Experts tackle COVID-19 and pregnancy concerns
A global pandemic can make the joy of becoming a mom even more stressful.
It can be hard to know what to expect and easy to be concerned about the situation – should you go to in-person medical appointments? Who can stay with you in the hospital? Will your care take priority?
We took some of the top questions facing pregnant women in Mid-Missouri and reached out to local medical experts for their advice.
Answering our questions today are Dr. Katherine Blount, DO, from SSM Health Medical Group, and Dr. John K. Olson, MD, with Capital Region Physicians.
Q. What risks would COVID-19 infection pose to me while pregnant or to my developing baby?
Katherine Blount
Blount: “There have been case studies of COVID-19 being passed to the baby, but this is still being studied and so far, it is thought to be very uncommon.”
Olson: “Although the data from the CDC suggests an increase in risk of severe outcomes in pregnant women with symptomatic SARS-CoV-2 infection, the absolute risk is still substantially lower than that of pandemic H1N1 influenza infection during pregnancy. Pregnancy and childbirth generally do not increase the risk for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but appear to worsen the clinical course of COVID-19 compared with non-pregnant individuals of the same sex and age. Pregnant patients with comorbidities such as obesity and gestational diabetes may be at an even higher risk of severe illness consistent with the general population with similar comorbidities.
Infected women, especially those who develop pneumonia, appear to have an increased frequency of preterm birth (birth before 37 weeks of gestation) and cesarean delivery, which is likely related to severe maternal illness. Most preterm births are iatrogenic (i.e., induced labor or scheduled cesarean delivery); however most (>90 percent) infected persons recover without undergoing delivery. More data is needed to understand the possible association between SARS-CoV-2 infection and delivery timing, placental function, and neonatal outcomes.
There is no definite evidence that SARS-CoV-2 crosses the placenta and infects the fetus; however, a few cases of placental tissue or membranes positive for SARS-CoV-2 and a few cases of possible in utero infection have been reported. Some of the neonatal cases may have been false-positive test results or due to acquisition of infection soon after birth.”
Q. What if I’m nervous about attending a medical appointment in an area with high COVID-19 positive rates? What would you recommend?
Blount: “It is extremely important to both the mom and the baby that mom attend all recommended prenatal visits to make sure both of you are healthy. Offices have put special measures in place to keep patients as safe as possible. In many offices, there are visitor limitations to help reduce exposure and the number of people in the office. Always wear your mask unless instructed otherwise.”
John K. Olson
Olson: “One solution would be to maximize the use of all telehealth modalities, while preserving in-person visits for those patients requiring physical evaluation or interventions (such as ultrasonography, blood draws and immunizations) or consolidating visits so that patients do not have to return to the facility or move among several locations for laboratory tests or ultrasonography.
Additionally, Capital Region Medical Center adheres to a universal mask policy for clinicians, staff, patients and visitors.”
Q. What risks would COVID-19 infection pose to a newborn?
Blount: “Infants with COVID-19 will be monitored closely by the pediatric team to make sure they remain hydrated, gain weight appropriately and do not show any signs of difficult breathing.”
Olson: “Children of all ages can get COVID-19, although they appear to be affected less frequently than adults. Reports of COVID-19 infection in the neonate have generally described mild disease.”
Q. Will my partner be able to be with me in the hospital while I’m in labor or having a C-section?
Blount: “Throughout the pandemic, SSM Health St. Mary’s Hospital has allowed one support person for the duration of the stay for patients in the Family Birth Center.”
Olson: “Our visitor policy at Capital Region will not be a barrier to an individual receiving medically indicated in-person care. Partners will be screened for symptoms of acute respiratory illness and will not be allowed entry if fever or respiratory symptoms are present. In those instances, a different, asymptomatic visitor can be allowed to provide support. Capital Region Medical Center strives to have your partner in the room for all types of deliveries.”
Q. Will my newborn be able to share a room with me after birth?
Blount: “This will be discussed with you and your care team to balance the risk and benefits to mom and baby. It is important for family and baby to stay together if possible, but there may be some situations where it is in the baby’s best interest for them to be cared for in the nursery or NICU.”
