Pregnant in the time of COVID-19

BEING a pregnant woman or a new mom is as amazing as it is nerve-racking. It can be a very anxious time in your life, filled with lots of fears and uncertainties. Coupled with the COVID-19 pandemic, one can imagine how uneasy pregnant women and new moms must be feeling in these unprecedented times. 

Being a mother myself, and a physiotherapist who works with numerous mothers, I decided to get some answers from Dr Theophilus Nelson, senior resident in obstetrics and gynaecology at The University Hospital of the West Indies.

KH: What are some of the changes implemented at the University Hospital to protect pregnant women?Dr Nelson: There are numerous changes with the physical structures as well as the day-to-day operations. As per regulations stipulated by the Ministry of Health where no more than 10 people can gather within any confined space, we have had to adjust our usual number of patients to facilitate this requirement. Patients who are high risk and need to be seen more often are called in advance and told when to come in.

For lower risk patients we extend the intervals at which they would be seen, just as a way to limit exposure for pregnant women who would have to come to the hospital. We also use a triage system to ensure we don’t compromise your care. We have a system where you can call our antenatal clinic — we actually recommend calling before coming in, so our medical team can decide if your concerns require coming in or if we can advise or reassure you over the phone.

We have also been utilising telemedicine a lot. We are trying our best to not compromise on care, but at the same time keep our patients safe in this uncertain time.

KH: Why are pregnant women in the vulnerable group for COVID-19?Dr Nelson: We call COVID-19 the novel coronavirus because we have never been exposed to a strain of coronavirus like this before. In terms of pregnant women being considered in the vulnerable group, women have to make many adaptations in their bodies to accommodate babies. A baby in the purest sense can be considered foreign in a woman’s body. In order for the body to accommodate something that is considered foreign, the immune system is weakened to prevent the body from rejecting the baby.

So basically, as a natural response in pregnancy, the immune system weakens to facilitate maintaining the pregnancy. With a weakened immune system a woman might be more susceptible to infections, including viruses. However, one of the most important things to note is that based on the information we do have currently, healthy pregnant women are at no greater risk of contracting COVID-19 than our normal, healthy population. Therefore, this consideration of pregnant women being in the vulnerable group is really out of an abundance of caution and our general knowledge on pregnancies.

KH: Are mothers allowed to have their spouses in the room during delivery? Dr Nelson: Every institution has their own policy and there are also governing bodies who produce their own recommendations. These bodies do allow for the partners to be present generally, once both partners are uninfected, under specific guidelines. For infected partners or mothers, there are provisions made to have partners present given that they are wearing the proper protective equipment, but locally that may not be the same.

There is a need to preserve the personal protective equipment we have available for our health care workers, so our health institutions would not be able to provide partners with protective equipment. So, from a resource standpoint, that might be a challenge.

KH: What about mothers who fear being exposed to the virus at the hospitals and clinics and would prefer to avoid these settings altogether? Dr Nelson: It’s a legitimate concern especially now when you are being advised to stay at home, but there are certain checks that need to happen at a clinic that would require a pregnant woman to come in and maintain her antenatal visits. But to put patients’ minds at ease, I will reiterate some of the policies put in place to protect them.

Before patients are called in for their appointments, there is a process which begins with screening them over the phone by asking particular questions to see if they have any symptoms or possible exposure to the virus. Before people are even allowed to enter the hospital compound their temperatures are checked with infrared thermometers.

We are able to triage our patients coming into clinic in order to limit the chances of patients with symptoms intermixing with patients without. If individuals do have symptoms, we recommend they call ahead so that we can plan for them in advance and know exactly where to take them so they can be managed appropriately.

KH: What can pregnant women do to reduce their anxiety?Dr Nelson: It is a very anxious time even for us doctors because of the uncertainty associated with the virus, but there are certain things that we do recommend. In addition to taking the general precautions recommended by the Ministry of Health, practise social distancing, limit the number of people in your vicinity, and maintain proper hand hygiene. It is also important to take care of your mental health. Constantly feeding yourself with COVID-19-related information is not advised — instead choose a particular time of the day to read updates. This is the same advice given to us (doctors) to protect our mental health.

The truth is the vast majority of the population will be fine. Most people who do get COVID-19 will only display mild flu-like symptoms that resolve quickly over a few days, and will get back to life as before. We have to use this fact to reassure ourselves and not immerse constantly in COVID-19-related news.

KH: If a pregnant woman is having symptoms, what numbers should she call?Dr Nelson: The pregnant woman who suspects she has coronavirus would go through the same process as any other member of society right now — that is to call the 888-ONE-LOVE hotline where she would be appropriately advised. If she is a patient at the University Hospital, there is a tele triage system that you can call — the numbers are 876-541-1043-4.

Next week: Part 2 —Newborn babies and COVID-19.

Kimberly Hoffman is a physiotherapist who is currently specialising in women’s health and fitness.