Everything we know (so far) about giving birth during the COVID-19 pandemic

The impact of coronavirus is unprecedented.

Everyone in the world is worried right now—we are worried about our collective wellbeing, and of course, we are worried about ourselves and our own unique circumstances. If you are pregnant during this wild time, you likely have even more on your mind. Mama, I am so sorry this is happening.

Your mind is likely reeling with all of the stories on the news and social media. Perhaps one of the hardest parts of this is that we are still learning. Few questions have solid answers. Still, every day we know more, and I want to assure you that although it feels scary, there is still a good chance everything will be okay, especially if you take the proper precautions.

Let’s take a look at some of the questions you may have about giving birth during the COVID-19 pandemic.

Can babies born to mothers with COVID-19 contract the virus?

So far, it does not appear that COVID-19 can be transmitted from a pregnant woman to her fetus. A small study was done in Wuhan, China, looked at four pregnant women who were known to have COVID-19. After their infants’ were born, three consented to infant-testing, and all were found negative. None of the four babies had symptoms of coronavirus.

Previously, a study of nine women had similar findings. On March 24th, 2020, a report by David A. Schwartz, M.D., from the Medical College of Georgia at Augusta University in Atlanta, that reviewed the cases of 38 pregnant women with COVID-19, found that “there were no confirmed cases of intrauterine transmission of SARS-CoV-2 from mothers with COVID-19 to their fetuses.”

Of note, most of the women in these studies had Cesarean sections in an attempt to reduce transmission—it is important to note that no changes in practice have been recommended yet, though. In other words, we are not currently suggesting that all pregnant people with COVID-19 have Cesarean sections. We simply need to learn more.

The American College of Obstetricians and Gynecologists (ACOG) writes that “adverse infant outcomes (e.g., preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, this information is based on limited data and it is not clear that these outcomes were related to maternal infection. Currently, it is unclear if COVID-19 can cross through the transplacental route to the fetus.”

A report released on March 26th, 2020 did state that we still cannot rule out in-utero transmission—this, in response to 3 babies who tested positive for COVID-19 on day 2 of life.

The current data does not show concern, though certainly, scientists are monitoring the situation very closely.

Here is what Sarah Bjorkman, MD, Motherly’s Medical Advisor, has to say about it:

“There is no hard evidence (yet) of a mom passing the virus to baby during the pregnancy/birth, but a new case report published today suggests it may be possible….The handful of positive cases of COVID-19 in babies seem to be from exposure AFTER birth.”

She also reassures that there is no evidence of birth defects due to COVID-19.⠀

Are there any cases of newborns with COVID-19?

Since March multiple newborn babies have tested positive for COVID-19 shortly after being born.

According to the CDC, “a very small number of babies have tested positive for the virus shortly after birth” and that while it is unknown if these babies got the virus before or after birth, “mother-to-child transmission of coronavirus during pregnancy is unlikely.”

Basically, newborns are susceptible to person-to-person spread after birth, and research suggests the youngest children are more severely impacted by COVID-19 than older kids are.

This is why the CDC’s Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings states that 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 [person under investigation] from her baby until the mother’s transmission-based precautions are discontinued.”

If a mother has COVID-19 while giving birth her baby may be cared for away from her temporarily, but the World Health Organization states that mothers with COVID-19 should be supported in sharing a room with their baby.

Mothers can choose to keep their infants with them while taking precautions to prevent the spread of the illness, including wearing a mask while breastfeeding or having someone who is well feed expressed milk to the baby.

During the coronavirus pandemic, what precautions should I take if I am pregnant?

Recommendations are evolving as we learn more about this, so the best thing to do is to keep in close communication with your provider, who will be able to provide you with the most up to date and personalized information. Some hospitals are limiting visitors, including partners.

Here are the current guidelines from ACOG:

• Regarding recent travel, people should adhere to the Centers for Disease Control recommendations for specific areas, in addition to consulting with their providers. Providers will likely ask a lot of questions about your recent travel.
• Providers will be following a detailed algorithm when deciding when to test pregnant people for COVID-19. The primary criteria involve assessing the presence of Coronavirus symptoms.
• Pregnant people should report concerning symptoms immediately: these include fever, cough, and chest tightness or difficulty breathing.

