COVID-19: all you need to know about pregnancy and childbirth during the pandemic.

Question 1. Am I, as a pregnant woman, more prone to catching infection with Covid-19?

Answer . Research says that pregnant women are NOT at a higher risk of getting infected with Covid-19 than the general population. The risk of complications of covid-19 is also the same as non-pregnant people.

Question 2. How does one get Covid-19 infection?

Answer . Covid-19 is a viral infection caused by the novel Coronavirus.

The main mode of transmission is DROPLETS.

When a person infected with the virus sneezes or coughs, the secretions carry the virus to the surfaces on which they fall. When a healthy person touches those surfaces, the virus transmits to their hands and from the hands to their nose and mouth. Depending on the immune status of the person, they may then get the disease.

Question 3. How can I protect myself from catching Covid-19 infection?

Answer. All the measures, well publicized in the media, are aimed at preventing contact of a healthy person with the virus and deactivating the virus with disinfectants.

The following measures are effective in preventing Covid-19 infection-

1. Any person with cough, cold, fever should isolate themselves. A pregnant woman should particularly avoid contact with anyone showing the above symptoms. Contact means being in the same room for 15 minutes or a face-to-face conversation for 5 minutes.

2. Use tele-consultation services to maintain care from your doctor during pregnancy. Visit the hospital when your doctor advises.

3. Practice social distancing. Maintain a distance of at least 6 feet when out in public.

4. Wear a mask. Ensure the people around you are wearing one too.

5. Practice hand hygiene. Wash your hands thoroughly for 30 seconds frequently. Hand wash is a must before eating, after coming back from outdoors, after sneezing or coughing. If soap and water is not readily available, an alcohol-based hand sanitizer may be used (with at least 60% alcohol).

6. Pregnant women should maintain a good nutrition, proper sleep, stress-free lifestyle, good physical and emotional hygiene to ensure a strong immunity and protection from Covid-19.

Question 4. When do I suspect if I have Covid-19?

Answer 4. A pregnant woman must contact her doctor if she or her contact develop any of the following symptoms-

• Fever

• Sore throat

• Cough

• Cold, sneezing

• Malaise

• Weakness, fatigue

• Nausea, vomiting

• Breathing difficulty

• Loss or significant decrease in sense of smell and/or taste

Question 5. How can I confirm if I have Covid-19?

Answer 5. The test to diagnose Covid-19 is RT-PCR (Reverse transcription-Polymerase Chain Reaction).

Upon a doctor’s prescription, a health care worker (using full PPE) collects a sample from the throat and nose of the person using a cotton swab and transports it to the laboratory. The results are available in about 24 hours. Isolation is recommended for the person under investigation until the results are out.

Question 6. How should I connect with my doctor if I feel I have symptoms of Covid-19?

Answer 6. If you feel you have any symptoms of Covid-19, it is advisable to reach your doctor through tele-consultation to avoid exposure to other pregnant women and staff. If online services are unavailable, you must inform the clinic prior about your symptoms so that your appointment can be arranged at an exclusive time. Home sample collection is preferable and can be arranged.

In case of severe symptoms (severe shortness of breath, blue lips, blue fingertips or toenails, dizziness, loss of consciousness etc.), immediately report to the nearest emergency room in a hospital.

Question 7. What if I test positive for Covid-19 in pregnancy? How does my care change?

Answer 7. First of all, if you have tested positive for Covid-19, take a deep breath. Relax!

Millions of doctors, nurses, scientists and researchers have been working day and night for months now. We have a much better understanding of this disease than we had in the beginning of the pandemic.

In India, most of the people getting infected are having a mild infection and home care is possible for a majority of them.

If you have an asymptomatic or mild infection, be in close contact with your physician and obstetrician/gynecologist via tele consultation. Simple medications prescribed by your doctor for symptom relief, plenty of fluids by mouth and rest will help. Take good care of your hygiene and nutrition. Ensure a positive frame of mind by indulging in non-strenuous indoor hobbies and online contact with your loved ones.

In case of severe symptoms like shortness of breath, blue lips, blue fingertips or toenails, dizziness, loss of consciousness etc.), immediately report to the nearest emergency room in a hospital. Most of the hospitalized patients improve with oxygen support and specific remedies advised by the treating physician. Intensive care may be needed for some.

Question 8. Will I get a bed in the hospital in emergency?

Answer 8. Most of the hospitals encourage pregnant women, once they are past their initial few weeks of pregnancy to book their delivery. This enables the hospital to plan for the expected mothers and babies in advance. If you haven’t booked your delivery yet, it would be prudent to do so now. As doctors and healthcare staff, our teams are committed to caring for you through this pandemic.

Question 9. Do I need a test for Covid-19 prior to hospital admission?

Answer 9. Most hospitals are following a protocol of testing for Covid-19 prior to hospital admission or after admission in emergency so as to triage patients effectively and ensure safety for all. Pregnant women diagnosed positive with Covid-19 are cared for in an isolation area specifically reserved for them. The staff caring for them is also dedicated to them and uses all precautions (PPE, sanitization) to avoid cross infections.

Question 10. What are the precautions taken by the hospital to ensure a safe environment for my delivery?

Answer 10. At my hospital, Cloudnine hospital, sector 14, Gurgaon, we have taken all recommended precautions to ensure the safest possible environment for your delivery.

The following measures are in place-

• Temperature check by non-contact thermometer by staff at entry

• Everyone is required to wear a mask in the premises

• Appointments are being scheduled in a way to avoid crowding in the waiting areas

• Tele consultation services are being used to minimize hospital visits

• PPE kits are being worn by personnel in close contact with suspected Covid-19 positive patients and areas such as Operation theatres.

• Sanitization of the hospital premises is being carried out as per recommended guidelines.

• Hand sanitizers have been installed at several places and their use is strongly encouraged for both, staff and visitors.

• The hospital has enforced a policy of one attendant only accompanying an expectant mother for outpatient visits or during inpatient stay.

Question 11. How does my delivery get impacted if I test Covid 19 positive around the time of my delivery?

Answer 11. Delivery in terms of its timing and mode (normal or caesarean) is not dictated by the Covid infection status alone. In mild or asymptomatic cases, the experience of labour (should it begin around that time) is more strenuous for the pregnant woman. But normal delivery is certainly possible and a Caesarean section (operative delivery) if needed, is decided on the merits of the case by the obstetrician and the pregnant woman.

If the pregnant woman has a severe disease with respiratory decompensation, the chances of a C-section or instrumental delivery (forceps or vacuum) may increase.

Question 12. Can I breastfeed if I have Covid-19 around the time of my delivery?

Answer 12. The decision to breastfeed is individualized based on the mother’s health status and preference. The benefits of breastfeeding far outweigh the risks and every effort should be made to support the mother in safely doing so.

Should the mother choose to directly breastfeed, she should wash her hands thoroughly before each feeding session. She must wear a mask. A healthy staff or family member should be around to support the mother.

If the mother chooses to express her breastmilk, she should wash her hands thoroughly before doing so. Preferably a dedicated breast pump should be used by her. All sterilization protocols should be followed to ensure safety while expressing milk. A healthy volunteer should feed the expressed breast milk to the baby in another room.

Donor human milk (where available) and formula feed are an option for mothers who are too sick or otherwise unable to breastfeed. This is decided in conjunction with a neonatologist.