Life finds a way: A complete guide for expectant mothers in the time of COVID-19

The pandemic has made pregnancy a particularly tumultuous time for mothers-to-be and new moms. But there's no reason to panic -- here's what to expect and follow during the various stages.

Pregnancy is a tumultuous time for any woman. The mixed bag of emotions can be daunting and exciting in equal measure. But with the outbreak of the COVID-19 pandemic, the overriding emotion in mothers-to-be has been one of anxiety rather than happiness. 

The world may have come to a screeching halt, as it is battles the COVID-19 pandemic. But even in epicentres, children are being born. Because life always finds a way. But there are many questions are making life difficult for new mothers and mothers-to-be:

  • What are your chances of infection?
  • How do you avoid getting infected?
  • What can you do to ensure safe prenatal checkups?
  • What are the protocols that hospitals need to follow?
  • What if an expecting or a new mother tests positive?
  • Can they pass the virus to the baby?
  • Why are the guidelines circulated by the WHO different from those that ICMR has, and whom do you follow? 

Given the limited understanding about the impact of the virus in pregnant women, information is still trickling in. But here is what we know.

Antenatal care

  • What are your chances of getting infected?

Though governments around the globe have classified pregnant women, along with the elderly and children, among the vulnerable, the Indian Council For Medical Research (ICMR) guidelines state that pregnant women are not more likely to contract the virus than the rest of the population.

COVID-19 isn’t as dangerous as the SARS virus. The chances of infection depend on the medical history – women with heart disease are at the highest risk of an infection. However since pregnancy impacts the immunity of a woman’s body, prevention is advocated to be better than cure. 

  • How do you avoid an infection?

The evidence so far does not suggest that pregnant women are at higher risk than the general population against the virus. However the basic rules of hygiene apply – wash your hands regularly with soap and water; practise social distancing ( it is advisable to avoid baby showers and other rituals to limit exposure); consult with your doctor about flu shots which will protect you from influenza (not COVID-19) to reduce complications.

  • Is it safe to go for your prenatal checkups and what are the measures to ensure safe pre natal checkups?

Most hospitals have moved prenatal check-ups online through video conferences. Dr Prakash Kini, a senior OB-gyn with Cloud Nine Hospitals in Bengaluru said, “Except for scans and blood tests, we have moved consultations online through video conferencing. We even suggest that people get blood tests done from their homes. This minimises any risk of infection. Even with the people who come for scans, we have a data bank with their addresses which helps us identify if they come to us from containment zones. They have to submit to a COVID test in that case.”

Preethi Sunil, a 40 year-old software engineer, who gave birth in the last week of May, was one of those patients who had to go for an ultrasound. “Of course the hospital took all the measures, but personally, I would sanitise files and reports I had to take with me after I returned home, leaving them aside till the next appointment.” 

So far there has been no evidence to suggest any kind of foetal abnormalities or increased rate of miscarriages among patients who tested positive for the the virus.

At birth

  • How do you prepare for the birth of the baby?

A COVID-19 test is conducted for the mother-to-be at the time of admission, according to the ICMR guidelines. While some of the large cities have worked with private hospitals to collect samples from homes of their patients (Delhi, Chennai, Mumbai), others started with testing only those women who reside in red zones like Bangalore.  While guidelines allow for a single asymptomatic partner to be present with the pregnant woman, hospitals are trying to minimising it.

Shantala Hegde, a thirty year old HR professional, who delivered on April 9th spoke of her experience: “My husband and I had planned for him to be there in the labour room through the entire birthing process, and have him cut the umbilical chord. However the new guidelines meant that couldn’t happen. Even when I had to go for scans, the hospital would not allow my husband to come in with me, to limit the infection. We had our temperature checked every time. Mentally, be prepared to handle a few things on your own.” 

Post delivery care

Shantala, who gave birth to a healthy baby boy, found herself in a situation when her baby developed jaundice. “We had to admit him in the hospital overnight to monitor him. Again, precautionary measures meant that only I was allowed to stay with my son.”

Shantala’s hospital has made arrangements for home vaccinations as well. The ICMR guidelines ask the hospitals to reduce the number of antenatal visits as much as possible. 

Even when I had to go for scans, the hospital would not allow my husband to come in with me, to limit the infection. We had our temperature checked every time. Mentally, be prepared to handle a few things on your own.

Shanthala Hegde, who delivered a baby boy in April 2020

If you test positive

It is the most terrifying question in these times that an expectant mother faces. But it is not going to be all bad. Let us first give you some news that will calm you down.

So far there has been no evidence to suggest any kind of foetal abnormalities or increased rate of miscarriages among patients who tested positive for the the virus.

However, there is set of protocols that have been established to deal with pregnancies as opposed to the previous times.

A COVID test from a designated lab is mandatory for a lady before her delivery. If you test positive and are asymptomatic, the rules are varied about whether you are allowed to home quarantine or not depending on each state. At the time of writing this article, the ICMR guidelines did allow for home quarantine for asymptomatic patients.

At the time of delivery you will be shifted into an isolation ward in a COVID designated hospital and the child will be temporarily separated from you to avoid contagion.  

While the WHO guidelines encourage breastfeeding and skin to skin contact even by mothers who are COVID-19 positive, the ICMR has suggested COVID-positive mothers to use breast pumps to maintain food supply for their child.

Again, there has been no evidence so far to support the idea that the virus is transmitted through breast milk. The reason for caution is to avoid infections through nasal and mouth secretions. Mothers are advised to wear a mask if they are breast feeding directly.

To wrap up, the conversation about general mental health has been at the forefront during this pandemic and it could not be more important in case of expectant or new mothers. A support system is extremely important – family, friends etc are vital in keeping you happy and calm. Reach out to them, ask for help, talk to people when you need it, consult your doctor when you feel it getting overwhelming.

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