Pregnant in a time of coronavirus - the changing risks and what you need to know

"So, being pregnant and delivering in a pandemic … what's that gonna look like?"

That question, sent to me by a colleague who is both a registered nurse and an expectant mother, stopped me in my tracks. As an OB-GYN physician, I naturally focus on the science of health care. Her email reminded me of the uncertainty expectant mothers now face as health risks and the health care system around them change amid this coronavirus pandemic.

While knowledge about the new coronavirus disease, COVID-19, is rapidly evolving and there are still many unknowns, medical groups and studies are starting to provide advice and answers to questions many expecting families are asking.



Do pregnant women face greater risk from COVID-19?

So far, the data on COVID-19 does not suggest pregnant women are at higher risk of getting the virus, according to the American College of Obstetricians and Gynecologists. However, as we have seen from the flu they are at greater risk of harm if they get respiratory infections. Pregnancy causes a variety of changes in the body and results in a slight immunocompromised state which can lead to infections causing more injury and damage.

Does having the coronavirus create a greater risk of miscarriage or preterm labor?

Studies have not yet been done to show if having COVID-19 during pregnancy increases the chance of miscarriage, but there is some evidence from other illnesses. During the SARS coronavirus epidemic in 2002-2003, women with the virus were found to have a slightly higher risk of miscarriage, but only those who were severely ill.

Having respiratory viral infections during pregnancy, such as the flu, has been associated with problems like low birth weight and preterm birth. Additionally, having a high fever early in pregnancy may increase the risk of certain birth defects, although the overall occurrence of those defects is still low.

Can a mother with COVID-19 pass the virus to her baby in the womb?

This data is evolving fast. Two papers published March 26 describe finding coronavirus antibodies in three newborns of mothers with COVID-19. That could suggest they had been exposed to the virus in the womb, though the virus itself was not detected in their umbilical cord blood and researchers have raised questions about the type of test used. Researchers in an earlier study found no evidence of COVID-19 in the amniotic fluid or cord blood of six other infants born to infected women. While the research papers include only a small number of cases, a lack of vertical transmission – from the mother to child in utero – would be consistent with what is seen with other common respiratory viral illnesses in pregnancy, such as influenza.

There have been a few reports of newborns as young as a few days old with infection. But in those cases, it is believed that the mother or a family member transmitted the infection to the infant through close contact after delivery. The virus can be transmitted through a cough or sneeze, which could spread virus-laden droplets on a newborn.

How are prenatal checkups changing?

Prenatal care may look different for a while to control the spread of COVID-19 among patients, caregivers and medical staff.

Typically, a pregnant woman has about 14 prenatal visits. That may be reduced by approximately half, with telemedicine playing a larger role. Telemedicine is already endorsed by the American College of Obstetricians and Gynecologists for patients in rural settings. Now, the pandemic is making virtual care solutions an indispensable tool. Pregnant women are able to do some at-home monitoring, such as for high blood pressure, diabetes and contractions, and telemedicine can even be used by pregnancy consultants, such as endocrinologists and genetic counselors.

The frequency of sonogram appointments may also change. The Society of Maternal Fetal Medicine says it is safe to reduce "routine" ultrasounds at this time without jeopardizing the health and safety of the pregnancy. Of course, some patients with specific conditions like twins or babies with suspected birth defects may require more traditional follow up.


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What should I expect during delivery?

Hospitals are doing what they can to minimize person-to-person transmission, and that may mean delivery looks different, too. Some hospitals are screening all medical staff, including with temperature checks, at the start of shifts.

Visitors are also being restricted. Recently, a hospital in New York enforced a no visitor policy, including partners, for patients about to give birth, citing coronavirus risk. This is definitely not what laboring women envision for their delivery, but in times of widespread communicable disease, it is reality.

If I have COVID-19, will I need a cesarean section?

No. Having COVID-19 is not a reason for a cesarean. There's no evidence that either method, vaginal birth or cesarean, is safer when it comes to COVID-19. Although data is still limited, other coronavirus infections have not been known to pass to the child from vaginal birth.

Both the American College of Obstetricians and Gynecologists and the Society of Maternal Fetal Medicine believe, in most cases, the timing of delivery should not be dictated by the mother's COVID-19 diagnosis. Women infected early in pregnancy who recover should see no change to their delivery schedule. For women infected later in pregnancy, it is reasonable to attempt to postpone the delivery, as long as no other medical reason arises, until the mother receives a negative test result.

How long will I be in the hospital after I give birth, and what if I have COVID-19?

