Pregnancy, Birth, and Postpartum During COVID-19

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NOTE: I will be updating this post as new research and information comes out, so check back regularly!

***Last updated on 4/1/2020***

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I’m 35 weeks pregnant with baby #6.

I’m due around May 5th, 2020.

And because of Coronavirus, I have absolutely no idea which of my birthing plans I’ll be able to follow, and which ones will have to be thrown out the window. 

I feel like I need contingency plans for my contingency plans, and it’s stressful. 

There’s so many variables, so many changing regulations, so much stress, and so many dang unknowns. All layered on top of what is an already difficult time for pregnant Mamas to relax. 

(I mean, can anybody else relate to the struggle of being close to your due date, and not being sure if you should schedule that particular commitment on your calendar…or will you be in labor by then? What to do? How to plan?)

Not that we’ve got a lot of things to schedule onto our calendars nowadays, of course. #SocialDistancing

But am I worried?

Not excessively. (Not yet.) I’m planning a home birth, and was intending to do that even before COVID-19 was a blip in the world. It will be my 4th home birth (my first 2 were born in the hospital, you can read about why those experiences drove me to explore home birth by reading my first birth story and my second birth story).

But even with a home birth, things are changing. My midwives have had to put new rules and regulations in place. If something happens and I need to transfer to the hospital during labor, what will that be like if my local hospital is inundated with COVID-19 patients? 

So I’m not scared, but I’m doing my best to think things through. And that means that:

  • I’m aware. 
  • I’m doing my research. 
  • I’m seeking out sources I trust, and gathering information ahead of time so I know what my options are. 
  • I’m communicating regularly with my healthcare providers, asking questions I’ve never asked them before (or even imagined asking them before, for that matter…) 

Basically, I’m preparing as best I can for a situation where (honestly?) nobody knows for sure what things are going to look in a month or two. 

(*Note: This post may contain affiliate links, which means I might receive a commission, at no extra cost to you, if you make a purchase using those links*)

So what’s a Mama-to-be to do? And if you know a Mama-to-be, how can you best support her during this extra challenging times?

Clarifying things like… 

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DISCLAIMER: I am a Registered Nurse, but I am not your Registered Nurse. The information in this article is basic info that applies to most situations where an otherwise healthy child (or adult) comes down with a relatively common, run-of-the-mill sort of illness. You should always follow your Mama instincts and seek additional help when you need it!

First of all, why doesn’t anybody seem to know what’s going on?

Well, that’s pretty much because Some experts are making dire, “end-of-world” style predictions. Other experts are playing down the risks and saying the risk doesn’t warrant all of our current precautions and fears. 

Frankly, it’s hard to know what to believe. And there’s a very good explanation for why this is happening.

COVID-19 is a brand new strain, and we simply don’t have enough data to answer all the questions we have about it, or even to be able to accurately predict what’s going to happen in the coming weeks and months.

(FYI: And anybody who tries to tell you differently is just confidently defending their own opinion.)

You can read more about what’s going on with Coronavirus in my very thorough article, COVID-19 FAQ: What Mamas Need to Know.

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H2: So IS COVID-19 more dangerous during pregnancy…or not?

Pregnant women are often told that they are “immuno-compromised”, and instructed to be careful. You know…things like no cat litter, avoiding soft cheeses and lunch meat, and things like that.

Recently, the government of Great Britain decided to include pregnant Mamas in their “high-risk of severe complications” category for COVID-19. 

However, it seems that this recommendation is simply out of an extreme excess of caution. 

Because the GOOD news for pregnant Mamas right now, is that the limited data we have looks promising for us preggos. 

Since COVID-19 is most deadly for people 60+ years old with at least one or more chronic health conditions…well, the age itself rules out almost all pregnant Mamas.

In fact, a very small data set from China showed that of 9 pregnant Mamas who tested positive for COVID-19 during their third trimester, none went on to develop severe symptoms. And all delivered healthy babies via C-section. None of their babies tested positive for Coronavirus, and there was also no Coronavirus found in the amniotic fluid or cord blood. They also tested the breastmilk for 6 of the Mamas, and found no evidence of virus there, either.

There has also been an “updated”, early online-released article reviewing 37 cases of pregnant women in China who developed Coronavirus during their 3rd trimester (this analysis includes the 9 pregnant Mamas discussed in the previous paragraph). This is the most comprehensive data we have so far about COVID-19 during pregnancy, and it looks good. There were no serious outcomes for the Mamas, and only 1 pre-term newborn died (it’s important to note that we don’t know all of the details about the health of the Mamas and babies, and we don’t know why the baby was pre-term, but that seems to be related to the cause of death more than Coronavirus). 

This is very good news if you’re pregnant, because the “relatives” of COVID-19 (SARS and MERS) were not so kind during pregnancy. Those two respiratory viruses did show a higher rate of death in pregnant Mamas. 

Of course, even with this data, there are a lot of unanswered questions. 

For example, we don’t know if there are any long-term effects of contracting COVID-19 earlier in pregnancy. Some viral illnesses, such as rubella, can cause birth defects if the Mama contracts it during the first trimester. However, so far we have seen no indication that COVID-19 causes birth defects during pregnancy, or even if that it can pass to the baby in utero (more on this in the next section). 

It’s also still unclear if the Mamas in these studies had a higher rate of pre-term births and C-sections due to their COVID-19 diagnosis, or because of other unrelated health problems. All of these cases were during the first wave of outbreak in China, so it’s possible that the doctors recommended an early delivery out of an excess of caution, even to the point of delivering pre-term babies. We just don’t know for sure yet. 

But one thing that does seem to be clear from the data that has been collected so far: pregnancy does not appear to increase the risks of contracting COVID-19. The inclusion of pregnant women in the “higher risk” category is out of an excess of caution, and not because there is any reason to believe that COVID-19 poses a more serious threat during pregnancy than at any other time.

Which is a big relief.

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Is COVID-19 more dangerous for my newborn? 

***UPDATED 3/30/20*** Is it weird that I’m updating this article before I’ve officially published it? 

But that’s how fast the data moves with COVID-19, so here’s the update!

