Over 20,000 babies are born every year in Northern Ireland.
During pregnancy, changes in the immune system make women generally more susceptible to respiratory infections. And this year, pregnant women also have to worry about Covid-19, a virus that can affect a person’s lungs and airways.
Last week, the UK government announced that pregnant women were at an increased risk of severe illness from coronavirus.
However, the advice to pregnant women was described by Chief Medical Officer Chris Whitty as “a precautionary measure” because “we are early in our understanding of this virus and we want to be sure.”
So how does the coronavirus crisis affect you if you are pregnant or have just had a baby?
This advice was compiled with the help of Dr David Glenn FRCOG, a Consultant Obstetrician and Gynaecologist at Kingsbridge Private Hospital and Clinical Director for Women and Child Health at Ulster Hospital.
Why are pregnant women in the high-risk category?
Pregnant women do not appear more likely to contract the infection than the general population. Pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for Covid-19.
Can a pregnant woman pass coronavirus on to her baby?
Transmission from mother to baby during the pregnancy or delivery is probable, although the proportion of pregnancies affected and the significance to the baby has yet to be determined. Amniotic fluid, cord blood, neonatal throat swabs, placenta swabs, genital fluid and breastmilk samples from Covid-19 infected mothers have so far tested negative for the virus. However, a new report describes a case in which the baby born to a Covid-19 positive mother was found to have antibodies in their blood at birth. This is thought to represent a baby’s response to infection within the womb.
Is there a greater chance of miscarriage if you test positive for Covid-19?
There is currently no evidence of an increased risk of miscarriage or early pregnancy loss in relation to Covid-19.
Moreover, there is no evidence that the virus damages the baby. Despite recent evidence that the virus can be passed from mother to baby, the proportion of pregnancies affected and the significance to the baby has yet to be determined.
What symptoms should pregnant women be aware of, and what should they do if they are experiencing any of them?
If you are infected with Covid-19 you are still most likely to have no symptoms or a mild illness from which you will make a full recovery. Most women will experience only mild or moderate cold/flu like symptoms. Cough, fever, shortness of breath, lack of smell/taste and even gastrointestinal symptoms are other relevant presentations.
For women who have had symptoms, antenatal appointments can be deferred until 7 days after the start of symptoms, unless symptoms (aside from persistent cough) persevere.
For women who are self-isolating because someone in their household has possible symptoms of Covid-19, appointments should be deferred for 14 days.
If women develop more severe symptoms or her recovery is delayed, this may be a sign that they are developing a more significant chest infection that requires enhanced care. In this situation you should contact your maternity care team.
Are all antenatal appointments going ahead as normal in Northern Ireland?
If you are well at the moment and have had no complications in your previous pregnancies arrangements for your care may be altered but they are still important to attend.
If you have a routine scan or visit due in the coming days, you will still need to attend but the appointment may change due to staffing requirements. Maternity care is essential to reduce complications in mothers and babies. Even in the context of coronavirus, it is important that pregnant women continue to attend their scheduled routine care when they are well.
Pregnant women will be asked to keep the number of people with you to a minimum. This will include being asked to attend maternity appointments alone.
There may also be a need to reduce the number of routine antenatal visits.
If women have an urgent problem related to the pregnancy but not related to coronavirus, they should get in touch using the same emergency contact details they already have. They should not contact that number unless they have an urgent problem.
If women have symptoms of coronavirus, they should contact their maternity service and they will arrange the right place and time for the visits. They should not attend a routine clinic.
What risks are there of an expectant mother contracting Covid-19 on a trip to hospital for an antenatal appointment?
Maternity care is essential and has been developed over many years with improving success to reduce complications in mothers and babies. The risks of not attending care include harm to mother, her baby or both.
Many provisions have been put in place to reduce risk to mothers. These include reducing the number of visits to the hospital to a minimum, advice to mothers on reducing the number of people travelling with mothers to the hospital, attending the appointments alone, keeping numbers reduced in waiting rooms, spacing patients in waiting areas, staff taking additional protective efforts to reduce transmission in clinics with hand washing, cleaning equipment etc.
How prepared are hospitals to deal with pregnant women with the virus?
Very significant changes have been occurring in hospitals over the past weeks to deal with pregnant women with Covid-19. Significant changes have been made in all areas of the hospital, from clinics to wards and including delivery suites. Practice drills are being run frequently to train staff, additional resources have been brought in to help and a huge effort has been made by all levels of non-clinical, clinical, administrative and management staff.
If the mother of a baby has symptoms or tests positive for Covid-19, should she isolate herself from the baby?
Given the current limited evidence, we advise that women and healthy infants, not otherwise requiring neonatal care, are kept together in the immediate post-partum period.
A risks/benefits discussion with neonatologists and families to individualise care in babies who may be more susceptible is recommended.
Can a new mother with the virus breastfeed?
The main risk of breastfeeding for infants is the close contact with the mother, who is likely to share infective droplets. In the light of the current evidence, it is advised that the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk. Precautions should be taken to reduce spread to the baby such as, hand washing before touching the baby, avoiding coughing or sneezing on the baby while feeding, and considering wearing a face mask, if available, while feeding or caring for the baby.
Can a pregnant person be accompanied by a partner or have visitors?
A person in labour can be accompanied by one birthing partner, according to the new guidelines. No visitors are permitted in ante-natal or post-natal ward areas.
Will babies continue to be delivered in all Northern Ireland hospitals?
No, not at Causeway Hospital in Coleraine. Antenatal services will continue but it is not possible to deliver babies in the hospital during this surge period.
This is due to a lack skilled paediatricians available to provide emergency care to a baby born in distress throughout the 24 hour period. To protect the wellbeing of mothers and babies, women booked to deliver in Causeway will be contacted and have their delivery transferred to Antrim or Altnagelvin Hospital.
Should parents introduce their newborn to friends and family?
Current government guidance is that you should not meet with people outside your household, so no family celebrations are permitted at present.