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.

Courtesy of Amita Swadhin
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In 2016, Amita Swadhin, a child of two immigrant parents from India, founded Mirror Memoirs to help combat rape culture. The national storytelling and organizing project is dedicated to sharing the stories of LGBTQIA+ Black, indigenous people, and people of color who survived child sexual abuse.

"Whether or not you are a survivor, 100% of us are raised in rape culture. It's the water that we're swimming in. But just as fish don't know they are in water, because it's just the world around them that they've always been in, people (and especially those who aren't survivors) may need some help actually seeing it," they add.

"Mirror Memoirs attempts to be the dye that helps everyone understand the reality of rape culture."

Amita built the idea for Mirror Memoirs from a theater project called "Undesirable Elements: Secret Survivors" that featured their story and those of four other survivors in New York City, as well as a documentary film and educational toolkit based on the project.

"Secret Survivors had a cast that was gender, race, and age-diverse in many ways, but we had neglected to include transgender women," Amita explains. "Our goal was to help all people who want to co-create a world without child sexual abuse understand that the systems historically meant to help survivors find 'healing' and 'justice' — namely the child welfare system, policing, and prisons — are actually systems that facilitate the rape of children in oppressed communities," Amita continues. "We all have to explore tools of healing and accountability outside of these systems if we truly want to end all forms of sexual violence and rape culture."

Amita also wants Mirror Memoirs to be a place of healing for survivors that have historically been ignored or underserved by anti-violence organizations due to transphobia, homophobia, racism, xenophobia, and white supremacy.

Amita Swadhin

"Hearing survivors' stories is absolutely healing for other survivors, since child sexual abuse is a global pandemic that few people know how to talk about, let alone treat and prevent."

"Since sexual violence is an isolating event, girded by shame and stigma, understanding that you're not alone and connecting with other survivors is alchemy, transmuting isolation into intimacy and connection."

This is something that Amita knows and understands well as a survivor herself.

"My childhood included a lot of violence from my father, including rape and other forms of domestic violence," says Amita. "Mandated reporting was imposed on me when I was 13 and it was largely unhelpful since the prosecutors threatened to incarcerate my mother for 'being complicit' in the violence I experienced, even though she was also abused by my father for years."

What helped them during this time was having the support of others.

"I'm grateful to have had a loving younger sister and a few really close friends, some of whom were also surviving child sexual abuse, though we didn't know how to talk about it at the time," Amita says.

"I'm also a queer, non-binary femme person living with complex post-traumatic stress disorder, and those identities have shaped a lot of my life experiences," they continue. "I'm really lucky to have an incredible partner and network of friends and family who love me."

"These realizations put me on the path of my life's work to end this violence quite early in life," they said.

Amita wants Mirror Memoirs to help build awareness of just how pervasive rape culture is. "One in four girls and one in six boys will be raped or sexually assaulted by the age of 18," Amita explains, "and the rates are even higher for vulnerable populations, such as gender non-conforming, disabled, deaf, unhoused, and institutionalized children." By sharing their stories, they're hoping to create change.

"Listening to stories is also a powerful way to build empathy, due to the mirror neurons in people's brains. This is, in part, why the project is called Mirror Memoirs."

So far, Mirror Memoirs has created an audio archive of BIPOC LGBTQI+ child sexual abuse survivors sharing their stories of survival and resilience that includes stories from 60 survivors across 50 states. This year, they plan to record another 15 stories, specifically of transgender and nonbinary people who survived child sexual abuse in a sport-related setting, with their partner organization, Athlete Ally.

"This endeavor is in response to the more than 100 bills that have been proposed across at least 36 states in 2021 seeking to limit the rights of transgender and non-binary children to play sports and to receive gender-affirming medical care with the support of their parents and doctors," Amita says.

In 2017, Mirror Memoirs held its first gathering, which was attended by 31 people. Today, the organization is a fiscally sponsored, national nonprofit with two staff members, a board of 10 people, a leadership council of seven people, and 500 members nationally.

When the pandemic hit in 2020, they created a mutual aid fund for the LGBTQIA+ community of color and were able to raise a quarter-million dollars. They received 2,509 applications for assistance, and in the end, they decided to split the money evenly between each applicant.

While they're still using storytelling as the building block of their work, they're also engaging in policy and advocacy work, leadership development, and hosting monthly member meetings online.

For their work, Amita is one of Tory's Burch's Empowered Women. Their donation will go to Mirror Memoirs to help fund production costs for their new theater project, "Transmutation: A Ceremony," featuring four Black transgender, intersex, and non-binary women and femmes who live in California.

"I'm grateful to every single child sexual survivor who has ever disclosed their truth to me," Amita says. "I know another world is possible, and I know survivors will build it, together with all the people who love us."

To learn more about Tory Burch and Upworthy's Empowered Women program visit https://www.toryburch.com/empoweredwomen/. Nominate an inspiring woman in your community today!

Gage Skidmore/Wikimedia Commons

Wil Wheaton speaking to an audience at 2019 Wondercon.

In an era of debates over cancel culture and increased accountability for people with horrendous views and behaviors, the question of art vs. artist is a tricky one. When you find out an actor whose work you enjoy is blatantly racist and anti-semitic in real life, does that realization ruin every movie they've been a part of? What about an author who has expressed harmful opinions about a marginalized group? What about a smart, witty comedian who turns out to be a serial sexual assaulter? Where do you draw the line between a creator and their creation?

As someone with his feet in both worlds, actor Wil Wheaton weighed in on that question and offered a refreshingly reasonable perspective.