So there is new data emerging over this past week which suggests that it may be possible for COVID-19 to be passed from Mama to baby during pregnancy or birth. 

But it’s very important to understand that research is not conclusive. There are still a lot of very big questions as to what this all means. So let me summarize what the experts are talking about.

So that you don’t freak out if you hear it on the news…

  1. The first research article describes a single Mama in Wuhan who’s newborn tested postiive for COVID-19 IgG and IgM antibodies within 2 hours after birth. These type of antibodies are created by healthy immune systems in response to infection. The IgG could easily have been from Mama’s immune response, and simply crossed the placenta to get into baby…but IgM antibodies are too big to cross the placenta. And if baby’s immune system created the IgM, then it usually takes 3-7 days after initial infection for them to appear in the blood. Therefore, the researchers suspect that the newborn may have been infected with Coronavirus during pregnancy, which may indicate that the Coronavirus can cross the placenta. In any case, the good news is that despite of the infection, Mama and baby were both discharged without any COVID-19 complications. 
  2. A second research article describes 6 Mama and newborn pairs from Wuhan who had mild cases of diagnosed COVID-19 pneumonia. Five of the newborns tested positive for COVID-19 IgG antibodies (which again, could have crossed the placenta from Mama’s immune response). In addition, 2 of the newborns tested positive for COVID-19 IgM antibodies. The researchers suggested 2 reasons why the newborns could have IgM antibodies in their blood: 1) the COVID-19 virus can cross the placenta and cause the baby to have an immune response during pregnancy, or 2) the placenta may have been damaged, which allowed Mama’s IgM to cross over into the baby. The researchers do not report the health outcomes for the Mamas and newborns in this study.
  3. A third research study reported that 3 out of 33 newborns born to COVID-19 positive Mamas in Wuhan also tested positive for COVID-19 on day 2 of life. However, it’s not certain whether these 3 newborns were born with COVID-19, or if they contracted the illness after being born.
  4. Finally, there was a meta-analysis that compiled current research on 3 coronaviruses: SARS, MERS, and COVID-19. They concluded (and this is the part that may be blown out of proportion by the media) that pregnant Mamas infected with these coronaviruses have a higher risk of Miscarriage, preeclampsia, cesarean, and perinatal death. The problem with these results, is that while SARS & MERS do have more clear research evidence that shows these increased risks, it is far from clear that COVID-19 affects pregnancies in the same way. For example, the extremely high rate of C-sections we currently see in the COVID-19 research could easily be caused by an excess of caution on the part of the doctors…meaning that since they didn’t know how COVID-19 would affect the baby, doctors may have recommended a C-section even though there was not a medical reason for it. (Also, the researchers acknowledge this possibility by emphasizing that COVID-19 diagnosis by itself should not be an indicator that baby needs to be urgently delivered.) 

So to summarize it all…although these new insights increase the possibility that we will eventually discover that babies can become infected with COVID-19 during pregnancy, it is still not a confirmed fact. And all the evidence still appears to tell the story that the vast majority of Mamas (and their newborns) that become infected with COVID-19 during pregnancy will recover just fine. 

And it doesn’t negate any of the research I explain in the rest of this (un-updated) section. 

So that’s the update! I’m sorry if it sounds a little technical, I tried to break it down into common language as much as possible…but if you have any questions about it, make sure to ask in the comments!

***END OF 3/30/20 UPDATE***

The same pre-release analysis that had good news for pregnant Mamas, also has good news for their newborns: there is zero evidence that COVID-19 passes from Mama to baby in utero. 

There has been no sign of the virus in breastmilk, placental tissue, cord blood, or amniotic fluid. And that’s great news!

You may have heard of a single case report in Great Britain of a COVID-19 positive Mama’s newborn also testing positive. However, it is unclear whether the baby became infected in utero (unlikely, given the other data we have access to) or very soon after birth. And as far as we know so far, both mother and baby have gone on to be fine. 

However, if your newborn does happen to contract COVID-19, then there is good news on that front, as well. 

There is an early data analysis on how many Chinese children who had known contacts with Coronavirus patients, and went on to test positive themselves. 

First of all, this data from China tells us that less than 1% of COVID-19 patients were children under 10-years old. This corresponds with the data we’ve been seeing in other countries, where the highest rate of cases seems to be in the +60 years crowd…especially when they have one or more pre-existing conditions

So of the relatively small number of children (171 of of 72,314 total COVID-19 cases) who were confirmed to have COVID-19, the data shows that almost 16% (abou 27 kids) were completely asymptomatic. 

In addition, of the 171 kids with confirmed COVID-19, only 3 required ventilation…and they all had pre-existing conditions

Also important…of those 3 children who needed ventilators, only one 10-month old died. (And don’t forget, that baby technically died from complications related to his pre-existing conditions. Although I’m sure the Coronavirus infection complicated and worsened his condition). 

Although the data looks promising for both pregnant Mamas and our newborns, there is no doubt that the current epidemic is going to greatly affect our birthing experiences in the upcoming months

So how will that effect our prenatal care, hospital care, and postpartum experience?

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How COVID-19 could affect your prenatal care

First off (and I’ll probably mention this in every section for the people who are skimming…), don’t feel like you have to make permanent decisions months in advance.

Why? Because this situation is changing rapidly, and in most cases, it’s not necessarily beneficial to make decisions too far in advance. You know, like whether you want to convert all your prenatal appointments to telehealth appointments to avoid possible exposures, vs simply deciding one prenatal appointment at a time…

After all, the whole landscape of this pandemic (and this country!) could change overnight if an effective treatment is found, if a vaccine is developed, or if it turns out that Coronavirus follows flu season and simply disappears with springtime. 

We simply don’t know what will happen. 

So do your best to let go, relax, and practice flexibility. (As a first-born perfectionist, who also happens to be an Enneagram 3w2…this is really, really hard for me, too…) 

The most important thing is to find a healthcare provider that is willing to work with you, be a partner in your healthcare, and talk through different scenarios that are important to you…but that’s something you’d be doing even if there wasn’t a pandemic going on.

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Changes to Pre-natal care routines

Since I was already planning a homebirth, you might think that not much has changed for me since COVID-19 hit. But you’d be wrong. 

