What to expect when you're expecting in a pandemic

Pregnancy, birth and introducing your little one to the world can be an incredible time as well as a stressful one. Throw in a pandemic that has dramatically changed the pregnancy experience and you might be wondering how to keep yourself and your baby healthy, and how you can mind your mental health at this tricky time.

Fortunately, Dr Elise, our GP that specialises in women’s health, has answered a few commonly asked questions on pregnancy and COVID-19.COVID-19 brings new challenges to parents of newborns and as a GP I have continued supporting parents throughout their pregnancies and beyond into the postnatal period with their new baby, during this pandemic.

Here are the most common questions I’ve been asked by people who are pregnant during this complicated time.

How do I protect myself and my unborn baby from COVID-19?

Studies from the UK show that pregnant women are no more likely to get seriously unwell from coronavirus than other people, but pregnant women have been included in the list of people at moderate risk (termed ‘clinically vulnerable’ in the UK) as a precautionary measure¹.

This means you should follow government/CDC advice about social distancing, stay away from public places and avoid anyone who has possible coronavirus symptoms, particularly if you are in your third trimester¹.

It is still considered necessary for pregnant people to go out for essentials, such as food shopping, exercise and attending antenatal appointments.

The key advice for all pregnant people is¹:

• Follow the social distancing guidelines and the use of face masks (follow the specific advice in your part of the world)
• Stay at home if anyone in your household has coronavirus symptoms
• Stay mobile and hydrated - this can reduce the risk of blood clots in pregnancy
• Keep active with regular exercise
• Eat a healthy, balanced diet
• Take folic acid and vitamin D supplements. This is essential in all pregnancies but particularly at this time as there have been some reports that people with low levels of vitamin D are at an increased risk of serious complications if they develop coronavirus
• Go to all of your pregnancy scans and antenatal appointments, unless you're advised not to
• Contact your maternity team if you have any concerns about your baby's wellbeing or yours

What effect does COVID-19 have on pregnant people?

We already know that pregnancy suppresses immunity slightly and can alter how your body handles severe viral infections, so some people can sometimes be more at risk from viruses like the flu.

However, all available evidence suggests that pregnant women with no underlying health problems are at no greater risk of becoming seriously unwell than other healthy adults if they get COVID-19¹.

The large majority of pregnant people experience only mild or moderate cold/flu-like symptoms. There seems to be no evidence that COVID-19 causes miscarriage or that it affects the development of the baby¹.

Pregnant people from Black, Asian and minority ethnic backgrounds, people over the age of 35, those with a BMI of 30 or more, and those who had pre-existing medical problems, such as high blood pressure and diabetes, are at higher risk of developing severe illness and requiring admission to hospital¹.

Occupation can also increase the risk of severe illness for COVID-19. For example, healthcare workers and people who work and/or learn in close quarters with others are at a higher risk of infection and/or severe illness.

Will my prenatal care be affected by the pandemic?

To keep you and your baby and family safe, many hospitals are trying to reduce the number of people coming in for appointments. This will help limit the spread of the virus¹.

Your maternity care may include more home visits or some care and support may be provided over the phone or by video to reduce the number of times you need to travel and attend hospital/clinics. It is completely understandable to feel a bit anxious about this, so do discuss this with your midwife¹.

Some visits in person with a midwife or doctor like myself, are essential and it is important for the wellbeing of you and your baby that you attend these to have routine checks. You will be required to follow infection control guidelines as required by your medical facility¹.

Can I still attend my antenatal appointments if I am self-isolating?

It is likely that routine prenatal appointments will be delayed until your self-isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements can be made for you to be seen¹. Please contact your OB/GYN or midwife for further information and instructions on appointments during self-isolation.

What should I expect when I go into labour?

The hospital experience for pregnant couples can vary depending on where you are in the country or world. For example, some places had to pause their home birth services or close their midwife-led units. It seems that things are returning to a bit more normality now, but it is very much country and area dependent, so it is best to run this question past your OB/GYN/midwife¹.

Can I have my partner with me at labour and birth?

Having at least one trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of people in childbirth. Throughout the pandemic, most facilities allow only one support person present at the birth and this includes those that have been induced and caesarean sections¹.

If a birth partner has symptoms of COVID-19, has recently tested positive for COVID-19 or is required to self-isolate for other reasons (e.g. recent contact with an infected person), they will likely not be allowed to enter the hospital in order to safeguard the health of you, other people and babies and the maternity staff supporting you1. Please check with the facility you will be delivering at and/or your OB/GYN or midwife.

I am so stressed - will this affect my baby?

Pregnancy, birth and introducing your little one to the world can be an incredible time, but also put extra pressure on your mental health at the best of times. Add in a worldwide pandemic that has dramatically changed the pregnancy experience and this can exacerbate feelings of anxiety, isolation or worries about the future.

I have noticed specifically that anxieties are likely to revolve around²:

• The virus itself. Parents are worried about catching the virus, transmitting it to their newborn and keeping their child safe during infancy
• The impact of social isolation resulting in reduced support from wider family and friends
• A strain on finances and job insecurity in certain industries
• Uncertainty in the way people are going to receive their parental care including appointments being changed from face-to-face to virtual contact

These are all widely recognised risk factors for mental ill-health so if you feel that you are suffering from anxiety or low mood please reach out and speak to your doctor and midwife.

How can I reduce my stress levels when pregnant?

The good news is that pregnancy stress during the pandemic can be reduced.

• A strong social support network can help hugely and although this cannot be face to face, technology these days allows free access to video calls which can help you feel connected. It helps to know that you don't have to get dressed up and travel but have a chat with your friends and family from the comfort of your sofa- this can be a huge weight that is lifted in an otherwise potentially stressful experience.

• Try to join a prenatal class - many of which have gone online. These can be a really important support group in the later stages of the pregnancy and when your baby arrives.

• Relaxing activities (gardening, yoga and listening to music) and mindfulness techniques have all been shown to help.

• A healthy diet, adequate sleep and exercise can also help - think healthy body, healthy mind.

• Try to avoid speculation and focus on reputable sources which can be hard on social media, and try to not watch or read too much news.

• Try to focus on you and your little one, and if it all feels like it is getting too much, it's ok to seek help and support and share how you are feeling with somebody you trust.

We are here to help you through this journey as well supported as possible.

References

1. Royal College of Obstetricians & Gynaecologists. 2021. Coronavirus infection and pregnancy. [online] [Accessed 18 February 2021].

2. Tubb, A., 2021. COVID-19 information and support from Maternal Mental Health Alliance members | Maternal Mental Health Alliance. [online]