Talk to your provider about their current policy regarding birth partners—many hospitals are restricting entrance, and only allowing one person to attend a birth. This might mean that your doula can’t come. If this happens to you, ask your doula about virtual support services, which can be highly effective.

I’m scared to go into a hospital right now. Are there any other options?

Due to concern surrounding the business and transmission risk in hospitals right now, some women are choosing to explore alternate options for their births, such as home birth or birth centers.

It’s important to know that these options may not be available to everyone—home birth and birth centers are considered safe for low-risk pregnancies. It’s also key to investigate whether your insurance covers out-of-hospital birth. And certainly, you’ll need to see if the midwives have availability.

If an out of hospital birth without an epidural sounds appealing to you, this might be a great option to consider. Reach out to a local birthing center or home birth midwife—if they are already full, they can refer you to other local professionals who might have space.

What will my birth be like if I have COVID-19?

If a pregnant woman has COVID-19 at the time of birth, they will be isolated from other patients, and providers who care for them will be wearing masks.

If you have a partner, they may or may not restrict their access to being with you. Here is what the CDC says about “visitors” of COVID-19 patients:

“Limit visitors to patients with known or suspected COVID-19. Encourage use of alternative mechanisms for patient and visitor interactions such as video-call applications on cell phones or tablets.” In the event of necessary visitors, they recommend that facilities “evaluate the risk to the health of the visitor” (for example, if your partner has a compromised immune-system).

Your partner will also be instructed to perform good handwashing, to limit touching surfaces, and to use masks following hospital policy. They will only be allowed to go to your room, (they cannot be in multiple patient rooms), and will be asked to leave the room when you are having specimen collection procedures.

When making the incredibly difficult decision about whether or not to have your partner with you, one factor is of course, the newborn. If your partner is able to stay infection-free, they might be able to care for the newborn while you recover from birth and your infection. This is, of course, a very personal decision, and I’d urge you to talk to your provider about what they recommend.

It may be recommended that the newborn be separated until their infection status can be confirmed—this is in an attempt to prevent transmission if it hasn’t happened—if this happens, you can ask to provide pumped breastmilk for your baby, as it does not currently appear that the virus is transmitted in breastmilk. If you have COVID-19 and your baby does not, you’ll likely be separated from them until your infection is over. If you already both have it, providers may be okay with you staying together—ask them what their current policy is here.

You’ll be allowed to leave the hospital when your symptoms have stabilized, and you’ve had two negative swabs tests, with 24 or more hours between them.

I am so stressed right now. What can I do?

Oh, mama. Now more than ever, I wish I could wrap you in my arms—but for a lot of reasons that’s not a possibility, so this will have to do:

1. Talk to your provider. They are home base right now. Tell them what you are worried about and let them calm your fears with information.
2. Take a birth class. Almost every person I know that teaches birth classes is offering them virtually right now. Find a class and gain valuable information and connection.
3. Protect your energy. Spend some time honestly assessing the sources of strength and stress in your life, and make choices accordingly. Does going for a walk make you feel better? Lace-up and head outside (away from people). Does your well-intentioned family member stress you out every time they call? Let the phone ring out. It’s okay to protect yourself and your wellbeing right now, mama.
4. Speak with a therapist. Whether you have been diagnosed with a mental health concern or not, this is an incredibly trying time. Therapists are amazing and can provide you with tools to help you cope. And, there are many services that offer virtual therapy appointments. Reach out for help immediately if you feel like hurting yourself or others.
5. Take it one day at a time. I know, I know. This is so cliche, but goodness, it is true. Thinking too far ahead can be really detrimental, especially when we just don’t have a ton of information. Do the best with the information you do have, and try to stay as present as you can.
6. Remember the helpers. Isolation is needed right now to #flattenthecurve. The hard aspect of isolating yourself, though, is that it’s hard to remember all the people out there who are helping—mama, there are so many. Researchers and scientists are working around the clock to learn more. Medical providers who are updating policies and ready to take care of you the moment you need it. Delivery drivers who can bring you chocolate and canned food. You are not alone in this.

[A version of this post was originally published March 27, 2020. This is a developing story, and we’ll continue to update it as new information comes in.]

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