My homebirth midwives have (wisely) chosen to institute many of the same precautions that mainstream OB’s and other medical personnel have put in place.

And some of these new restrictions are really sad. Understandable, but sad.

But despite the changes, it is still very important to receive regular prenatal care during this time…and all of the major health organizations recommend that you do so.

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Switching to telehealth appointments when no physical exam is needed (especially during early pregnancy)

During most of your pregnancy, there’s really not a whole lot of “hands-on” examining that needs to be done. However, this can be a bit alarming to Mamas who are accustomed to feeling the reassurance that comes with hearing baby’s heart beat at each monthly appointment. 

(Since we can’t see what’s going on inside of us, pregnancy is such a mind game, am I right??)

Your healthcare provider may ask you to get a thermometer, scale, and blood pressure cuff so that you can take your own vital signs. This will help monitor for any concerning pregnancy symptoms from afar. You should also have an opportunity to ask questions and discuss any concerns you have about your pregnancy, your maternity care, or any developing issues related to the Coronavirus.

Of course, if you are considered a high-risk pregnancy (or have a history of pregnancy issues), then your healthcare provider may want to skip the telehealth appointments and see you in-person throughout your entire pregnancy. It’s definitely something you need to discuss with them. 

Check yourself for illness/infection before attending in-person appointments

As you get further along in your pregnancy, you will likely be required to physically come to appointments such as your ultrasound, Gestational Diabetes test, and Strep B test. Your provider will also want to start monitoring your urine for glucose and protein, if they haven’t been able to do that earlier in the pregnancy. 

Other important reasons for in-person appointments later in pregnancy are so that your healthcare provider can measure your abdomen to make sure baby is growing as expected, check for excessive swelling, and determine baby’s position in your uterus, among other reasons. 

Before coming to your in-person appointments, your healthcare provider may ask you to take your temperature and self-assess for any signs of illness. They especially want to know about fever, cough or shortness of breath, as those seem to be the cardinal signs of COVID-19 infection. 

If you have any of those symptoms, make sure that you call the office before coming to your appointment so that they can advise you on their policy. They may choose to switch to a tele-health appointment. If your symptoms are severe enough, they may even suggest that you go to your local hospital to be tested.

Limit of 1 Adult support person at prenatal appointment (or none)

It makes me sad that my older children are no longer allowed to come with me to my prenatal appointments, even though I understand the reasons why. Usually, they attend every appointment so that they can listen to baby’s heartbeat…I feel like it helps make the pregnancy more real to them, especially early on.

But an additional complication that many Mamas-to-be face is finding someone outside the home to provide childcare…or having your husband stay home to watch them. And that means that your husband may end up missing your prenatal appointments, too. 

Since not all of my kids are old enough to stay home alone, and we’re trying our best to maintain #SocialDistancing, we have decided not to try and find outside childcare. Since I am relatively close to my due date, we want to do what we can to prevent any of us from getting sick before I go into labor. 

Shortened (or modified) in-person appointments

Many OB appointments already feel short and rushed. 

With my home birth midwives, on the other hand, I’m accustomed to casual, hour-long appointments that give us time to chat and develop our friendship long before birth happens. 

But with COVID-19, many in-person appointments with all healthcare providers are being shortened. This allows for additional cleaning between patients, and also reduces the amount of interpersonal contact between you and your healthcare provider. And honestly, that’s safer for both of you. 

In addition, some appointments may be a little…unusual. For example, I have heard some Mamas on Facebook report that they were instructed to wait in their car during their Gestational Diabetes screening test (you know, the one where you drink that nasty sugar drink…). This step limits the time spent in the office around other people, even though it may not be the most comfortable “waiting room.”

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Suggestions for making the best of Prenatal appointments during COVID-19

There’s always a bright side: pregnancy has really been over-medicalized over the past 100 years, when it’s actually quite a natural process. In fact, in most cases, it requires very little hands-on “managing” of the pregnancy process. Your body already knows what to do!

However, it’s certainly beneficial to do some monitoring for those potential problems, which can often be caught and treated without harm to Mama or baby. The problem is that many mainstream healthcare providers have been trained to expect problems. This often leads to an attitude of assuming there will be a problem, even when it’s unlikely. 

And this attitude does not come without consequences…it can cause increased anxiety for Mama and her family, as well as additional testing and pregnancy interventions that may not necessarily be needed. It is certainly not a case of “better safe than sorry.”

So taking a more hands off approach to early pregnancy by utilizing telehealth appointments, while still monitoring for the most common pregnancy concerns and giving Mamas an opportunity to build a trusting relationship with their healthcare provider, could potentially be a good thing in the long-run by helping to “de-medicalize” normal pregnancy.

Here’s some other suggestions for “making the best of” your changing prenatal appointments:

  • Use your cellphone to record or video chat with your kids (and/or husband) when your healthcare provider checks the baby’s heartbeat.
  • If you’ve hired a doula who is willing to attend prenatal appointments with you, and you’re comfortable having her in your home, then ask if she would be willing to watch your kids so that your husband can attend the appointment instead. 
  • If possible, email questions ahead of time to your healthcare provider so that they are prepared to answer.
  • If emailing questions ahead of time isn’t an option, then make sure you write them down before you come so that your shortened time can be used most efficiently (a good suggestion any time!).
  • Not related to prenatal office visits, but…if you’re bummed out because you’re missing out on professional maternity photos due to #SocialDistancing, look for a photographer in your area who is offering “Porch Pictures”. This way you can still memorialize your pregnancy with a lovely (and unique) picture…all while still maintaining appropriate #SocialDistancing.

(If you have any other positive suggestions for how to make the best of prenatal appointments during COVID-19, please leave a comment below and tell me so I can add them!

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H2: How COVID-19 could affect your labor & delivery

(Reminder for the skimmers…don’t feel like you have to make permanent decisions months in advance. The COVID-19 situation can change rapidly, so be alert and prepared…but no need to be fearful.

There’s no getting around it: COVID-19 is changing, and often limiting our options, when it comes to childbirth. Many of these changes are completely out of our control…and even out of the control of our healthcare providers. 

Here’s something you need to keep in mind, though: many of your healthcare providers are just as scared as you are right now…if not MORE so, since they are on the “front lines” dealing with COVID-19. 

