COVID 19 & Pregnancy

Wednesday, March 11, 2020

Boston, MA, USA

This was written by HeHe Stewart M.S., FLE, IFS,
 Founder of Tranquility by HeHe Maternity Concierge 

COVID-19 & Pregnancy 


**Update: Our updated blog on COVID-19 can be found here.

“Is it the end of the world?” You wouldn’t believe how many folks have said this, either joking or 100% completely serious. I’ve probably heard it 50 times over the last two weeks and every time I hear it, it still shocks me like the first time. I don’t think the world is ending, but I do think that Coronavirus is something to be very mindful of when thinking about your everyday life and especially your hygiene. 


There’s so much information out there right now about COVID-19 and it feels overwhelming. But one thing I haven’t seen much of is how this can impact pregnant women. The most common thing I have been hearing from the medical community and clients sharing what their doctor recommended is that the seasonal flu is much more of a concern and riskier for pregnant women than coronavirus. I had such big questions about this and that's the drive for this blog. I am going to share the most asked questions we have received about this pandemic with you! My goal is not push your thought one way or the other, rather educate you with factual information so you can make your own conclusions. Evidence based education is the only defense you have against fear-based information. 


Please remember I am not a doctor, and I’m certainly not your doctor. I want to help you think things through rationally and with as much research as possible so you can have as little fear as possible. Be sure to talk to your doctor about how to keep yourself and your baby safe with COVID-19 in the air.. Literally. 


Pregnancy


No doubt this is a scary time as a pregnant person, but it may not be as scary as the media would lead you to believe. One consistency that I continue to hear from client after client after client is that there healthcare provider has said the seasonal flu is much more of a concern than coronavirus to expecting folks. The Lancet has published research that looked at 9 pregnant females who had contracted coronavirus. They found pregnant women had similar susceptibility and symptoms as non-pregnant women. They also reported that all 9 babies were born alive, had 1-minutes APGAR scores of 8-9 and 5-minutes APGAR scores of 9-10. This is incredibly telling that it will not impact the health and safety of your baby. 


Like with any illness during pregnancy, we are, of course, worried about a few things: a fever and dehydration. The CDC shares this about fevers, High fevers during the first trimester of pregnancy can increase the risk of certain birth defects.” American College of Obstetrics and Gynecology has officially published a practice advisory concerning coronavirus and pregnancy. They do recommend that all pregnant women cancel any non-essential travel. You can read the report here






The National Perinatal Association has produced a series of infographics that really help understand what is going on! You can view the full series here


The World Health Organization stated, “ As opposed to Influenza A(H1N1)pdm09, pregnant women do not appear to be at higher risk of severe disease. In an investigation of 147 pregnant women (64 confirmed, 82 suspected and 1 asymptomatic), 8% had severe disease and 1% were critical.” You can read that on page 32 of this WHO report


The CDC also shared information stating that the virus was not transferred from an infected birthing parent to baby.However, in limited recent case series of infants born to mothers with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for the virus that causes COVID-19. Additionally, virus was not detected in samples of amniotic fluid or breastmilk. Based on limited case reports, adverse infant outcomes (e.g., preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, it is not clear that these outcomes were related to maternal infection, and at this time the risk of adverse infant outcomes is not known.”


As the hospitals gear up for lock down, there have been restrictions placed on labor and delivery units concerning the number of support people allowed in the birth room. As a birthing person, remember it is your right to have your doula and your partner with you. The Association of Women’s Health, Obstetrics and Neonatal Nurses put out a statement supporting the exemption of doulas from any “1 support person” rule. 



During your birth, there are a few things you can do to protect yourself against transmission. Labor at home as long as possible. This is extra motivation for folks that are hoping for an unmedicated labor, but will be trickier for folks who are hoping for an epidural placement. You can also request for staff to touch you as little as possible. Remember any puncture or anything in your mouth increases the risk of exposure so be sure to use BRAIN (benefits, risks, alternatives, intuition, no thanks) when considering your options.

You can also consider bringing your own linens like pillow cases and socks. You can wear your won clothes, too, instead of a hospital gown. Finally, request that everything that has a disposable options be used (rather than things that are washed/sanitized between patients and used again).

We share tips on how to prepare for birth (and your baby) in our updated coronavirus blog here.

Infants


“Fortunately, we think kids have cross immunity,” a Pediatric Resident at Vanderbilt University Medical Center told me. It seems as if COVID-19 is really mainly impacting adults. However, that doesn’t mean don’t be vigilant AF when it comes to germs. Make sure you are taking the precautions to protect your baby. The younger they are within the first year, the more precautions you want to take. 


