By Carrie Schram, Medical Director, Natural Conception Program
Here, and in my antenatal practice, I’m being frequently asked questions about infection with COVID-19 and pregnancy.
By background, I’m a family doctor who has done a fellowship in women’s health that included low-risk obstetrical training, and a few years back I completed a master’s of public health.
Although all of the physicians at Hannam Fertility Centre have training in labour and delivery, some much more than I, at present I’m the only doctor still practicing and seeing women delivering in our current pandemic climate.
I will be honest, it is a bit of a scary time to be getting pregnant and having a baby. There is a lot we don’t know, and information is changing quickly.
But there is good news.
The three major medical associations regarding pregnancy, including the Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG) and the Society of Obstetricians and Gynaecologists of Canada (SOGC), all agree that based on what we know to date and the properties of COVID-19 (and its similarity to other viruses) pregnancy is, on the whole, quite safe. Phew!
Specifically, COVID-19 does not appear to increase the risk of miscarriage or cause birth defects, should you catch it at the beginning of pregnancy.
Women who get COVID-19 in the first two trimesters of pregnancy, that is less than 28 weeks gestational age, appear to not be severely affected and do well.
Later in pregnancy, however, could be more concerning. There are small case reports (of not many women), that infection in the third trimester can be pretty severe and either cause pre-term delivery or make doctors force a pre-term delivery to save the affected mother. The good news is that most pre-term babies in Canada do very well.
There continue to be questions about whether or not infection can pass through the placenta. At first, we thought it could not, now we think maybe it can. Perhaps it is related to viral load? That verdict is still unclear.
So what we know now is an infection in early pregnancy is likely OK, but later on, it could put mothers and babies at risk. Even later in pregnancy, however, almost all mothers and babies have recovered and are now well.
For women who are pregnant now and early in pregnancy, I’m recommending they take the same precautions as everyone else – stay home if possible, wash hands frequently, avoid touching one’s face, see loved ones virtually.
For those later in pregnancy, those precautions all still apply, but I’m also helping people plan for delivery. At present, hospitals are restricting access to visitors and this includes labour and delivery.
Women in labour are allowed one support person, who must not have travelled recently and who must be clinically well. That person has to stay with the labouring woman, and cannot come and go, not even for coffee. So, pick that person, have a back-up in case that person becomes unwell, and pack lots of snacks as you’ll both be in the hospital for two-to-three days, and hospitals don’t feed support people.
Unfortunately, this may mean that you cannot have your mother or best friend or doula, which we apologize for, but it’s for everyone’s safety. Your delivery team will also be wearing extra protective gear when you deliver, to protect us and you, so expect to see that.
Also for those later in pregnancy, if you have any symptoms of COVID-19, or even what you’re sure is a typical cold, you have to go to a COVID-19 testing centre for testing. We need to know before you arrive in labour.
There have been and will be, women in Toronto who actively have COVID-19 when they deliver. For those women, we will be wearing even more protective gear, so expect that. For these women, at this time, we cannot have support people present. We deeply apologize, but we need to keep everyone safe to continue to help bring babies into this world.
As always, talk to your obstetrical care provider for more specific information about your pregnancy and policies at your hospital. Know things are evolving quickly, but that all of us delivering babies right now are doing our best to do so safely.
And what a story you’ll have to tell baby someday when he/she is older!
About the Author
Carrie Schram MD CCFP MPH
The Medical Director of Hannam’s Natural Conception Program, Dr. Schram has fellowship training in Women’s Health and a Masters of Public Health from the University of Toronto, where she is an assistant professor.