Expect a faster discharge from the hospital. To limit the risk of inadvertent exposure and infection, the ACOG says discharge may be considered after 12 to 24 hours, rather than the usual 24 to 48 hours for women with uncomplicated vaginal births, and after two days for women with cesarean births, depending on their health status.

For mothers with confirmed COVID-19, the Centers for Disease Control and Prevention advises that infants be isolated from them, which understandably is not ideal. That could mean drawing a curtain between the mother and newborn and keeping them at least six feet apart. The CDC suggests continuing that separation until 72 hours after the mother's fever is gone. If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed or suspected COVID-19 should put on a facemask and practice hand hygiene before each feeding or other close contact with her newborn.

Is home birth safer than a hospital right now?

If a woman chooses to have her baby in a hospital or birthing center, she will have a dedicated team of health care providers trained to protect her and her baby from COVID-19 and handle any unforeseen complications. There is some concern regarding person-to-person exposure with COVID-19 in a home birth setting due to fewer restrictions on visitors. Although the ACOG has not made a statement specifically on this risk, the United Kingdom's Royal College of Obstetricians and Gynaecologists has a statement advising against home birth for women who have been exposed to COVID-19.

Can I breastfeed my baby if I have COVID-19?

In limited cases reported to date, no evidence of virus has been found in the breast milk of women infected with COVID-19; however, precautions are still recommended. Breastfeeding is encouraged and is a potentially important source of antibody protection for the infant. The CDC recommends that during temporary separation, women who intend to breastfeed should be encouraged to pump their breast milk to establish and maintain milk supply. The mother should wash her hands before touching any pump or bottle parts. If possible, it is also recommended to have someone who is healthy feed the infant.

Having a child is a momentous occasion that should be celebrated, including during a pandemic. Do your part to keep yourself healthy. Wash your hands, maintain social distance and keep in close contact with your health care providers throughout the pregnancy. It may not be what you envisioned, but you will have quite a story to tell your children.

Hector Chapa is Clinical Assistant Professor, Director of Interprofessional Education, College of Medicine, Texas A&M University.

This article originally appeared on The Conversation. You can read it here.

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Judy Vaughan has spent most of her life helping other women, first as the director of House of Ruth, a safe haven for homeless families in East Los Angeles, and later as the Project Coordinator for Women for Guatemala, a solidarity organization committed to raising awareness about human rights abuses.

But in 1996, she decided to take things a step further. A house became available in the mid-Wilshire area of Los Angeles and she was offered the opportunity to use it to help other women and children. So, in partnership with a group of 13 people who she knew from her years of activism, she decided to make it a transitional residence program for homeless women and their children. They called the program Alexandria House.

"I had learned from House of Ruth that families who are homeless are often isolated from the surrounding community," Judy says. "So we decided that as part of our mission, we would also be a neighborhood center and offer a number of resources and programs, including an after-school program and ESL classes."

She also decided that, unlike many other shelters in Los Angeles, she would accept mothers with their teenage boys.

"There are very few in Los Angeles [that do] due to what are considered liability issues," Judy explains. "Given the fact that there are (conservatively) 56,000 homeless people and only about 11,000 shelter beds on any one night, agencies can be selective on who they take."

Their Board of Directors had already determined that they should take families that would have difficulties finding a place. Some of these challenges include families with more than two children, immigrant families without legal documents, moms who are pregnant with other small children, families with a member who has a disability [and] families with service dogs.

"Being separated from your son or sons, especially in the early teen years, just adds to the stress that moms who are unhoused are already experiencing," Judy says.

"We were determined to offer women with teenage boys another choice."

Courtesy of Judy Vaughan

Alexandria House also doesn't kick boys out when they turn 18. For example, Judy says they currently have a mom with two daughters (21 and 2) and a son who just turned 18. The family had struggled to find a shelter that would take them all together, and once they found Alexandria House, they worried the boy would be kicked out on his 18th birthday. But, says Judy, "we were not going to ask him to leave because of his age."

Homelessness is a big issue in Los Angeles. "[It] is considered the homeless capital of the United States," Judy says. "The numbers have not changed significantly since 1984 when I was working at the House of Ruth." The COVID-19 pandemic has only compounded the problem. According to Los Angeles Homeless Services Authority (LAHSA), over 66,000 people in the greater Los Angeles area were experiencing homelessness in 2020, representing a rise of 12.7% compared with the year before.

Each woman who comes to Alexandria House has her own unique story, but some common reasons for ending up homeless include fleeing from a domestic violence or human trafficking situation, aging out of foster care and having no place to go, being priced out of an apartment, losing a job, or experiencing a family emergency with no 'cushion' to pay the rent.

