During a webinar hosted by TOTUM Women and Not Safe for Mom Group (nsfmg) on April 29th, Dr. Shirazian (OBGYN and founder of Saving Mothers and Mommy Matters) answered questions related to pregnancy and the current Covid-19 pandemic. To learn more about conceiving during Covid, anxiety around hospital birth and protocols, or the effect of Covid on newborns, here’s a Q&A adapted from Dr. Shirazian’s responses from the webinar.
How has prenatal care changed during this pandemic?
- At the start of the pandemic, doctors were trying to limit prenatal visits where they could, because they wanted to limit opportunities for exposure to the virus.
- However, in New York City, things are starting to change. Doctors are having more people come into the office. Patients should not feel like their appointments aren’t important. If you should be following up with visits, you should be coming in, and wear masks and gloves to minimize your exposure.
- Doctors actually get more worried when patients say they’re not going to come in, because if there’s an issue, your doctor won’t see it early on and complications can develop. This applies to obstetrical and gynecological care.
- In terms of the issue of partners coming into the hospital with you, that was overturned in NY, and partners are allowed to come in for delivery.
In terms of protocols for delivery procedures, what has changed?
- The important thing to realize is that even though Covid is happening and it seems like the world is in chaos, labor and delivery is its own protected place. There is not much that changes, except for how Covid patients are treated and some of the rules surrounding traffic.
- A lot of labor and delivery units are looking at universal testing right now, so that every pregnant woman will be swabbed for Covid when they come into the hospital.
- Women that test positive are going to have a slightly different protocol, with negative pressure rooms for instance, but their doctors, checks and management will be the same (healthcare workers will just be wearing additional protection).
- If the mom is Covid-positive, hospitals give the mom the choice of staying with the baby or being separated from the baby, so the baby can be tested and managed separately.
- A lot of women are still opting to wear the mask and be with their baby, but currently the CDC and WHO don’t quite recommend it. Even though we don’t think Covid is passed through breastmilk, were are not sure if initial breathing on the baby can bring any risks.
- As always, after returning home, women need to pay particular attention to unusual symptoms, which include vomiting getting worse, headaches not going away, shortness of breath, and visual changes. Do not hesitate to contact your doctor if you notice something unusual.
What about hospitals that require partners to leave after the baby is born?
- Having an advocate with you is extremely important in general. After delivery, you’re tired, and recovering, and it might be hard to articulate what you need.
- Remember that there are nurses that are there for you at all times, so you should be able to call your nurse and ask for anything you need. They can address concerns as they arise, pain can be treated with pain medication.
- There’s also a patient advocate in every hospital and they will make sure you get what you need.
- You can also use video calls to get your family member on the line, if you don’t feel comfortable articulating it to the nurse or doctor.
What are your thoughts about women opting for home births?
- If someone were to have a home birth and transferred to the hospital due to complications, the regular protocols would be activated.
- However, my worry about home delivery is that you’re at home, so the only reason you’d be coming to the hospital is if you had a problem. With the current pandemic, the referral to the hospital may be slow, and if you’re calling 911, that response may be slowed down.
Has access to lactation consultants been affected?
- Currently, there are many ways to prepare that often we may not get to do. There are virtual classes on so many platforms, and lactation may be one of them. You can form a relationship prior with a consultant, so that you have it established beforehand.
- CPR classes, lactation consultations, prenatal classes, yoga: you can take advantage of these resources ahead of time.
Should I be trying to conceive?
- Some women have been wondering whether now is a good time to conceive. Right now, I would still suggest to wait 1 more month.
- The reason for this is two-fold: one is that you never know exactly what’s going to happen in early pregnancy. You are much more likely to need additional care in the beginning of pregnancy because things like miscarriages or ectopic pregnancies can happen, and when those things do happen, women are acutely in need of services.
- So to decrease anxiety and the need for additional services are reasons to wait it out a little bit.
- IVF services have been suspended, and most centers aren't offering those services simply in an attempt to reduce traffic, and to avoid starting a new medical treatment right now, when things are uncertain. Hopefully in 1-2 months things will get back to normal.
- In the meantime, you can take this opportunity to track your cycle, take a prenatal vitamin, and make sure any other medical issues are in control.
What is the effect of Covid medications on newborn neural development?
- If you are pregnant and you’re in the 1st trimester, and you’re hospitalized for Covid, there are maybe some medicines that will be given to you.
- Although there is no consistency surrounding which medications are being used, a few are being tried, and antiretrovirals like Remdesivir should be fine in pregnancy.
- So while a lot of medications have not been studied, we currently don’t know of any bad side-effects with many of the medications.
With Zika, we heard about specific consequences on the babies- what about Covid?
- The good news is that the vast majority of data to date says that pregnant women are not at more risk for severe disease than non-pregnant women.
- This is very positive, because for most infectious diseases pregnant women are more at risk, but that doesn't seem to be the case for Covid.
- In fact very few newborns have been diagnosed with Covid, and Covid is thought to not cross the placenta.
- So in general newborns, and even kids under the age of 10 don’t seem to be at significant risk.
How can we make our partner feel involved even though they’re not allowed to be there for prenatal visits?
- Everyone can have their FaceTime on during a telehealth visit, and a partner can ask questions at the same time. You can also capture the entire visit, and share it with your partner after.
- I have actually spoken to more family members recently, because patients are bringing in more people in for telemedicine visits.
- However, this might depend on providers: some don’t allow Facetime because of liability issues, but that is not frequent.
- You can also create a list of what you want to know or get out of your visit and share it with your partner.
Postpartum, can close family members visit, including grandparents?
- For grandparents, because there is so much asymptomatic carriage of Covid, you want to be as safe as possible and avoid in-person interactions with that group as much as possible. Even if Facetime and Zoom don’t quite feel the same, they are the safest options.
- You can perhaps wear masks and see them outside, spaced apart to introduce the baby. Some have even chosen to visit the baby from outside, through the window.
- Remember that the risk is more so from the parents towards the grandparents, rather than risk for the newborn.
In terms of antibody tests: if you do have the antibody, are you good?
- There is still a lot of uncertainty around these antibody tests. Currently, I would discourage people to spend a lot of money to get tested, since there’s not much data, and it hasn’t been validated.
- The most important thing to remember is do not change your behavior just because you think you have antibodies. Many individuals have been exposed to Covid and don’t develop antibodies. This might be linked to the amount or time of exposure, but we still do not know for sure.
To watch the entire recording webinar, click here.
