Being pregnant is hard and expecting a baby during the coronavirus pandemic is harder. Pregnant women normally have to face certain problems throughout their nine months of pregnancy but with the novel coronavirus, that has been exacerbated. The anxiety of ‘to be’ mothers has grown exponentially as they are among the high-risk group and prone to complications, especially during these times.
Covid-19 has been an overwhelming crisis for the healthcare industry and prenatal care presents a major challenge. Amid a hoard of worries disturbing the mental well-being of pregnant women coupled with restricted movement due to the pandemic, Dr Vivek Jain, Director and Head of Department, Neonatology, Fortis Hospital Shalimar Bagh, lists their common concerns. “One of the problems is lack of physical activity and outdoor exposure that has led to various physical ailments and a psychological impact. Another concern is the difficulty being faced by them in visiting the hospital for their regular antenatal checkups and ultrasound examinations. We call them only for the essential visits and cover their doubts through telemedicine,” he says.
Covid & pregnancy complications
Does Covid-19 increase a patient’s risk of complications during delivery? Dr Sweta Jaiswal, Resident (OBGYN), Holy Spirit Hospital, Andheri East, Mumbai, says, “Usually Covid-19 doesn’t increase risk significantly in mild to moderate cases. But in severe cases, urgent termination may be required to relieve pressure on diaphragm due to gravid uterus so that lungs can expand. The patient may require non-invasive or mechanical ventilation. Pregnancy is a hypercoagulable state and due to Covid-19, it further increases. Hence they should be given low molecular weight heparin in moderate to severe cases.”
“With the advancement of technology, many kinds of childbirth and delivery methods are available among which the safest in case of Covid-19 is Normal Vaginal Delivery as it demands shorter hospital stays, lower infection rates, quicker recovery and babies born vaginally have a lower risk of respiratory problems,” adds Dr Sandeep Chaddha, obstetrics and gynaecologist, Motherhood Hospital Noida.
In the meantime, the precautions Covid-positive mothers should take after delivery like mothers should maintain distance from baby except during feeding, before feeding hands to be washed properly, while feeding she should wear a mask and avoid coughing while feeding. In case if symptoms worsen then visit the hospital immediately.
Does virus transmit from mother to foetus?
Whether or not Covid-19 can be transmitted from a mother who has been tested positive for the virus to the developing foetus is a topic of debate. Research has shown that breastfeeding has to be continued even in Covid-positive mothers as the benefits outweigh the risks.
Breastfeeding mothers (with Covid-19) are advised to continue feeding by taking the usual precautions of masking and strict sanitisation or extracting the breast milk beforehand to avoid infection. Dr Sudeshna Ray, consultant obstetrics and gynaecologist, Jaslok Hospital & Research Centre, Mumbai, says, “The evidence so far is not conclusive of transmission of the virus from the positive mother to the baby while in the womb. There are some studies which have not shown any transmission while some other small studies have shown a neonatal infection of SARSCOV-2 following birth from symptomatic positive mothers. More robust and longer studies are needed to come to a reliable consensus and research is being carried out for the same. So far, breast milk is not found to be carrying the risk of infection to the breastfed baby but the proximity to the positive mother carries the risk.”
Alternatives are asking a positive mother to feed the baby or using an exclusive, well-sanitised breast pump and accessories to avoid transmission through contact and droplet infection. The asymptomatic Covidpositive mothers can follow general precautionary measures such as washing hands, breasts and nipples well before feeding, wearing a well-fitted mask (only the mother) and avoid coughing and sneezing while feeding and continue to do direct breastfeeding.
With regards to vertical transmission (transmission from mother to baby during pregnancy), the data available so far confirms that transplacental transmission is indeed possible in the last weeks of pregnancy, says Dr Sunil Eshwar, lead consultant, obstetrics and gynaecology, Aster RV Hospital. “Since Covid -19 is a relatively new virus, we are learning about its effects on pregnancy and childbirth as time progresses. Although the results so far have not been proven to be detrimental to the baby, the long-term consequences of this virus on the new born are yet to be researched,” he further adds.
Avoid clinics if not serious, go for telemedicine
With the rising fear among pregnant women to attend the doctor in clinics/hospitals, many are relying on telemedicine for routine checkups and there’s a surge in online consultations. “Since pregnancy itself is considered a physiological immune-compromised state which makes them more vulnerable to infections, it’s desirable to minimise the exposure. A to-be mother comes for a physical consultation when she is assured of the safety measures taken in the hospital,” says Dr Ray.
She adds, “For the birthing process, usually, they have no inhibitions to come to the hospital. The healthcare care providers have to ensure all measures for safety against the virus are strictly in place which needs to be communicated to the pregnant women’s family. Only one relative can stay with the birthing woman throughout her stay these days for as short a period as possible.”
Anxieties and apprehensions of pregnant women can be largely addressed through telemedicine but the occasional need for physical examinations and tests remain unmet. “Often, they have to make do with suboptimal imaging services from nearby facilities, thus impacting diagnosis and eventual care. We are currently encouraging remote consultations for planning and counselling, thereby avoiding extensive in-clinic interactions,” says Dr Rohit Gutgutia, Medical Director, Nova IVF Fertility East.
Hospitals treating Covid-19 patients seem a risky option for delivery, but single super speciality hospitals can be a better choice. Dr Chaddha says that for new-borns, single speciality hospitals are the best as the chances of contracting coronavirus infection are minimum there. They have advanced technology and infrastructure, to take extra precautions and safety guidelines for both deliveries and taking care of newborns. But if the hospitals take precautionary steps to make the would-be mothers feel safe and at ease in a hospital during delivery, then they can be trusted. Dr Jain says, “Since the pandemic, we have trained our staff to exercise additional measures. We have dedicated OTs and delivery rooms, which are separate from those housing Covid-19 patients. There is rigorous screening as per ICMR guidelines.”