So while it’s tempting to feel angry, and even to lash out at the doctors, nurses and hospitals who are making and enforcing new COVID-19 policies…remember that they are simply doing the best they can to protect you, protect themselves, protect their families, and to protect their co-workers. 

Basically, everybody’s kind of flying by the seat of their pants with this thing. 

After all, there are some scary predictions being made for what could happen in our local hospitals over the coming weeks and months! If your hospital happens to be overwhelmed with COVID-19 patients when you go into labor, then what will that mean for the sort of care that you will receive?

What if there are Mamas diagnosed with COVID-19 who are laboring at the same time as you? What if…

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…what if you have COVID-19 when you go into labor?

We have to wrap our minds around the fact that our birth plans need to be a bit more flexible than usual, given the unusual circumstances.

This being said, there are many things that you can (and should!) do to prepare, and to be your own advocate if you run up against childbirth policies that you’re not too happy about.

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Know your rights

Even during a time of pandemic, you are still entitled to informed consent. 

That means that you have the right to have your medical options explained to you in terms that you can understand. And that you have the right to accept or decline any medical procedures that are offered. 

Of course, there are exceptions. After all, your right to informed consent does not negate your healthcare provider’s right to safety. And, of course, that’s where it starts getting a little bit tricky with COVID-19.

For example, depending on the projected number of COVID-19 cases in your area as you near your due date, some healthcare providers may recommend an induction to try to avoid having you go into labor during a time when your hospital may be particularly overwhelmed (or you may be thinking about it yourself, if you’re starting to get nervous). 

Just like when COVID-19 is not pandemic, you are not required to schedule an induction simply because your healthcare provider recommends it. Whether you schedule an induction should be a very personal decision between you and your healthcare team, based on your personal preferences and current medical condition

All in all, the best thing you can do right now is to educate yourself on current “best practices” for childbirth during COVID-19. You can find this information (such as it is…) on the website for the Centers for Disease Control and Prevention (CDC) and/or World Health Organization (WHO). This way you are better prepared to serve as your own advocate during labor, because you will have more factual resources at your fingertips. 

The next best thing to do is to be proactive. Talk to your healthcare provider before you go into labor about what the current hospital policies are, and what changes they anticipate may be coming based on COVID-19 projections for your area. 

If your healthcare provider (or hospital) has a personal preference or policy that you don’t agree with, compare it to the current recommendations that WHO or CDC is making. If it doesn’t match up, then calmly provide the resource to explain why…then ask why they are choosing to do things differently than the current WHO/CDC recommendation. 

You may or may not be able to persuade them, but at least you can start the conversation. 

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What if my hospital won’t let me bring my doula…or my husband?

***UPDATED 3/30/20*** Let me show you exactly how fast this situation is changing…I originally wrote this section last night, and then woke up this morning to discover new developments already! Luckily, this development happens to be GREAT news for laboring Mamas!

New York has issued an executive order that requires that hospitals allow Mamas at least one support person with them during their hospital stay. 

(The original executive order can be found here, and then clarified here to explicitly include labor, delivery, and immediate postpartum.)

This is good news for everybody, because it indicates that this important issue is not being overlooked by our policymakers. 

(Either that, or Governor Cuomo has a pregnant Mama on staff who just wouldn’t let it go…)

In any case, I see this as a very positive sign! If New York is making support people a priority for laboring Mamas, then I expect that other states will follow their lead…even as COVID-19 cases increase in their areas, too.

Of course, we can still expect reasonable limitations on who the support person can be. For example, your support person must be healthy, as they will be screened for COVID-19. In addition, you will not be able to “swap out” your support person for someone else, and it your support person may be required to stay in the room with you and not go wandering around the hospital (like to the cafeteria…).

In addition, a new study examining 7 COVID-19 positive Mamas in New York may lead to additional policy adjustments: don’t be surprised if you and your support person are required to wear masks during your hospital stay. Of the 7 Mamas in this small study, 2 were completely asymptomic during childbirth, and only developed systems in the postpartum stage before being discharged

That means that 15-20 healthcare workers were unknowingly exposed to COVID-19…eek! Wearing a mask may not be ideal during labor, but it’s worth it to protect our health care workers.

Other than that, the below information is still good advice to stay educated on why allowing a support person is a good policy…just in case your local hospital system decides to “go rogue”.

***END OF 3/30/20 UPDATE***

This has got to be one of the most talked about (and potentially scariest) changes in hospital policies for laboring Mamas so far.

Despite what some healthcare providers may believe (and tell you…), laboring without a support person is not a recommendation from the CDC or WHO. 

In fact, as best I’ve been able to find (and I’ve been searching…), the CDC does not offer direct guidance on how hospitals should handle laboring Mamas who are not suspected to have COVID-19. The closest I can find is their general recommendations for how to minimize the spread of infection in the hospital, which suggests limiting hospital visitors in general.

However, even there they include a caveat that should certainly apply to laboring Mamas.

“If restriction of all visitors is implemented, facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.”

CDC Website, retrieved 3/29/2020

Of course, CDC recommendations are simply that…recommendations. They are not binding to individual hospitals. And even the wording of this recommendation is phrased in such a way that the hospital is well within their right to create a stricter policy (“…facilities can consider exceptions…”).

The WHO guidelines, while also non-binding to individual hospitals, are much more explicit in their recommendations for how to treat laboring Mamas…whether they are infected with COVID-19 or not. In fact, one of their bullet points describing “a safe and positive childbirth experience” includes:

Having a companion of choice present during delivery…

WHO Website, retrieved 3/29/2020

Notice that even this WHO recommendation implies having only a single companion. So if you bring this to the attention of your hospital and/or healthcare provider, they are still unlikely to allow both your husband and your doula to attend your birth (much less your mother, best friend, and other children…). But at least it gives you an opportunity.

