St Patricks Day 2020 was a day the seriousness of our world came real. The French government asked its people to stay at home. Restaurants and cafes already closed . If you can work from home do. It was the whole world trying to fight a virus never seen before, how it was going to effect the various people in our communities. As a midwife it was a scramble to find out what can I do for the pregnant women whom had trusted me to guide them . I needed to make contact with them all to make sure they were ok and what they should do in the various different scenarios that they might meet. By the second week of lock down various groups in our community asked me to do a virtual conference to reassure the families. So I thought I would put it on my blog so here you go.
Disclaimer:. Any and all information provided is for guidance purposes only and is not to be considered as medical or clinical advice. It is recommended that all pregnant moms or new moms consult with their medical professional or midwife.
What is the Coronavirus (COVID-19)?
The World Health Organization (“WHO”) states the following on their website:
· Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.
· The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it’s important to practice respiratory etiquette (for example, by coughing into a flexed elbow).
· Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.
· At this time, there are no specific vaccines or treatments for COVID-19.
· The best way to prevent and slow down transmission is be well informed about the COVID-19 virus, the disease it causes and how it spreads. Protect yourself and others from infection by washing your hands or using an alcohol based rub frequently and not touching your face.
What should I do if I suspect I have COVID-19 or I live with someone with symptoms of COVID-19?
If an asymptomatic pregnant woman or nursing mother lives with someone with symptoms of COVID-19:
· Pregnant women and nursing mothers should be physically isolated from this person.
· The person with symptoms of COVID-19 should self-quarantine for 14 days.
o This doesn’t mean the person has be to removed from the family home – they can be isolated in a room.
· Wash hands thoroughly, everyone should use their own set of cutlery and plates, and the clothes and bedding of the person with COVID-19 symptoms should not be handled (put them in a plastic bag, for example).
· The pregnant woman or mother needs to report that they live with someone who has symptoms of COVID-19 so that there can be some sort of medical supervision.
If a pregnant woman or nursing mother develops symptoms of COVID-19:
· From experience, a significant amount of cases where a mother reported that she was suspicious of being COVID-19 positive turned out to be either the flu or a cold, so understanding the symptoms of COVID-19 is extremely important. As the number of COVID-19 cases rise this may change, so please look out for the known symptoms.
· While there are some rare variables, symptoms are globally similar:
o The most common:
§ People lose their sense of smell, and this might be the first sign
§ A sore throat
§ They spike a temperature
§ They have a cough
§ They may or may not have a runny nose
§ Extreme tiredness
o Less common:
· If the pregnant woman / nursing mother develops symptoms:
o The first step is to report it to her family doctor, or if she doesn’t have one, to the maternity hospital she is attending. Otherwise call 15.
o Regardless of the duration or severity of her symptoms, if she is COVID-19 positive she will need to quarantine for 14 days.
· If there is suspicion of infection, the pregnant mum should first call her GP. The Doctor will work with her to decide if she should remain at home or go to a certain hospital for treatment.
Can I get tested for COVID-19?
· Not everyone can be tested for COVID-19 as it is not financially viable. The good news is that symptoms can work as indicators as to whether or not to treat a case as suspicious.
· The French government have published a questionnaire online that can help you self-diagnose: https://maladiecoronavirus.fr/
What will happen to me during my pregnancy under COVID-19?
During the pregnancy
· Given that this is a new virus, the information we have about it is still unclear, but what they’re feeling at the moment is that it is more the symptoms than the virus itself that cause a woman to miscarry. Note that we might have different information down the track.
· One particular symptom that is of concern regarding COVID-19 is a reduction in lung capacity.
· Hospitals have started postponing routine appointments. Some are doing them virtually, and some are asking midwives to step in and do home visits. High risk mothers will be seen at their homes.
· The three ultrasounds are still taking place, but often they are being outsourced to private clinics/ cabinets as they feel there is more control over managing the spread of the virus. Partners are no longer allowed to be present at these ultrasounds. A suggestion is to Facetime/Skype partners during these appointments so that they can participate virtually (to ask questions, translate, watch the ultrasound, etc.).
· All group classes have been cancelled. Midwives can do these classes via virtual consultations. These are fully reimbursed.
