non-pregnant individuals. This is different than what was expected as we do know that pregnant individuals are higher risk for influenza and flu-related complications but to date, this does not seem to be the case for COVID-19 , but again, this is based on the limited data that we have right now.

WHAT WILL MY PRENATAL APPOINTMENTS LOOK LIKE?

Across all parts of our healthcare system, facilities are limiting in-patient visits and trying to manage what they can virtually over video, email or phone. Prenatal care is different, however, and there are several essential visits that do need to be done in person. Maternity care is essential, and has been developed over many years to reduce complications in women and babies. The risks of not attending antenatal care include harm to you, your baby or both of you, even in the context of coronavirus. It's important that you keep in contact with your maternity team and continue to attend your scheduled routine care when you are well.If you're sick prior to a scheduled appointment, call your provider as they may suggest a specific time to come in or guide you to be assessed appropriately in a different setting. This may involve: virtual visits for intake and check-ups with in-person visits for blood work and ultrasounds (these cannot be done virtually.) This revised schedule may not apply to all pregnancies and certainly those that are high risk may require more visits depending on each individual’s unique situation.Despite this being a time of pandemic, the Society of Obstetricians and Gynaecologists still recommend the same things we do always including screening for diabetes (24-28 weeks), GBS screening (34-36 weeks) and pertussis vaccine (after 21 weeks gestation.)The bottom line is this: There may be an altered schedule of visits during pregnancy. Any change in prenatal care needs to be individualized to the particular circumstances of the patient.[video_embed id='1935881']An expecting mother shares what it's like to be pregnant during the COVID-19 crisis[/video_embed]

WHAT CAN I EXPECT AT A VIRTUAL APPOINTMENT?

If and when your appointments become virtual, what is some important information that moms to be will need to know? Knowing ahead of time what visits will be virtual is important to set aside time/tech in home.During a virtual visit, your care provider may ask you to do one or more of the following:

• Measure your own weight and blood pressure (can be done with home machine or at pharmacy)
• Measure the size of your growing belly (symphisis-fundal height)
• Count baby's movements

It’s also important to note that even if visits are virtual, if you have a concern about your pregnancy – your care team/hospital labor and delivery can be reached (have these numbers handy) for guidance.

WHAT CAN I DO IF MY PRENATAL CLASSES HAVE BEEN CANCELLED?

Virtual classes! Many hospitals, midwife teams and other organizations that previously would have offered in person classes – are now using tech and online meetings to run virtual prenatal classes and support groups. In addition to prenatal classes – there are many options like virtual pelvic floor physio, lactation consultants, psychotherapy and other support services that are available to you online.You can also check out this Instagram page, created by Dr. Sheila and some of her colleagues at St. Michael's Hospital in Toronto. This online guide has tips, videos from experts, different sessions like mindful movement/yoga/grounding exercises and up to date information as they receive it.

SHOULD I CONSIDER A HOME BIRTH?

The decision to have a home birth needs to be made after an informed discussion with your care provider. Home births are limited to people who are low risk for complications (so individuals who have higher risk pregnancy for any reason would not qualify for home birth). If the labouring individual or support people screen positive for COVID, there may need to be a discussion to change location of birthplace based on the circumstancesThe decision to deliver at home depends on:

• Patient factors (low risk, COVID positive/suspected case)
• Provider factors (access to PPE, availability of 2 midwives to do home delivery), and
• Systemic factors (ambulance availability, for example)

A note from the Ontario midwives: “If client is current confirmed or suspected COVID-19 and has a fever, hospital birth is recommended regardless of severity of COVID-19 symptoms.”Other factors: Water birth is not currently recommended for clients who have suspected or confirmed COVID-19 (concern for contamination of water from feces and exposing midwife/baby to an additional route of transmission)If this is something you are considering, have a discussion with your midwife about what precautions are being taken, ask when things may change/what decision point would things switch to a hospital birth. The main thing is to be as informed as possible, take into consideration the potential risks/and your baseline risk and make a decision accordingly.[video_embed id='1921431']How COVID-19 is affecting pregnant women and newborns[/video_embed]

WILL MY PARTNER OR SUPPORT PERSON BE ALLOWED IN THE DELIVERY ROOM?

This is dependent upon each individual institution and policies are changing regularly, so check with your care providerHealthcare providers are committed to advocating for patients to have a support person in the room (partner/doula) as they know this is an incredibly important and vulnerable time for labouring patients. Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth.Currently, most hospitals are allowing one support person as long as you or they screen negative for COVID-19 (from survey done upon arrival). Each hospital’s policy will differ, so please ask ahead so you know what to expect when coming in to the hospital.Some hospitals have changed how long a support person can stay in the hospital postpartum (two hours, for example). Check this too as it varies from hospital to hospital.Some hospitals will not allow in or out privileges to your support person, so pack your bag with all the things you need as you may not be able to bring anything new in once you are admitted.

WHAT HAPPENS IF I'M SHOWING COVID-19 SYMPTOMS?

If a patient has any fever, cough respiratory illness they must put on a mask and sanitize or wash their hands. You will not be turned away from the hospital if you have symptoms of, are a suspected case of or have COVID-19. There will be extra precautions taken however.That said, some hospitals have implemented that if your birth partner has symptoms of coronavirus, they will not be allowed to go into the maternity suite, to safeguard the health of the woman, other women and babies, and the maternity staff supporting you.

CAN COVID-19 BE TRANSMITTED THROUGH PREGNANCY OR BREASTFEEDING?

Based on the data we have to date, COVID 19 does not appear to affect the developing baby during early and late parts of the pregnancy. Studies looking at amniotic fluid and breast milk have also shown no COVID-19 RNA – again, early studies but this is reassuring. It does not appear to be evidence of higher rates of miscarriage or birth defects in mothers who had COVID-19 infection during pregnancy. There have been some recent reports of the possibility of pre-term birth but it’s not clear why at this point so we are watching this space to understand more.

WHY DOESN'T THE VIRUS IMPACT BABIES OR YOUNG CHILDREN?

We don’t know why except that this is incredibly reassuring with the data we have to date. Right now, the data on COVID-19's effects on the young are sparse. Some studies show that even with children, some groups are more vulnerable than others depending on age and health conditions (immunocompromised, less than age 1). Compared to adults, COVID-19 appears to be less severe in most kids but we do not know why.

WHEN CAN I HAVE VISITORS?

When you’re pregnant and have a baby and you are ready to go home, it’s a mixed bag of emotion of joy but during the pandemic there is an elevated level of understandable anxiety. Needing support is really important during this time, but the safest thing is to not have any visitors come into your home during the pandemic.

WILL I BE DISCHARGED FROM HOSPITAL SOONER?

Not at this time, but each hospital has a different policy. For low risk pregnancies, generally within 24 hours. Beds in maternity wards have not been affected to date.

HOW CAN I STAY SAFE?

There is no recommendation to isolate infant from mother and breastfeeding in those who choose to breastfeed should be allowed to do so – as long as taking proper precautions like hand-washing. It's the same guidelines as what we have recommended for the general population of physical distancing and limiting contact with others:

• Regular hand washing
• Avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough
• Avoid non-essential use of public transport when possible
• Work from home, where possible.
• Use telephone or online services to contact your GP or other essential services
• Connect virtually

[video_embed id='1797082']BEFORE YOU GO: Debunking the most common pregnancy myths[/video_embed]