The Royal College of Obstetricians and Gynecologists (RCOG) seems to offer the most extensive guidance, and at this time they are officially recommending that laboring Mamas be allowed at least one support person at all times:

Women should be permitted and encouraged to have a birth partner present with them in their labour and during birth. Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and well-being of women in childbirth. A single, asymptomatic birth partner should be permitted to stay with the woman, at a minimum, through pregnancy and birth, unless the birth occurs under general anaesthetic. Additional restrictions, such as limiting the number of birth partners to one, restricting any visitors to antenatal or postnatal wards, and preventing swapping and postnatal visitors, should follow hospital policy.

RCOG Website, from “Coronavirus (COVID-19) infection and pregnancy”, Version 5, retrieved 3/29/2020

If your hospital decides to implement a policy of not allowing any support people to stay with you during labor, it is certainly reasonable to bring these recommendations to their attention. (Preferably before you go into labor, just sayin’…). 

And here’s one last “talking point” that you can use to persuade your healthcare providers and hospital that it is in everybody’s best interest to allow a single support person to stay with you during labor. A 2008 study measured how much time nurses spent in the room with laboring women…and it was an abysmal 30%. And remember, not all of that 30% was even spent in “supportive” activities (aka, the nurse may have been prepping supplies or administering medication, but not providing direct labor support to Mama). 

Evidenced Based Birth offers an extremely informative overview of this issue (you can find her discussion of the 30% around the 8 minute mark). She also offers some suggestions that you can try to use to get your support person in the room with you, even if your hospital policy currently restricts all visitors. 

Some of her suggestions include speaking to reporters about this information before your due date, or laboring…loudly…out front of the hospital and refusing to go inside unless they allow your support person as well. 

But what to do if that’s not your style? And all your best efforts to change an overly restrictive hospital policy fail? Then you can always bring an extra long charging cord to the hospital, and video chat with your support person during labor. Although be aware that most hospitals also have a policy against “filming” the actual birth…so you may want to clarify that policy in this unique situation.

Or in this case…perhaps it may be better to ask forgiveness rather than permission. Totally up to you…

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What can I do to minimize my risk of catching COVID-19 while in the hospital…especially if my hospital is overwhelmed with Coronavirus patients?

  1. First of all, realize that your healthcare providers are doing everything possible to contain the spread of COVID-19 in the hospital setting. Thank them for their efforts! And don’t be afraid to ask them if they remembered to wash their hands. Handwashing is still the number 1 way to prevent the spread of Coronavirus, even in a hospital setting. 
  2. Make sure that you follow all of the commonly recommended infection control recommendations. Wash your hands after touching anything that may be contaminated (but don’t go crazy…remember that they are cleaning and disinfecting the hospital rooms after each patient…). Don’t touch your face unless you know your hands are clean (aka you just washed them). Oh, and if you are able to have a support person with you…these recommendations are for them, too.
  3. Labor at home for as long as seems reasonable, so that you can minimize the amount of time you are laboring at the hospital. (This is also good advice if you’re not able to bring any support people to the hospital…take advantage of them at home while you can!)
  4. If you have a support person with you in the hospital, make sure that they stay in the room with you. This means no running down to the cafeteria to grab a bite to eat! So pack accordingly…and maybe bring snacks.
  5. Talk to your healthcare provider in advance about getting discharged early if there are no complications. The average hospital stay after a vaginal birth is about 48-hours, but there’s generally no reason why a Mama and baby with no problems can’t go home sooner if they prefer it. And given the circumstances, I imagine many healthcare providers will be more than happy to help you get home quicker!

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What if I have COVID-19 when I’m in labor?

Don’t freak out: remember, all signs so far indicate that you will more than likely make a full recovery. 

In the meantime, having COVID-19 definitely does not negate your right to informed consent, as well as the autonomy to make your own decisions…even if they go against what the doctor is recommending. 

Simply be aware that your healthcare providers also deserve to take reasonable precautions for their own safety. And be respectful of that.

At the time I’m writing this, the CDC provides detailed guidelines for how to treat pregnant patients with diagnosed (or suspected) COVID-19 infection

You will likely be asked to notify the hospital in advance when you are on your way during labor. If you have mild COVID-19 symptoms, you may be asked to labor for as long as possible at home (so long as you have reliable transportation to get to the hospital when you need to!). 

Once you arrive at the hospital, you will probably be asked to wear a mask until you can be placed in an isolation room. In addition, the healthcare providers will be limiting their visits (and the time spent) in your room in order to protect themselves.  

That’s a good reason why it’s important to note that even when you have been diagnosed with COVID-19, it is very reasonable to request one healthy support person to remain with you. 

CDC has general recommendations for how to treat visitations that must occur, but these recommendations are not specific to laboring Mamas. They involve educating the visitor on proper hand washing for infection control, wearing appropriate personal protective gear, and not allowing the visitor to go elsewhere in the hospital. 

However, WHO clearly states that a laboring Mama has a right to high-quality care, regardless of her COVID-19 status. And part of that high-quality care includes having at least 1 support person present at delivery. 

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Will I be required to get an Induction or C-Section if I have COVID-19?

Absolutely not. This is a decision that should be made on a case-by-case basis between you and your healthcare provider, and based on your personal preference, particular situation, your current condition, and your health history. 

In fact, the WHO specifically advises that women testing positive for COVID-19 not automatically be given a C-section

And a recent meta-analysis that analyzed data from COVID-19, MERS, and SARS also recommended that diagnosis with COVID-19 should not be an indication that an immediate delivery should be scheduled.

That being said, if your COVID-19 symptoms become severe, then that may increase the likelihood that a C-section (or induction) would be the best option. 

But all that being said…remember that most COVID-19 infections are generally mild. Which should be very reassuring for us preggos right now!

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Will I be able to hold my newborn immediately after birth if I have COVID-19?

As part of their infection control guidelines, the CDC officially recommends that you be temporarily separated from your newborn immediately after birth. The purpose is both to reduce the risk of your newborn also contracting COVID-19 for you, and also to treat the newborn as a suspected COVID-19 case in order to prevent the spread. 

But the CDC also makes it clear that the decision to stay with your newborn or be temporarily separated should be made in accordance with you, the Mama, and your personal preferences. In fact, the CDC also provides alternative guidelines to follow should you decide that you would prefer to keep your newborn in the room with you during your postpartum stay.

The WHO takes this recommendation even a step farther, by emphasizing that COVID-19 positive Mamas should be supported to allow skin-to-skin contact, room sharing, and breastfeeding. 