· As mentioned above: what they’re feeling at the moment is that it is more the symptoms than the virus itself that cause a woman to miscarry, but as it is a new virus this information may change down the track.
· Research conducted in China sees no direct correlation between COVID-19 and miscarriage, but this doesn’t mean we won’t see this as time goes on.
· As a precaution, a mother in early gestation is better off physically isolating herself as much as she can.
· Most worrying are the symptoms the mother would experience as opposed to the virus itself causing problems to the foetus.
· At the moment, we are seeing that mothers with COVID-19 do very well if they are treated correctly and quickly.
· Affects on unborn baby are still showing to not be hugely concerning.
Third trimester and giving birth
· To minimise the chance of getting in contact with COVID-19, stay at home for as long as possible. A contraction that is lasting for a minute for a duration of 2-3 hours is a cervix that’s starting to open. This is a good time to start preparing to go to the hospital. At this stage mothers usually have another 4-5 hours ahead of them before birth (shorter for those who’ve had two or three babies) so one shouldn’t worry too much about not getting to the hospital in time.
· We worry that the mother is infectious at the time of giving birth, which would risk her baby contracting the virus.
· If the mother were infectious at the time of giving birth: the mother would be treated in isolation and would give birth in isolation. She would also wear a mask during the birth.
· If the mother does not have COVID-19 the staff would work to protect her from the virus, so in this case , depending on the hospital it may not be her who would wear the protective gear but the staff. She might be asked to wear a mask at the stage she starts pushing.
· Several weeks into this crises most maternities are letting the partners in for the last few hours of labour/birth. Once the mother and baby are transferred from the labouring area, the partner is sent home until its time to take mother and baby home. In the maternity hospitals mothers will also be alone for the duration of their postpartum stay at the hospital.
A note on home births:
· Most are booked out as there are not many midwives practicing homebirths in Paris. Last minute homebirths are not ideal anyway as they should be planned for throughout the duration of a pregnancy, having trust and confidence in the attending midwife is part of this journey.
· In France, it is illegal to birth unattended by a professional.
What happens to me after I give birth?
· From the latest government ruling, mothers will be alone for the duration of their stay at the hospital, i.e., the partner is not allowed to stay with them.
· If both the baby and mother test positive for COVID-19 they stay together but are isolated from everyone else. They may be asked to stay at the hospital until blood tests show that there is no more COVID-19.
· If the mother has symptoms, she can stay with her baby but she is asked to wear a mask.
· If the mother is very sick and needs life support or a lot of support, then the mother and baby will be separated.
· There have been no reports of women coming out from birth and dying from COVID-19.
· Paracetamol only for managing postnatal pain – do not take Ibuprofen as we are informed it does not mix well with COVID-19.
What about if I am doing a caesarean birth?
At present most maternities are trying hard to find solutions for the father of the new babies to have time doing skin to skin while waiting for their partner to leave the recovery area. Its then that the fathers are asked to return to their home.
· As mentioned above, partners cannot stay with the mother and baby in the hospital during the pandemic and this includes if the birth was by caesarean.
· If your caesarean is planned: ask to be discharged early, as you won’t have your partner there to support you. Also, the hospital might be understaffed, and you might not receive the level of assistance that you’d like.
Is getting discharged early possible? How do I make it happen?
· Mothers can ask to leave early but it is suggested to not hesitate to speak up about this, the recommendation is to rest in the hospital for a minimum of 48 hours.
· It’s a good idea to write in the birth plan that the mother is planning to be discharged early because of the virus. This way everyone knows in advance, and any important discussions can be had. PLEASE discuss this with your midwife before hand so she is ready for you when you’re discharged.
· During their pregnancy, mothers can also organise a midwife through the PRADO system and register their midwife on their Ameli profile (online). This can give a bit of scope when asking to discharge from the hospital early. https://www.ameli.fr/sage-femme/exercice-liberal/services-patients/programmes-retour-domicile
Should I breastfeed my baby even if I think I have COVID-19?
· Absolutely YES – you should continue to breastfeed your baby if you so choose to.
· What we are seeing is that COVID-19 it is not transferring into breast milk within the mother .
· WHO is encouraging mothers to continue breastfeeding their babies .
· WHO also suggests that mothers who have the virus wear a mask while they breastfeed. In France, at present, prescriptions for masks are currently not being given.