COVID-19

Hello moms and future moms, I am collecting material on the virus and scientific evidence on the effects on pregnancy on the fetus and/or newborn.

On this page you can find links that refer to reliable sources. I will try to keep this page updated with the latest news. In the meantime, I suggest attending the free Positive Birth Movement meeting scheduled for Monday 30 March.

Evidence Based Birth is one of the most reliable sources. It has a lot of links and updated information with new evidence.

Evidence Based Birth

Research Update from Monday, March 16, by Evidence Based Birth.

According to the World Health Organization’s (WHO) most recent situation report here.

  • The WHO published interim guidance on March 13, 2020, here. 
  • There is little research on the clinical presentation of COVID-19 in pregnant women and children 
  • There have been a few cases of infants with COVID-19 and they experienced mild illness 
  • So far, there is no evidence of mother-to-baby transmission, and when researchers tested women who were infected, the samples of amniotic fluid, cord blood, vaginal discharge, newborn throat swabs, and breast milk have all been negative. 
  • Some reports of PROM (premature rupture of membranes), fetal distress, and preterm birth have been reported when mothers became infected in the third trimester 
  • The mode of birth should be individualized and Cesarean used only when it is medically justified 
  • Standard infant feeding guidelines should be followed with appropriate precautions for infection prevention and control. These standard guidelines include initiating breastfeeding within 1 hour of birth and continuing to exclusively breastfeed for 6 months, continuing breastfeeding up to 2 years or beyond. Infected mothers who are breastfeeding or practicing skin-to-skin should wear a medical mask, perform careful hand hygiene, and clean and disinfect all surfaces. Infected mothers should still be provided with breastfeeding support. If complications prevent the infected parent from breastfeeding, they should be encouraged and supported to express milk for the infant for someone else to feed to the baby or to maintain milk supply. There should be no promotion of breastmilk substitutes (formula) or pacifiers. 
  • “Mothers and infants should be enabled to remain together and practice skin-to-skin contact, kangaroo mother care and to remain together and to practice rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.” 

 

UpToDate® guidance for clinicians  here
  • There is very little info regarding COVID-19 during pregnancy 
  • Mother-to-baby transmission during pregnancy or birth has not been identified 
  • There have been at least two newborn cases documented 
  • Pregnant people are more susceptible to infectious diseases due to immune suppression during pregnancy 
    • Other respiratory infections—(SARS)-CoV, (MERS)-CoV, and influenza—have been shown to develop into more severe disease in pregnant people 
  • Out of 18 pregnant women with confirmed or suspected infection, there was no laboratory evidence of transmitting the virus to the newborn 

 

New research on PubMed

A retrospective study reviewed the clinical and CT imaging features of 59 people in China with COVID-19. This group included 14 non-pregnant adults with lab-confirmed infection, 16 pregnant women with lab-confirmed infection, 25 pregnant women with clinically diagnosed infection, and 4 children with lab-confirmed infection (Liu et al.) 

  • All of the pregnant women had mild illness. None were admitted to ICU and none of the babies had abnormalities or evidence of mother-to-baby transmission. 
  • Compared with the non-pregnant adults, the pregnant women (both lab-confirmed and clinically diagnosed) had atypical clinical features, making early detection difficult. It was more common for pregnant people to have an initial normal temperature—only 36% to 44% had a fever. This means that fever may not be as useful of a screening tool with pregnant people. 
  • It was also more common for the pregnant people with infection to have leukocytosis (increase in white blood cells) and elevated neutrophil ratio (a marker of inflammation) compared to the non-pregnant people with infection. 
 

Research update from Monday, March 23

 The main way the virus spreads is person-to-person. This virus can be isolated from respiratory secretions and feces. A new study found that the virus is also stable on surfaces for up to several days. The study was conducted by scientists from the National Institutes of Health, CDC, UCLA and Princeton University and was published March 17 in The New England Journal of Medicine (van Doremalen et al. 2020).  
  • SARS-CoV-2 (SARS-CoV-2 causes COVID-19)  was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.  
  • The results suggest that people may acquire the virus through the air and after touching contaminated objects. 

A new study from Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, confirms that the median incubation period of the new virus is around 5 days, meaning that about half of the people who contract SARS-CoV-2 will start showing symptoms at that point in time.