Given the low rate of severe COVID-19 cases that we have seen in children so far, it seems reasonable to choose to keep your newborn with you, if you so desire. But you will want to take reasonable precautions, such as frequent handwashing and wearing a mask in order to reduce the risk of transmitting COVID-19 to your newborn.

And obviously, if your COVID-19 symptoms become too severe, then you may also want to evaluate your own ability to appropriately take care of your newborn until you are recovered.

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Can I still breastfeed if I have COVID-19? 

Absolutely! 

The CDC has clear guidance indicating that all mothers with COVID-19 who intend to breastfeed should be supported. So if you choose to stay temporarily separated from your newborn while you’re contagious, you should have access to a breast pump. And any pumped milk should be fed to your newborn by a healthy caregiver. 

And if you prefer to feed directly from the breast, then the recommendation is simply to wash your hands immediately before breastfeeding, and to wear a mask to reduce risk of transmission. 

The WHO offers similar guidelines, as does the RCOG.

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How COVID-19 could affect your postpartum experience

Remember! For the skimmers…don’t feel like you have to make decisions months in advance

Once you come home from the hospital with your newborn, the #SocialDistancing might seem even more of a burden than before. 

Long-distance family members may not be able to travel to see your new bundle of joy. Church members may be less likely to want to start a meal train. And even friends (or postpartum doulas) may not be able to come over and help clean or take care of your other children. 

It could feel socially isolating, or even overwhelming, to bring a newborn home without the social support many of us have come to rely on.

Personally, I think that the thing I’m going to miss the most will be getting newborn photos professionally taken…

Here’s some things that may be a bit different than normal when it comes to Postpartum care…

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Changes to Postpartum care routines

  • Don’t plan to bring your newborn with you for your Postpartum appointments…as much as your health care providers would love to see the bundle of joy that they helped you bring into the world, it’s much safer to leave baby at home.
  • If you planned to have your mom or another family member come to stay and help out, travel plans may need to be changed. Flying may not be an option. And depending on your family member’s ability and willingness to self-quarantine, you may want to consider what sorts of exposures they’d be bringing into your home. 
  • Check with your pediatrician to see if there are any changes to the recommended appointment schedule for newborns. If everything about your birth was normal and uncomplicated, then your doctor may want to utilize telehealth options.
  • Sadly, newborn pictures will probably have to be cancelled.
  • Friends may be less willing to drop off meals for a meal train (or they may simply forget, since they haven’t seen you in person!)
  • If you planned to hire a Postpartum doula to help, they may not be able to come into your home to do many of the “hands on” sort of things that they would normally help with
  • Although a lactation consultant appointment should definitely be considered essential, some lactation consultants may prefer to utilize telehealth when feasible. 

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Suggestions for how to make the best of this weird Postpartum situation during COVID-19

  • If your mom (or other family member) is willing to self-quarantine for 2-weeks, and lives in driving distance, then you may still be able to make the travel plans work while honoring the guidelines of #SocialDistancing. 
  • In my opinion, it’s actually a good thing to have tele-health options for baby’s first appointments! It gives you more time to rest and relax at home, while still having an opportunity to ask any burning new Mama questions you may have. If you’ll be delaying those first pediatrician appointments, then it might be wise to source an inexpensive baby scale so that you can monitor your newborn’s weight at home. (We use a fish scale!!) And if you choose to vaccinate, expect that you will need to come in for an in-person visit no later than 1-2 months if you want to stay on the recommended CDC schedule. But if you don’t choose to vaccinate, then there may not be a need to bring baby in-person as long as there are no health concerns and baby is gaining weight as expected. 
  • If you and your spouse are both stuck at home together, it can be some wonderful opportunities for newborn bonding time with Daddy! And also nice to have an extra pair of adult hands available to help out. 
  • Although it can be fun to see your friends “ooh” and “aah” over your new baby, you’ll likely 
  • Food delivery is easier than ever! Instead of only local friends signing up for your meal train, invite long-distance friends to participate as well! (After all, there’s no real reason to be concerned about the transmission of COVID-19 via take-out food)
  • In lieu of newborn photos, see if any area photographers are offering “Porch Pictures”. You and your newly expanded family can sit out front of your house while your photographer drives up to the curb, takes a few adorable pictures, and sends them to you in a few days. Alternatively, I have heard reports of some photographers who are offering a service to professionally edit photos that you have taken yourself. It never hurts to call around and ask!
  • Enjoy the extra “downtime” with your newborn. If there’s going to be a bright side to being forced to stay at home without any unexpected guests stopping by…it’s got to be more uninterrupted naps.

Got any other good ideas? Leave a comment to let others know about it!

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Should you switch to a home birth?

***UPDATE 4/1/20*** An excellent podcast about home birth during this pandemic was posted this morning by Rebeca Dekker of Evidence Based Birth. Definitely worth a listen if you’re thinking about it, or already planning one! One note…in the podcast, she mentions how some women in New York are being required to birth alone at the hospital…that guideline was changed due to an executive order between the recording of the podcast and when it was released. Yay!

***END OF 4/1/20 UPDATE***

The answer really depends on how far along you already are, what your personal health history is…and whether you would have ever considered home birth as an option under normal circumstances.

Remember…if all goes well, I will be having my fourth home birth in a few weeks! So I am a huge proponent of home birth. 

But I also recognize that home birth is definitely not for everybody. And it carries its own set of risks and benefits, the same as having a hospital birth does. 

That’s why it is super important for you to do your homework, thoroughly research your options, and find a home birth care provider who is a good fit for you and has availability to take on additional clients. 

Make sure to ask questions about what policies the midwife has in place for infection control right now, and what is her back-up plan if she becomes ill when you go into labor. 

Also, don’t assume that our current COVID-19 crisis won’t affect home birth. For example, in my previous home births I had the option of a water birth if I wanted. But this time, my midwives have already informed me that while it’s still perfectly fine to labor in the water, they will not be assisting with water births until the COVID-19 restrictions have been lifted. 