"Homelessness is not a definition; it is a situation that a person finds themselves in, and in fact, it can happen to almost anyone. There are many practices and policies that make it almost impossible to break out of poverty and move out of homelessness."

And that's why Alexandria House exists: to help them move out of it. How long that takes depends on the woman, but according to Judy, families stay an average of 10 months. During that time, the women meet with support staff to identify needs and goals and put a plan of action in place.

A number of services are provided, including free childcare, programs and mentoring for school-age children, free mental health counseling, financial literacy classes and a savings program. They have also started Step Up Sisterhood LA, an entrepreneurial program to support women's dreams of starting their own businesses. "We serve as a support system for as long as a family would like," Judy says, even after they have moved on.

And so far, the program is a resounding success.

92 percent of the 200 families who stayed at Alexandria House have found financial stability and permanent housing — not becoming homeless again.

Since founding Alexandria House 25 years ago, Judy has never lost sight of her mission to join with others and create a vision of a more just society and community. That is why she is one of Tory Burch's Empowered Women this year — and the donation she receives as a nominee will go to Alexandria House and will help grow the new Start-up Sisterhood LA program.

"Alexandria House is such an important part of my life," says Judy. "It has been amazing to watch the children grow up and the moms recreate their lives for themselves and for their families. I have witnessed resiliency, courage, and heroic acts of generosity."

When "bobcat" trended on Twitter this week, no one anticipated the unreal series of events they were about to witness. The bizarre bobcat encounter was captured on a security cam video and...well...you just have to see it. (Read the following description if you want to be prepared, or skip down to the video if you want to be surprised. I promise, it's a wild ride either way.)

In a North Carolina neighborhood that looks like a present-day Pleasantville, a man carries a cup of coffee and a plate of brownies out to his car. "Good mornin!" he calls cheerfully to a neighbor jogging by. As he sets his coffee cup on the hood of the car, he says, "I need to wash my car." Well, shucks. His wife enters the camera frame on the other side of the car.

So far, it's just about the most classic modern Americana scene imaginable. And then...

A horrifying "rrrrawwwww!" Blood-curdling screaming. Running. Panic. The man abandons the brownies, races to his wife's side of the car, then emerges with an animal in his hands. He holds the creature up like Rafiki holding up Simba, then yells in its face, "Oh my god! It's a bobcat! Oh my god!"

Then he hucks the bobcat across the yard with all his might.

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Images courtesy of John Scully, Walden University, Ingrid Scully
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Since March of 2020, over 29 million Americans have been diagnosed with COVID-19, according to the CDC. Over 540,000 have died in the United States as this unprecedented pandemic has swept the globe. And yet, by the end of 2020, it looked like science was winning: vaccines had been developed.

In celebration of the power of science we spoke to three people: an individual, a medical provider, and a vaccine scientist about how vaccines have impacted them throughout their lives. Here are their answers:

John Scully, 79, resident of Florida

Photo courtesy of John Scully

When John Scully was born, America was in the midst of an epidemic: tens of thousands of children in the United States were falling ill with paralytic poliomyelitis — otherwise known as polio, a disease that attacks the central nervous system and often leaves its victims partially or fully paralyzed.

"As kids, we were all afraid of getting polio," he says, "because if you got polio, you could end up in the dreaded iron lung and we were all terrified of those." Iron lungs were respirators that enclosed most of a person's body; people with severe cases often would end up in these respirators as they fought for their lives.

John remembers going to see matinee showings of cowboy movies on Saturdays and, before the movie, shorts would run. "Usually they showed the news," he says, "but I just remember seeing this one clip warning us about polio and it just showed all these kids in iron lungs." If kids survived the iron lung, they'd often come back to school on crutches, in leg braces, or in wheelchairs.

"We all tried to be really careful in the summer — or, as we called it back then, 'polio season,''" John says. This was because every year around Memorial Day, major outbreaks would begin to emerge and they'd spike sometime around August. People weren't really sure how the disease spread at the time, but many believed it traveled through the water. There was no cure — and every child was susceptible to getting sick with it.

"We couldn't swim in hot weather," he remembers, "and the municipal outdoor pool would close down in August."

Then, in 1954 clinical trials began for Dr. Jonas Salk's vaccine against polio and within a year, his vaccine was announced safe. "I got that vaccine at school," John says. Within two years, U.S. polio cases had dropped 85-95 percent — even before a second vaccine was developed by Dr. Albert Sabin in the 1960s. "I remember how much better things got after the vaccines came out. They changed everything," John says.

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