Olson: “Early and close contact between the mother and neonate has many well-established benefits including increased success with breastfeeding, facilitation of mother-infant bonding and promotion of family-centered care. Given the available evidence on this topic, mother-infant groupings where the mother has suspected or confirmed SARS-CoV-2 infection should ideally room-in according to usual facility policy.”
Q. Will hospitals overwhelmed with COVID-19 patients have trouble caring for other patients including those in maternity care?
Blount: “At SSM Health, we know you and your loved ones still need access to high-quality health care services. Our hospital, urgent care and walk-in clinics, and physician offices remain open and ready to provide care if and when you need it. SSM Health has extensive safety precautions and infection control measures in place at all of our facilities to limit the risk of exposure and keep everyone safe. This includes:
- Screening/testing of all patients prior to their scheduled procedures.
- Strict visitor policy to limit unnecessary traffic in our facilities.
- Entrance screening for all employees, patients and visitors to our facilities; hand sanitation is required.
- Adherence to all CDC guidelines and protocols regarding appropriate personal protective equipment (PPE) for providers and staff.
- Requiring all employees, patients and visitors to wear masks or other face coverings when they enter our facilities.
- Enhanced cleaning/disinfection processes in our clinics, hospitals and surgery centers.
- Plexiglass barriers at check-in and registration to ensure appropriate distancing.
- Realigned waiting room seating to ensure appropriate physical distancing.
- Discontinuation of public water fountains.”
Olson: “Capital Region has several plans in place to continue with excellent care for mother and baby throughout the pandemic and beyond.”
Q. Will it be safe for my extended family to meet the baby?
Blount: “This depends on your family and their risk exposures in their lives. The more limited a baby’s exposure to others, the lower their risk of infection. However, it is understandable how important it is to have the support of close family members after having a new baby. Have honest conversations with your closest family members who you may want to visit in the baby’s first two months of life. Let them know your comfort level with visitors and don’t hesitate to ask them to quarantine for two weeks prior to visiting you and your infant, and to wear a mask at all times.”
Olson: “Limiting transmission of SARS-CoV-2 is an essential component of care in patients with suspected or documented COVID-19. This includes universal source control (e.g., covering the nose and mouth to contain respiratory secretions), early identification and isolation of patients with suspected disease.”
Q. How would contracting COVID-19 affect my ability to breastfeed safely?
Blount: “Breastfeeding is encouraged for all interested moms, even if they are COVID positive. The safest way to feed your baby breast milk while you are COVID positive is to pump and have someone else feed the baby until you have recovered and can no longer pass COVID to the baby. If you prefer to breastfeed directly, it is recommended that you wash your hands prior and wear a mask while feeding.”
Olson: “Breast milk provides protection against many illnesses and there are few contraindications to breastfeeding. It is not known whether COVID-19 can be transmitted through breast milk, or if any potential viral components, if transmitted, are infectious. Although a recent case report detected SARS-CoV-2 RNA in the breast milk, the majority of the data has not demonstrated the presence of SARS-CoV-2 virus in breast milk. Therefore, suspected or confirmed maternal COVID-19 should not prohibit a mother from breastfeeding.”
Katherine Blount, DO, MPH is a board-certified pediatrician with SSM Health Medical Group in Jefferson City who completed her master of public health degree at the University of Missouri. She attended Des Moines University College of Osteopathic Medicine in Iowa and completed her residency through University of Missouri Health Care in Columbia. She holds a professional membership with the American Academy of Pediatrics. To make an appointment with Dr. Blount, call 573-761-7210.
John K. Olson, MD, obstetrician and gynecologist, received his medical degree from Creighton University School of Medicine in Omaha, Nebraska, and completed his residency in obstetrics and gynecology at the University of Iowa Hospital and Clinics in Iowa City, Iowa. He is board certified by the American Board of Obstetrics and Gynecology. Dr. Olson is accepting new patients at Capital Region Physicians – Women’s Health.
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