The Coronavirus has sent anxiety amongst the entire population, but for expectant mothers, there is added stress and worry. Are hospitals safe to give birth in? What happens if I get infected?

New data out of Iceland shows 50% of all Covid19 infected individuals have no symptoms, yet they can pass the virus to others without knowing. So what does this mean for pregnant women about to give birth?

There is enough anxiety in the last trimester of pregnancy with labor on the horizon already. Add fears surrounding the Coronavirus and shelter-in-place orders…women about to give birth are facing an entirely different world than they imagined nine months ago.

Pregnant women may worry:

• How will shortages in medical supplies affect them?
• Will their partners be allowed in the delivery room?
• What happens if they have Covid19?
• What are the risks to babies?
• Is it safe to give birth in a strained hospital setting?

Furthermore, many OBs have shifted prenatal care to virtual visits making one wonder if they might miss any signs of an abnormal pregnancy.

Giving birth without a partner

In some Los Angeles hospitals, triage areas are restricted to mothers in labor only while their partners have to wait in their car. In some cases, partners are allowed to meet the newborn for a few minutes after birth, then asked to leave again. This is certainly not in the birth plan mothers created.

The same situation of isolating mothers from their partners while in labor is occurring across the United States, with some states, like New York, flip-flopping on the decision to isolate mothers from their partners in labor.

Pregnant women are considered “high-risk” for Covid19

Doctors have identified people with certain pre-existing conditions, such as heart disease, as at higher risk of complications and death from the Coronavirus. One population not included in most lists is pregnant women.

NPR explains:

Because COVID-19 is so new, definitive answers are hard to get. So far, there doesn’t seem to be evidence that women are more likely to contract the virus when they’re pregnant, and limited research suggests that the coronavirus cannot be transmitted during childbirth or breastfeeding, although the preliminary studies are sometimes conflicting.

“The reality is we don’t have a lot of data related to outcomes in pregnancy in women who have COVID-19 or their risk of contracting COVID-19,” says Maureen Phipps, chief executive officer of American College of Obstetricians and Gynecologists, “and that does put us at a disadvantage.”

Pregnant women are considered an “at-risk population for COVID-19” because they’re generally at higher risk from respiratory infections, so numerous hospitals nationwide are minimizing childbirth visitors and doing more prenatal visits by phone or online, as recommended by the American College of Obstetricians and Gynecologists.

Pregnant Women Worry About Pandemic’s Impact On Labor, Delivery And Babies

Can my baby get the Coronavirus from in me labor?

The good news out of China is that it does not appear that mothers pass on Covid19 to their children during labor. The bad news is that the virus might increase the risk of fetal distress and the need for a c-section.

Researchers from the College of Medicine at Zhejiang University in Hangzhou, China report of a 30-year-old pregnant woman with Covid19 who gave birth to a Covid19-free baby via c-section. She was 35 weeks pregnant when doctors decided to perform an emergency c-section three days after hospitalization. The infant was tested seven times in its first two days of life with negative results; however, it was not released from the hospital until 15 days after birth five days later than its mother.

Another small study of 9 pregnant women in China with Covid19 found similar results of negative Coronavirus, though the babies did not all survive. The virus did cause fetal distress, for example, necessitating birth by c-section.

The authors conclude:

Conclusions: Perinatal 2019-nCoV infection may have adverse effects on newborns, causing problems such as fetal distress, premature labor, respiratory distress, thrombocytopenia accompanied by abnormal liver function, and even death. However, vertical transmission of 2019-nCoV is yet to be confirmed.

Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia

If I have the virus, will my baby be separated from me for 14 days?

According to hospital and CDC guidelines, the answer is likely yes.

Even if the transmission of the Coronavirus during labor is unlikely, the highly contagious nature of the virus has caused doctors to be cautious.

The CDC uses the term person under investigation (PUI) in terms of evaluating and assessing for Covid19 and makes the following recommendations for positive Covid19 and PUI new mothers:

It is unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of  transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued, as described in the Interim Considerations for Disposition of Hospitalized Patients with COVID-19. 

Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings

The length of this isolation is dependent upon the mother’s condition, but given quarantine recommendations of 14 days, that could be a possibility depending on the date of diagnosis.

One bright side, this separation does not discourage feeding the newborn child breastmilk. The CDC states women can express their breastmilk to be fed to the child by a health care worker. In addition, the CDC states, “If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding.”

Should all pregnant women be tested for Covid19 before labor?

Given the large number of asymptomatic Coronavirus cases and the risks to the newborn during labor, in a perfect world, all mothers would be screened prior to delivery. Unfortunately, the lack of available tests in the United States and the criteria for using them, this is unlikely to be advised by public health officials.