Should Pregnant People Attend Prenatal Visits? & 4 Other Coronavirus Questions
Kara Lambert is self-quarantining in her Mundelein, Illinois. home. She’s 32-weeks pregnant, and she — like just about everyone else in the country — has stopped leaving her house. For Lambert, this is especially daunting, since she is due to give birth in eight weeks, and has doctor’s appointments scheduled every week.
So she isn’t leaving her house, except when she’s supposed to enter doctor’s offices and hospitals, which are crowded with sick people who may have the novel coronavirus. Should she risk breaking the quarantine to step into a doctor’s office at this point? And how exactly is the coronavirus affecting pregnant women right now?
“I have a doctor’s appointment tomorrow, and I am not sure I will go,” says Lambert, who just made the decision Monday to home birth because she doesn’t want to be a burden to a health care system already in trouble.
What Is The Risk Of Pregnancy Complications From Coronavirus?
“Pregnant women are going to get this,” says Joshua Copel, M.D., a Yale Medicine OB/GYN who specializes in high-risk pregnancies. “At the moment, our information is limited on the effects on pregnancy.”
Here’s what the doctors do know right now: This doesn’t appear to be as dangerous for pregnant women as influenza can be. But severe COVID-19 can still be a big risk. The CDC advised that a high fever in early pregnancy could lead to problems like birth defects or miscarriage, per previous studies of SARS and MERS; a high fever and dehydration in the second and third trimester could lead to preterm labor, Copel says.
Fortunately, in the absence of a high fever, the CDC says that there is no increased risk of pregnancy complications, such as miscarriage or fetal malformations, as long as there’s no high fever. Limited data suggests that pregnant women who get COVID-19 may be a higher risk for premature birth, but those studies are small and retrospective.
The CDC doesn’t know if COVID-19 will affect the health of the baby after birth, but a tiny study in February of nine pregnant women in China who had the coronavirus found that none of their babies were affected.
Should Pregnant Women Change Their Birth Plans?
So pregnant women should or should not be worried about catching the coronavirus, which probably won’t affect their baby, but nothing is known for sure — great. Now what?
You should be washing your hands and socially distancing, and it’s probably best (definitely best) to cancel your baby shower and babymoon. But since nearly all hospitals are limiting delivery rooms to only one visitor (check with your hospital about their new coronavirus rules), it’s time to figure out how to deliver that baby without the help of a doula — unless you’d prefer the doula to your partner, says Sharyn Lewin, M.D., a New Jersey-based gynecologic oncologist at Holy Name Medical Center. You’ll also need to find someone to watch your other children, and they probably won’t be allowed to visit.
If a pregnant person late in pregnancy was to contract COVID-19, a March 3 study published in The Lancet concluded that "whenever possible, vaginal delivery via induction of labour, with eventual instrumental delivery to avoid maternal exhaustion, should be favored," given that that patient would already be sick, and surgery may have risks.
Should Pregnant People Attend Regular Prenatal Visits?
As for regular doctor visits, the American College of Obstetricians and Gynecologists suggests looking into the use of telemedicine — online sessions — for low-risk pregnancies. (Some birth workers are also offering remote sessions.) So what’s more dangerous — doctor visits that aren’t as thorough or clinic waiting rooms?
Astrid Mayor is 22 weeks pregnant, and went to a doctor’s visit on Thursday. “Someone walked in with flu-like symptoms and no mask,” she says. “I’m worried about my next visit, as I have to sit and wait an hour for a glucose test.”
Still, prenatal visits detect everything from preeclampsia to fetal irregularities, so they aren’t superfluous. Emily Oster, author of Cribsheet, noted in her March 17 newsletter that prenatal visits serve an important purpose: "A missed case of pre-eclampsia can be extremely dangerous."
Lewin suggests discussing with your doctor which prenatal visits to continue with, though all of them are important, she says.
“It really is an individual discussion based on the pregnant woman’s history and pregnancy,” she says, suggesting also the women avoid the busy or crowded waiting rooms.
Lewin says women can call ahead and make sure they’re not waiting with other people.
Most likely, this won’t be an issue, says Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University and founder of MadameOvary.com.
Most offices are encouraging women with gynecological appointments to postpone their visits to free space for prenatal spots, Minkin says. They’re also highly encouraging women to attend their appointments alone so everyone can adhere to the social distancing guidelines as much as possible.
Any Chance Of Confusing The Coronavirus With Morning Sickness?
Probably not, Copel says. Morning sickness won’t cause a fever or coughs or sneezing along with the malaise associated with COVID-19, he says.
What Should You Do If You Think You Have COVID-19?
Don’t go to your doctor’s office, Copel says. “Having COVID-19 testing doesn’t really guide treatment at this time,” he says. “Do not go to your OB-GYN office or an emergency room directly without calling, because you may expose other people unnecessarily.” But you can take acetaminophen for fever and stay hydrated. Also, Copel says, speak with your doctor about Tamiflu, as you may have influenza.
Are There Any Other Precautions Pregnant People Should Take?
As hospitals become packed and birthing plans change at the last minute due to staffing issues, it’s best for all pregnant women to get a hold of their prenatal records, says Missi Burgess, an Atlanta-based midwife.
“As hospitals become more invested in caring for the critically ill, you may find yourself birthing at a different hospital or even out of the hospital,” Burgess says. “Everyone should do this.”
If you think you’re showing symptoms of coronavirus, which include fever, shortness of breath, and cough, call your doctor before going to get tested. If you’re anxious about the virus’s spread in your community, visit the CDC for up-to-date information and resources, or seek out mental health support. You can find all of Romper’s parents + coronavirus coverage here, and Bustle’s constantly updated, general “what to know about coronavirus” here.
Joshua Copel, M.D., Yale Medicine OB/GYN
Sharyn Lewin, M.D., gynecologic oncologist at Holy Name Medical Center
Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University
Missi Burgess, certified professional midwife
(2020) Pregnancy & Breastfeeding: Information about Coronavirus Disease 2019, CDC, https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fspecific-groups%2Fpregnancy-faq.html
Huijun Chen, Juanjuan Guo, Chen Wang, Fan Luo, Xuechen Yu, Prof Wei Zhang. (2020) Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30360-3/fulltext
Favre, G., Pomar, L., Qi, X., Nielsen-Saines, K., Musso, D., Baud, D. (2020) Guidelines for pregnant women with suspected SARS-CoV-2 infection. The Lancet, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30157-2/fulltext
(2020) Practice Advisory: Novel Coronavirus 2019 (COVID-19), ACOG, March 13, 2020, https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false