There is still a lot we don't know about the effects of COVID-19 on pregnancy. There have been only a few studies published to-date, and while there is currently no evidence that COVID-19 is subject to intrauterine transmission or increases risk of maternal death, research suggests it may have indirect adverse effects on newborns. It's important to note that these studies were extremely limited in sample size, and there has been some debate on the appropriateness of creating broad clinical guidelines based on select findings.
March 26 webinar: How COVID-19 is transforming telehealth—now and in the future
The CDC largely echoes this uncertainty, confirming that we do not know for sure whether the coronavirus can be passed from a mother to her fetus, result in negative maternal or infant outcomes, or infect pregnant women more easily than the general public.
So what do we know?
First, there is a risk of spreading the virus from mother to child after birth. We also know that many women (and their providers) are concerned about the risk of transmission during prenatal and hospital visits.
These facts have led to three major implications for pregnancy:
Implication 1: Increase in virtual visits
As pregnant women and physicians seek to limit potential exposure, many routine gynecology and prenatal care appointments have been canceled, postponed, or transitioned to virtual visits.
For example, MultiCare is now offering free e-visits to anyone with COVID-19 symptoms and highly encouraging these visits for those who are at increased risk, including pregnant women. These women can further enroll in their Virtual OB Visits program. Similarly, Maven Clinic is also strongly recommending women consult over the phone with their doctors or online with a Maven telemedicine provider, especially if they are feeling any coronavirus symptoms.
Further, MomDoc and eVisits recently partnered to provide virtual gynecology care to patients, especially pregnant patients, across Arizona. While the plan had been in the works for a while, leaders and employed OBs believe the offering is especially timely to reduce COVID-19 exposure for mothers-to-be.
Implication 2: Updated obstetric unit protocols
Labor and delivery units have also made a number of changes in response to COVID-19.
First, many units are limiting partner and birth attendant support and instituting special visitor stipulations. For example, Rose Medical Center in Denver now limits each OB-GYN patient to only one birth partner and one visitor, who must wear personal protective equipment (PPE). While Elmhurst hospital in Chicago also allows one birth partner, the facility has effected a no-visitor policy for OB. It's important to note that these restrictions have also created situations where women cannot have alternative birthing providers, such as doulas, attend their births, further disrupting the planned birth experience.
Second, if a pregnant patient has tested positive for COVID-19 or is a person under investigation (PUI), the CDC's interim guidance for infection prevention and control in OB units recommends that providers consider temporarily separating mother and baby. Changes to breastfeeding practices are also recommended, including the use of face masks, hand hygiene, and bottle disinfection. Additionally, babies must be monitored more closely for potential complications.
Implication 3: Increased patient interest in out-of-hospital births
Fears of catching COVID-19 while in the hospital have also led many women to express concerns about delivering their children in inpatient delivery units. This has spiked interest in alternative birthing options, increasing business for many freestanding centers, midwives, and doulas.
While out-of-hospital births have historically comprised less than 2% of all deliveries in the United States, we may see an increase as COVID-19 continues to spread. Especially with new caps on birth attendant or support personnel in inpatient units, women who were already interested in having a midwife or doula attend their birth may now be even more inclined to consider alternative options.
Overall, COVID-19 is changing the way pregnancy and OB programs provide care, elevating the importance of telehealth, careful delivery unit protocols, and alternative birthing options in the women’s health landscape.
To prepare, women's programs should weigh the feasibility of virtual prenatal care visits, ensure mother and baby's safety through necessary protocol changes, and effectively communicate both the importance of continued pregnancy care and the efforts their units are taking to ensure the safety of in-hospital delivery.
Your top resources for COVID-19 readiness
You're no doubt being inundated with a ton of information on how to prepare for possible patients with the 2019 coronavirus (COVID-19). To help you ensure the safety of your staff and patients, we've compiled our top resources on how to safely manage and prevent the spread of COVID-19.