A reader who goes by @avinlander asked Wheaton on Tumblr:

"Question: I have more of an opinion question for you. When fans of things hear about misconduct happening on sets/behind-the-scenes are they allowed to still enjoy the thing? Or should it be boycotted completely? Example: I've been a major fan of Buffy the Vampire Slayer since I was a teenager and it was currently airing. I really nerded out on it and when I lost my Dad at age 16 'The Body' episode had me in such cathartic tears. Now we know about Joss Whedon. I haven't rewatched a single episode since his behavior came to light. As a fan, do I respectfully have to just box that away? Is it disrespectful of the actors that went through it to knowingly keep watching?"

And Wheaton offered this response, which he shared on Facebook:

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Images courtesy of Mark Storhaug & Kaiya Bates

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The experiences we have at school tend to stay with us throughout our lives. It's an impactful time where small acts of kindness, encouragement, and inspiration go a long way.

Schools, classrooms, and teachers that are welcoming and inclusive support students' development and help set them up for a positive and engaging path in life.

Here are three of our favorite everyday actions that are spreading kindness on campus in a big way:

Image courtesy of Mark Storhaug

1. Pickleball to Get Fifth Graders Moving

Mark Storhaug is a 5th grade teacher at Kingsley Elementary in Los Angeles, who wants to use pickleball to get his students "moving on the playground again after 15 months of being Zombies learning at home."

Pickleball is a paddle ball sport that mixes elements of badminton, table tennis, and tennis, where two or four players use solid paddles to hit a perforated plastic ball over a net. It's as simple as that.

Kingsley Elementary is in a low-income neighborhood where outdoor spaces where kids can move around are minimal. Mark's goal is to get two or three pickleball courts set up in the schoolyard and have kids join in on what's quickly becoming a national craze. Mark hopes that pickleball will promote movement and teamwork for all his students. He aims to take advantage of the 20-minute physical education time allotted each day to introduce the game to his students.

Help Mark get his students outside, exercising, learning to cooperate, and having fun by donating to his GoFundMe.

Image courtesy of Kaiya Bates

2. Staying C.A.L.M: Regulation Kits for Kids

According to the WHO around 280 million people worldwide suffer from depression. In the US, 1 in 5 adults experience mental illness and 1 in 20 experience severe mental illness, according to the National Alliance on Mental Illness.

Kaiya Bates, who was recently crowned Miss Tri-Cities Outstanding Teen for 2022, is one of those people, and has endured severe anxiety, depression, and selective mutism for most of her life.

Through her GoFundMe, Kaiya aims to use her "knowledge to inspire and help others through their mental health journey and to spread positive and factual awareness."

She's put together regulation kits (that she's used herself) for teachers to use with students who are experiencing stress and anxiety. Each "CALM-ing" kit includes a two-minute timer, fidget toolboxes, storage crates, breathing spheres, art supplies and more.

Kaiya's GoFundMe goal is to send a kit to every teacher in every school in the Pasco School District in Washington where she lives.

To help Kaiya achieve her goal, visit Staying C.A.L.M: Regulation Kits for Kids.

Image courtesy of Julie Tarman

3. Library for a high school heritage Spanish class

Julie Tarman is a high school Spanish teacher in Sacramento, California, who hopes to raise enough money to create a Spanish language class library.

The school is in a low-income area, and although her students come from Spanish-speaking homes, they need help building their fluency, confidence, and vocabulary through reading Spanish language books that will actually interest them.

Julie believes that creating a library that affirms her students' cultural heritage will allow them to discover the joy of reading, learn new things about the world, and be supported in their academic futures.

To support Julie's GoFundMe, visit Library for a high school heritage Spanish class.

Do YOU have an idea for a fundraiser that could make a difference? Upworthy and GoFundMe are celebrating ideas that make the world a better, kinder place. Visit upworthy.com/kindness to join the largest collaboration for human kindness in history and start your own GoFundMe.

Chris Evans is playing the lead role in the upcoming Pixar film "Lightyear."

Chris Evans was already skilled at squeezing hearts on social media, cavalierly sharing sweet pics of his adorable dog and piano-playing videos on Instagram, as if we could just casually watch him be a near-perfect man without swooning. And now he's being even more delightful with his gushing giddiness over getting to play his dream role.

The guy is already best known as the studly Marvel superhero Captain America, so what could possibly top that? Pixar, apparently. Evans' ultimate acting dream is being in a Pixar movie. And now that dream is coming true, the most eligible of the Chrises could not be cuter in his expressions of joy.

Sharing the new trailer for "Lightyear"—Pixar's origin story about the astronaut the Buzz Lightyear toy was based on in the "Toy Story" universe—Evans wrote on Twitter:

"I'm covered in goosebumps. And will be every time I watch this trailer. Or hear a Bowie song. Or have any thought whatsoever between now and July cause nothing has ever made me feel more joy and gratitude than knowing I'm a part of this and it's basically always on my mind."

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Cipolla's graph with the benefits and losses that an individual causes to him or herself and causes to others.

Have you ever known someone who was educated, well-spoken and curious, but had a real knack for making terrible decisions and bringing others down with them? These people are perplexing because we're trained to see them as intelligent, but their lives are a total mess.

On the other hand, have you ever met someone who may not have a formal education or be the best with words, but they live wisely and their actions uplift themselves and others?

In 1976, Italian economist Carlo Cipolla wrote a tongue-in-cheek essay called "The Basic Laws of Human Stupidity" that provides a great framework for judging someone's real intelligence. Now, the term "stupid" isn't the most artful way of describing someone who lives unwisely, but in his essay Cipolla uses it in a lighthearted way.

Cipolla explains his theory of intelligence through five basic laws and a matrix that he believes applies to everyone.

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