(And there’s a very good reason…there is still some reason to suspect that the COVID-19 virus could be transmitted in feces, and we know that it’s all too common to poop while in labor. Especially during the pushing phase. So if I pooped in the water while the midwives had their hands in it to help catch baby, then it could potentially put their health at risk. And we definitely don’t want that!)

And keep in mind, even if you switch to a home birth now, there is always the possibility that you may need to transfer back to the hospital at some point. For example, if you develop a fever (or any other signs of infection…especially COVID-19 infection…), then that (should) disqualify you from a home birth (and rightly so!). You might also need to transfer to the hospital if you have any other complications before or during labor, or even if you just decide that you can’t do it anymore (aka, no pain meds, remember?).

To give you an idea of your likelihood of needing to transfer to the hospital during labor, let’s review some statistics. In Emily Oster’s excellent book Expecting Better, she combs through the available research data and concludes that first-time Mamas have an approximately 30% hospital transfer rate, while Mamas who had a previous vaginal birth have a 10% transfer rate.

And according to my midwife (from a personal communication), her practice’s approximate hospital transfer rate for first-time Mamas is roughly 10-15%, while the transfer rate for “experienced” Mamas drops to 5%. 

Now, if you ultimately end up transfering to the hospital after you have switched to a home birth…then you’ve just ended up in the same situation you originally feared. 

Only now, you’re in a potentially emergency situation without a dedicated healthcare provider who knows you and has been working with you throughout your pregnancy. And unless your home birth midwife has hospital privileges (most do not), it is unlikely that she will be allowed to accompany you into the hospital under current COVID-19 restrictions that limit support persons to 0-1…unless you’d rather leave your hubby at home. 

All this to say…if  home birth was something you were considering anyway, if you’re a low-risk pregnancy (the best home birth candidate!), if you can find a home birth midwife that you connect with and has availability…then go ahead and switch!

But if the only reason that you are considering switching to a home birth is because you’re afraid of going to the hospital during COVID-19? Then it’s probably best to skip the home birth, and discuss your concerns with your current health care provider.

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How birth professionals are continuing to provide support right now

If there’s one thing I know about birth professionals, it’s that they’re passionate about their jobs.

(They have to be, otherwise they would never survive the unpredictable and stressful schedule that being a birth professional entails…)

It’s the type of job that is truly a labor of love (pun intended), and so it’s no surprise that many birth professionals are working hard to quickly pivot their businesses. They know the importance of continuing to support the many pregnant and birthing Mamas like us during this weird time of COVID-19!

Here’s a list of various birth professionals, and how I have seen them adjusting their service options to continue to provide as much support as possible to pregnant, birthing, and postpartum Mamas: 

  • Conventional OBs and Nurse Midwives: Many are moving to telehealth for appointments that don’t have to be “hands-on”. They are also working hard to communicate changes to you in a fast moving situation. 
  • Homebirth Midwives: Many are also offering telehealth appointments when possible. And in an effort to keep the appointments friendly and casual, some midwives are reportedly having “Virtual tea” with clients. They are also implementing other infection control policies that will help keep both you and them safe. 
  • Doulas: Unfortunately, many Mamas are being forced to choose between having their husband or their doula present during labor. To compensate, doulas are making themselves available as a virtual support person through video chats in the delivery room. Many are also leading online birth classes, and hosting Birth circles via zoom. 
  • Postpartum doulas: They may not be able to physically come into your home and provide hands-on help with baby and cleaning, but they can still drop off nourishing and nutritious postpartum meals, organize “no-contact“ meal trains, run errands, and do your grocery shopping (aka make sure you don’t run out of toilet paper…)
  • Lactation Consultants: Many are also offering telehealth appointments for those Mamas who need it, although some options may be limited due to the need for a “hands-on” assessment. And they are already accustomed to panicked phone calls from Mamas needing urgent troubleshooting for breastfeeding issues, so no change there!
  • Birth Photographers: Traditional Maternity pictures and Newborn photo shoots are gone, as well as the opportunity for childbirth pictures (unless you’re having a home birth and can have multiple support people present). Many photographers are offering Porch Pictures, which is a great option for a photo of your newly expanded family (or a cute shot of that baby bump). I’ve also heard reports that some photographers are offering packages where they professionally edit pictures that you took yourself, so it’s worth calling around to ask!
  • Naturopaths: If you’re into utilizing herbs as part of your wellness plan before or after pregnancy, then some naturopaths are offering virtual consults to customize herbal preparations suited to your specific needs. 
  • Online classes about all things baby: There has been an explosion of online classes on all topics recently. So whatever you want help with, you can find it…from baby sleep, what to do with colic, how to bond, and more.

Ultimately, if there’s something you need (or if you feel like you need something, but have no idea how to put it into words…), contact the relevant birth professional and talk to them. Chances are, they’ll be able to pinpoint the type of help you’re looking for, even if you can’t! 

After all, it’s kind of their job.

And if you think you can’t afford it, don’t assume that until you find out for sure! Call around because you may be surprised. After all, people in the birth profession understand how important their support is for women, and they all have a heart for helping. 

They certainly deserve to be well paid for their efforts, but they are also often willing to work with you on price, or refer you to other helpful resources that may be more in your budget. It never hurts to ask!

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Creative ideas for supporting pregnant friends during pandemic

I’m not judging anyone…but it is easier to forget about our pregnant friends when we’re not seeing them during our normal weekly activities. 

And that can be particularly hard on us preggos during a season of life where we want to feel like we’re “glowing goddesses”…but in reality, we feel like waddling ducks. 