No Kissing - This should be a rule anyway for a baby (usually less than 4 months old due to their very limited immunity to the outside world), but if you have a baby that is used to being kissed by family members (siblings and grandparents included), now is the time to put a hard stop on this. It’s temporary, but kisses aren’t worth spreading the coronavirus. Transmission happens when infected droplets get in or on your body! We want to make sure that we do our part to reduce any non-essential contact with your baby and adults. 


Keep Breastfeeding - The fact that your baby has a very small immune system is scary, but breastfeeding parents hold such a magical immune booster! One of the best things you can do, if you are breastfeeding, is to continue to breastfeed. In limited case series reported to date, no evidence of virus has been found in the breast milk of women with COVID-19.” 


The United Nations Populations Fund produced a statement that said, Breastfeeding women who become ill should not be separated from their newborns, the statement adds. There is no evidence that the illness can be transmitted through breastmilk. However, breastfeeding mothers who are infected should wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces. If a mother is too ill to breastfeed, she should be encouraged to express milk for the baby, while taking all necessary precautions.”


100.4 Fever - Fevers are incredibly scary. Especially if it’s the first fever and extra especially if it happens in the first 6 months of life! I just interviewed Dr. Amy Fan in The Birth Lounge Expert’s Lounge. We dove into fevers and what to do for the first fever plus what to have on hand at home before the first fever. You can access that interview plus others in Tier 2 of The Birth Lounge. Dr. Amy shares that anything above 100.4F is considered a fever and should be shared with your child’s pediatrician. To get an accurate reading, you should take your baby’s temperature rectally. 

We share tips on how to protect your baby and still enjoy postpartum in our updated coronavirus blog here.


Your Home 
Your home is your safe haven. It’s a place you should be able to relax, but a pandemic is just the thing needed to rob you of this comfort. I’ve had so many parents share with me that they are feeling so anxious about the germs in their homes (even though they are cleaning like crazy!). I know how that feels. Here are some things to consider. 


What’s your partner tracking in?  Many companies are suggesting, even requiring, their employees and staff to work from home. When you have a pregnant person and a newborn (although neither are at particular risk), you want to take extra precautions. I’m not talking about voluntary quarantine even though you have 0 exposure risk, but I am saying if the opportunity presents itself to be safer, take it. Don’t eat from the buffet at Whole Foods. Don’t eat finger foods if you haven’t washed your hands after touching your credit card and the door handle plus the back of the chair you sat down in. Think about these things. Consider getting take out to minimize your exposure risk. Remove your shoes before coming inside, change clothes when you get home, and shower before bed or after being around any crowd, no matter how large or small. 


Boundaries around who comes into your home - Some folks really struggle when you have to set boundaries around seeing your baby, but the fact of the matter is every person who crosses the threshold of your home, increases the risk of exposure to everyone in your house. You, your partner, your child(ren), your other visitors. Facetime is a great and safe alternative to in-person visits. When considering grandparent visits, it’s important to remember they are the most at risk. 


Castile Soap - Castile Soap is real soap without a bunch of additives. It is organic and very versatile meaning you can use it in multiple ways in your home. Check out this Earth Mama article about the effectiveness of Castile Soap. It’s also gentle enough to be used on human skin, but powerful enough to be a fighting agent I use this brand of Castile soap at my own home and it’s what I recommend to everyone when they are cleaning anything for their baby--coronavirus or not.  Here are 12 ways to begin cleaning your home with castile soap




Hand Sanitizer - It’s not new that hand sanitizer across the country is sold out! I think it really hit home for lots of folks when Amazon officially ran out of it! *cue mass panic* Okay, jokes aside, this can seem scary, but if you think about the active ingredient in hand sanitizer, you can still achieve the same results. The magic in hand sanitizer comes from alcohol. You can create your own hand sanitizer from mixing aloe vera gel and rubbing alcohol. Coincidentally, as I was trying to gather links for you, Amazon sold out of aloe and alcohol. This is madness. 

I share what I'm choosing to do to protect my home and myself during this time in our updated coronavirus blog here.


How to Keep Yourself Safe
The CDC has put out very simple suggestions of how to keep yourself safe like social distancing, washing your hands regularly, using hand sanitizer, stay home if you are sick, cover your coughs/sneezes with you ELBOW (not your hand!!!). 


Social Distancing - When you are out in public, it’s important to keep 3-4 feet between you and other folks. Remember the transmission happens when someone coughs, sneezes, or talks and the droplets get on you. The CDC is clear that you do not need to wear a mask if you are not sick. If you are sick, stay home. This is your responsibility as a human part of a larger ecosystem.