How long are you contagious? A retrospective review of adult patients in China with lab-confirmed COVID-19 found the median length of viral shedding was 20 days in survivors. The longest observed duration of viral shedding was 37 days (Fei Zhou et al. 2020).  

To date, no evidence of parent-to-baby transmission during pregnancy has been published. Samples of breastmilk, cord blood, placenta, and amniotic fluid from infected pregnant people have all been negative.

 So far, there is no evidence that pregnant people are at greater risk of infection or severe illness with COVID-19 (they are only considered a ‘vulnerable group’ as precaution).
 

Research update from Monday, April 13

 Q&A Session

This is a deeply personal choice, but we can share a few factors you might consider when deciding whether or not to delay trying to conceive because of the pandemic. First, pregnant people are not any more likely to become infected with this virus or to develop serious illness with COVID-19 disease compared to non-pregnant adults. The majority of infected pregnant people will only experience mild or moderate cold/flu symptoms. No reports of maternal deaths have been published. There is no evidence to suggest an increased risk of miscarriage with COVID-19. Researchers aren’t sure yet whether the virus can pass from parent to baby during pregnancy; several babies in published case series have tested positive soon after birth, but all recovered without complication. The virus has not been detected in cord blood, amniotic fluid, vaginal fluid, or breast milk.   

The Institute for Health Metrics and Evaluation has a great website with COVID-19 projections for the U.S. (nationally and by state) and for European countries. You can see projected resource use (ICU beds, ventilators), deaths per day from COVID-19, and total deaths from COVID-19.  

Their projections go all the way out to August 1. The researchers state this is a model of the first wave of the epidemic, after which they state 97% of people will still be susceptible to the disease. The models assume social distancing will be in place through the end of May. The projections could change if social distancing recommendations are lifted before then. The model also assumes that appropriate measures will be taken in July and August to prevent further spread of the disease, including mass screening, contact tracing, testing of everyone who enters the country, and quarantine of positive individuals.

The CDC recommends using N95 respirators for aerosol-generating procedures (AGPs). However, there has been disagreement over whether the second stage of labor is an AGP. The Centers for Disease Control dose not list the second stage of labor as an AGP. 

We don’t have any published evidence yet on COVID-19 and waterbirth, but there are research efforts underway (if you are approached about participating in a study, please participate!) Guidance from the Royal College of Obstetricians and Gynaecologists (dated April 9) advises against waterbirth for anyone with suspected or confirmed COVID-19. However, this recommendation is based on theoretical risk, not evidence.  

The virus has been detected in feces, so there is a concern that the pool water could become contaminated, increasing the risk of infection for the baby and birth attendants.  

According to a CDC FAQs on Water and COVID-19, “There has been no confirmed fecal-oral transmission of COVID-19 to date.” The CDC goes on to say, “There is no evidence that COVID-19 can be spread to humans through the use of pools, hot tubs or spas, or water playgrounds. Proper operation, maintenance, and disinfection (e.g., with chlorine and bromine) of pools, hot tubs or spas, and water playgrounds should inactivate the virus that causes COVID-19.”

Birth Monopoly has good suggestion

  1. Doula are not visitors, they are Essential Support people and members of the healthcare team. Why? Because of all the benefits of their presence.
  2. Let’s always remember that it is a human right of the birthing person to decide who attends their birth as well as a federal right to have support, in-person or virtual.
  3. If your doula is not going to be able to be present at your births, now it’s more important than ever that you get a good prenatal preparation.
This month’s topic is “My Birth Room?”

The group is open to everyone to discuss the actual situation, thoughts, questions, concerns, etc.

Please come and invite your friends!
I think it is very important to talk about it. I am here to support you.
Details of the meeting
The meeting is free and virtual via Zoom.

Where:
Soon a Zoom link

You need to download the Zoom app but you do not need to register.
 
 

You deserve expert guidance through one of the most important times in your life. The Natural Power of Birth honors your desires and respects your wishes, while professionally informing you of all of your options and giving you the emotional support you need. I’m honored to be of service to you and your family.

Let’s talk about how I can help you plan and prepare for the next step on your journey!

The first meeting is always free and there is no obligation. Click here to schedule a free 30 minutes meeting.

With warmth and respect, Tamara