So here’s a list of ideas for supporting your pregnant friends…all while still maintaining appropriate #SocialDistancing during the current COVID-19 pandemic:

  • Tell her she’s beautiful: When you see a pregnant friend post pics on Social Media, tell her how cute her baby bump is looking (and ignore the fact that she’s still wearing jammies, going bra-less, and who needs make-up anyway).
  • Speaking of Social Media…: If you see your pregnant friends mention a pregnancy craving, track it down and send it to them! Mail it, or drop it by their door (followed by a call or text, so the neighbors don’t snatch it). If you see them mention their pregnancy nausea, pick up a remedy that worked for you and pass it along in the same way. Let her know that you remember her!
  • Virtual Baby Shower: Your pregnant friend is probably bummed that her baby shower got cancelled, so plan a virtual one! Invite her friends, hop on a Zoom call, and play some goofy baby shower games. And don’t feel like everybody has to send a gift. You can also shower her with baby shower cards containing special messages from all her friends!
  • Send her a gift from her Baby Registry: Even if she’s not having a Virtual Baby Shower, you can still help her prep (and make her feel loved) by sending her something from her registry.
  • Hand-me-down clothes: Personally, I never turn down hand-me-downs! If you’ve got some that Mama-to-be could use, drop them off out front or mail them before baby is due to be born.
  • No contact meal train: Homemade meals are always appreciated and can be easily left at the front door, but with COVID-19 “Stay At Home” guidelines in place for so many areas, take-out and delivery has never been easier as well. That means that even out-of-town friends can participate, making it easier to fill a meal train (or even stretch it a bit longer). Don’t forget that restaurant gift cards are always appreciated, too, as sometimes postpartum Mamas need help even after the initial “rush to help” has ended…
  • Ask for pics of the precious newborn: Make sure to text Mama to ask for more adorable newborn pictures! Your postpartum friend is probably bumming that she can’t show off baby to anybody in-person, but she’s still craving all the compliments…so give her an opportunity to get them!
  • Provide online subscriptions: There are so many fun (and useful) online subscription options. Pick one that you think Mama (or her older kids…) might enjoy (or keep them occupied…), and gift it to her.
  • Send a postpartum care package: Postpartum Mamas are always starving, so a care package containing snacks is brilliant! Bonus points if she can eat it one-handed while breast or bottle feeding baby. (Double bonus points if you send chocolate…) And don’t forget her other kids…consider sending them a snack and/or activity so that they don’t try to steal Mamas.

Got any other useful or creative ideas for how to support pregnant and postpartum Mamas during a pandemic? Let me know in the comments so I can add them!

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Dealing with the grief of unmet birth expectations

There’s no way around it…this pandemic is changing the pregnancy experience. There are many formerly “normal” events that pregnant Mamas like me are going to miss out on…baby showers, photo shoots, family and friends “oohing” and “aahing” over our little bundle of joy. 

I know how you feel…I’m due in about a month, and it looks like I’ll be missing out on a newborn photoshoot. Plus, even though it’s my 6th pregnancy, it’s the first baby that hasn’t been celebrated with a baby shower. And we may be keeping our kids in the house (rather than sending them to stay with friends) when it’s “go” time for our home birth…I’m a bit anxious about how we’ll all handle that one.

You may be struggling with different issues than I am. Maybe you’re struggling with issues like:

  • Family members who can’t travel to help out during the birth
  • Feelings of loneliness, or loss of physical touch…especially if your husband has an essential job that requires travel, or deployed with the military
  • Not being able to show off your precious baby to friends and family
  • Missing out on all the fun excitement that comes with a first pregnancy
  • Not being able to savor every moment of a last pregnancy
  • Friends not willing/able to watch your older kids during labor because of #SocialDistancing
  • Waiting for older siblings to meet their new baby until you’re home from the hospital
  • Fear of hospital germs
  • Worry that stores will be sold out of necessary baby items when you need them
  • Fear that you’ll have to labor alone

It’s totally okay to grieve things like these. 

So sit with it a little bit, have a good cry, and vent to a friend. 

Process your feelings. It’s all good.

Then gather your resources, and look for ways that you can still enjoy your pregnancy and postpartum period during this weird time of pandemic. 

  • Create an online baby registry anyway: Even if your baby shower won’t be happening, you can have fun “shopping” online and dreaming about baby items. (And at the very least, many stores offer discounts after baby is born for items that you “finish buying” off of your registry…so take advantage!)
  • Pack an extra long charging cord in your hospital bag: If your other children, close family, or friends can’t come visit you in the hospital, then you can always plan a virtual visit. Let your older kids “meet” their new sibling via video chat so that they can feel part of the excitement even before you come home. 
  • Learn the signs of postpartum depression: There’s a decent chance that this pandemic could cause an increase in postpartum depression rates. Don’t be fooled…it’s not only about “feeling sad”! Postpartum depression symptoms can also include anxiety and anger and irritability. Be quick to seek out help…it should be easier than ever, with so many telehealth options right now!
  • Consider hiring a doula: Even if they can’t come with you physically to the hospital, they may be willing to come to your house and labor with you at home before you go. At the very least, doula’s can serve as a sounding board to validate your feelings and help you focus on the positive aspects of your pregnancy. Who knows, maybe they’d even be willing to watch your other kids for you when it’s time to go to the hospital so that you can have your husband with you for the birth…it never hurts to ask!
  • Gather your own support group: Connect with other Mamas who are due around the same time, because they are trying hard to process the same crazy things that you are. Join a virtual Birth Circle, a Facebook Group based on due dates, or even an online chat room. Find your tribe.
  • Utilize positive, online resources: You know, the kind of resources that will help you calm down (definitely not freak you out some more…). Here’s a few I like:
  • Let yourself grieve: Don’t let anyone tell you that these things aren’t worth grieving. We’re all different…different life experiences, different hopes and dreams, and different ideas of what our ideal pregnancy would be like. And we’re all being disappointed right now. It’s okay to feel sad, angry, disappointed…a whole range of emotions. Just make sure to talk it out with someone. 

But for now? I’m doing my best to enjoy my favorite part of every pregnancy…feeling baby boy rolling around in my belly. I don’t know if this will be my last pregnancy or if there are more in my future, so I want to savor these small moments while I can.

I’m taking it one day at a time…because in all honesty, none of us know for sure how this pandemic is going to play out, or how long it will last. 

But in the meantime, there’s a lot to be hopeful for, too! Technology makes it easier than ever to find creative ways to connect with other Mamas in similar situations. 

And in the end? We still get a sleepy newborn to snuggle with.

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***LEAVE A COMMENT: What other questions or suggestions do you still have? Let me know in the comments, so that I can add them in for the next update!***

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2 thoughts on “Pregnancy, Birth, and Postpartum During COVID-19”

  1. Thank you for all the Covid 19 pregnancy and postpartum research. Excellent resource, and I’ll be checking back for updates!

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