Consider Telemedicine Pediatricians - Dr. Amy Fan is the Founder of Kinder Pediatrics, a telemedicine pediatric practice. This is not a sponsored post--it’s truly just that good and amazing timing! Dr. Amy sends you a box of all the things you need to complete your pediatrician appointment You can use the box beginning at birth (for the first pediatrician appointment!) so you don’t have to leave your home or get your baby outside! This is ideal for staying safe during this outbreak!


Wash your hands - I am disgusted to think about how many folks don’t/didn’t wash their hands on a regular basis throughout each day. As someone who works in homes, changes diapers, and touches other humans on a daily basis, I wash my hands so, so much. Make sure when you wash your hands, you are doing it the right way. Yes, there is a “right way” and a “wrong way” to wash your hands and today is the day you’re going to learn the difference! Yay! Here is a simple video that explains it all so simply


Don’t touch your face - It’s all about breaking habits. The good news is that it takes 21 days to break/change a habit, so it looks like this is a positive change that will continue to keep you safer and healthier long after COVID-19 is gone. Your face is filled with mucosal openings to your body (your nose, eyes, mouth) that present an easy way to transmit germs. 


Probiotic -  A probiotic helps keep you healthy by building your microbiome, particularly your gut microbiome. Your gut plays a very large role in your immune system and you should be boosting your immune system more than ever right now. For pregnant and nursing folks,  You can find our favorite probiotics here! Probiotics will help build your gut health which is amazing for your baby. Your gut health plays a direct role in your breastmilk and your baby’s immune system!  Be sure to ask your doctor before starting a probiotic. 


Elderberry - This one is tricky! There are thousands of women who say yes, this works, but the research just isn’t quite there. It is not generally recommended as safe during pregnancy. Many providers are not super on board with Elderberry as a remedy, but I found this very interesting research study that shows it as effective in pregnant people. However, the bummer is that the study only had 77 folks. 


Bone Broth - There’s mixed reviews on whether or not bone broth is actually effective. There’s research that points in all directions. It is believed, by some, that consuming bone broth (containing amino acids, collagen, minerals, fatty acids, iron, zinc, and manganese) can help boost your immune system. Regardless of whether it helps you stave off sickness or not, it is a yummy and warm meal that’s so easy to make! 


Tumeric - Tumeric is great in postpartum for many reasons like it has been used in many cultures as a ways to increase and support lactation, but did you know that tumeric also has antibacterial properties? Yes, you can take tumeric daily as a preventative measure. Other than the coronavirus pandemic, here are a few other great reasons to incorporate tumeric after having a baby!  Be sure to ask your doctor before starting tumeric. 

*Tumeric consumed in “medical doses” is not safe during pregnancy  


Bromelain: If you are nursing or trying to conceive, this may be a great option for you! For TTC people, get bromelain *without Quercetin* (often sold together in one combination pill). Bromelain actually supports TTC by bringing blood to the uterus. Bromelain is an enzyme actually so it helps with implantation by acting as an anti inflammatory for the uterus! Double whammy! Be sure to ask your doctor before starting bromelain.  


*Bromelain is not safe during pregnancy and may lead to abnormal bleeding. 


Colloidal Silver - You can get colloidal silver as a nasal spray (that’s what I have) or as a liquid (put it in drinks). Colloidal silver has been observed killing germs by binding to the bacterial cell wall. It is believed that the silver mixes with substances in the body to create what’s called silver salts, which is an effective antimicrobial. There is very very little (literally nothing even worth pulling) as research on colloidal silver and nursing. There are, however, thousands of anecdotal stories of women who use colloidal silver as a natural remedy for common colds and keeping their immune system strong while nursing. Be sure to ask your doctor before starting Colloidal Silver. 


*Colloidal silver is not safe during pregnancy  


Know the symptoms of COVID-19 -  fever, cough, shortness of breath. If you exhibit symptoms, give your healthcare provider a call. Call your doctor before going to the office as many doctors are telling pregnant women to stay home as to reduce the exposure! Try to avoid going to the ER if possible by calling your OBGYN or midwife before deciding to go to the doctor. 


If you happen to get sick while you are pregnant, stay home, stay hydrated, stay in bed. Be sure to alert your doctor and monitor your temperature. Mama Natural has great remedies for combatting the seasonal flu (remember, what I shared in the beginning!) and I think it will be exactly the perfect place to start for coronavirus, too. 

To know if your insurance covers the cost of a corona virus test, give them a call. Most insurances have an on-call nurse on staff to take calls like this. They will also answer general questions. Although, at the moment the wait time may be astronomical.

**Update: Our updated blog on COVID-19 can be found here.

Here's a great handout to see the facts about Coronavirus! God speed out there to yal! Stay safe, stay healthy. Xo,HeHe





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