The state of pandemic by Covid-19 declared by the WHO, together with the state of alarm decreed by the government of Spain, means that we are living an exceptional situation. This experience can create a feeling of uncertainty, worry, and sometimes fear. And all these feelings increase in pregnant women and for that reason, doctors Llanos Gómez and Sara Cholvi, Gynecologists of the Obstetrics and Gynecology service of the Hospital de Manises explain to us how they are caring for pregnant women in their hospital. In turn, they want to convey to you that you are not alone, and that they will accompany you on this beautiful path of bringing a new life to the world.
As you all know, SARS CoV 2 infection is a new disease and, as such, not everything is known about it. The information we have on Covid-19 and pregnancy is based on studies that have been published recently, and medical practice may change.
How to protect myself against infection?
For now, the transmission of the virus through the secretions of infected people has been described, mainly by direct contact with respiratory droplets (invisible water droplets that are expelled when talking, coughing, sneezing) and hands or surfaces contaminated with these secretions. followed by contact with the mucosa of the mouth, nose or eyes.
Therefore, the recommendations are:
- Avoid close contact (less than 2 meters) with people with symptoms.
- Staying home (to avoid contacting people who do not have symptoms but do have the virus).
- Frequent hand washing with soap and water (or hand hygiene with a hydroalcoholic solution). Above all, if you have had to go outside, as soon as you get home. Avoid touching our hands, eyes, nose or mouth.
- Attempting to use your non-dominant hand to touch doorknobs or other surfaces in public areas. (More information in this link)
Symptoms of Covid-19 in pregnant women
The pregnant woman is not more susceptible to contracting the infection compared to the general population , but she can have more severe symptoms (however, the absolute risk is small). From infection to the onset of symptoms can take up to 14 days, but most people develop the first symptoms within 5-6 days of infection.
The most common symptoms are fever and a dry cough. However, there are people who are practically asymptomatic, another group of people have a mild cold (the majority) and a smaller group suffer from a serious condition characterized by pneumonia that affects both lungs and causes a sensation of shortness of breath.
It is important to note that if you think you may have been infected and you have symptoms (fever, dry cough and feeling short of breath), avoid going to the Health Center or going to the Hospital.
Instead, you can call the information telephone number that your community has enabled for care in case of suspected contagion and they will indicate the steps to follow. In most cases, people with symptoms are cared for preferably at home.
If you have doubts about whether you are a carrier of SARS CoV 2 and have Covid-19, the Conselleria de Sanitat Universal have created the following test to get you out of doubt.
Uninfected pregnant women
In the case of pregnant women who do not present any symptoms of Covid-19, the follow-up will be normal, applying the measures indicated by the health authorities for prevention and safety for people and health professionals. Despite the confinement situation, your pregnancy will be properly controlled.
What will the visits to the midwife be like?
Face-to-face visits for essential tests will alternate with non-face-to-face tests that will be carried out by phone in order to avoid unnecessary travel to ensure your safety and the personnel of your Health Centers.
Pregnant women will go to the midwife for the first visit and for the third trimester visit. The midwife will arrange the dates for you to go to the Health Center for tests.
The midwife will contact you periodically to inform you of your progress and the results of the tests. We recommend that you take your blood pressure (every 15 days) and keep track of your weight (once a month) so that you can provide them to the midwife.
What will hospital visits be like?
Only essential visits will be made:
- First trimester ultrasound (week 11-13).
- Morphological ultrasound (week 20-22) that will coincide with the vaginal test to measure the cervix.
- Third trimester ultrasound
- Consultation of monitors (straps)
Each case will be studied individually. This scheme that we show you is indicated for “low risk” pregnant women.
You will go to the unaccompanied consultations and, upon entering, you will perform hand hygiene.
We will also make telephone consultations to give you some results and thus avoid unnecessary visits to the hospital.
What will my delivery be like?
In principle, if you are healthy, delivery care will not change from what we usually do. When you go into labor, you will enter through the Emergency area, you will inform us if you have had symptoms of Covid-19 and they will take you directly to the delivery area.
Protective measures must be taken into account: if you go into labor, to provoke it or to perform a scheduled cesarean section, we will give you a mask to wear at all times.
Epidural
You do not need to sign any prior consent. If you meet the hospital requirements, they will give you the epidural.
Companions
Regarding the companions, only one will pass, always the same person and it is mandatory that they wear a mask. You will have to bring that mask from home.
And when is my baby born?
If you are healthy and the delivery has passed normally, you can do skin to skin, delayed clamping of the umbilical cord (if you wish), and your baby will stay with you. The same with breastfeeding: you decide the type of breastfeeding.
In pregnant women who are infected or with symptoms
In the case of pregnant women who are infected or have symptoms of Covid-19, the Manises Hospital has prepared an exclusive circuit of care for the pregnant woman suspected or confirmed with Covid-19. The circuit includes all the reasons why you may need to go to the Hospital: external consultations for pregnancy control, emergency consultations, need for admission, delivery process or cesarean section.
What will hospital visits be like?
Ideally, you should delay your scheduled appointment for about 14 days after the symptoms disappear (due to the still risk of contagion in that period). For this you will have to call the admission of external consultations and the administrative will contact us to give you the new appointment.
In the case of not being able to delay that appointment, the visit would be made late in the morning. It is very important that you tell us that you have the infection so that we can provide you with a surgical mask and so that the staff who treat you can protect themselves adequately.
What will my delivery be like? Am I more likely to have a cesarean section?
Based on the data we have so far, Covid-19 infection is not an indication for caesarean section. Therefore, you can have a normal vaginal delivery.
What protection measures are being adopted in the delivery room?
It is very important that you let us know if you have symptoms suggestive of Covid-19 infection: dry cough, fever (temperature of 38 degrees or more), respiratory distress.
The protection measures will be the following:
- You will wear a surgical mask at all times (provided by the delivery staff).
- We will assign you a specific dilatation room and hospital room.
- You may be accompanied during the dilation and delivery process, but your companion must follow the safety instructions and adopt all the safety and protection measures, as well as the pertinent and available protection material that will be provided by the health team itself.
- As, despite this health emergency situation, we want your delivery to be special, if you could not be accompanied during the dilation or delivery process, we will try to offer you the possibility of making a video call so that you are closer to your loved ones. In that case, we will always preserve the right to privacy of the healthcare professionals who are treating you.
Epidural
You do not need to sign any prior consent. If you meet the hospital requirements, they will give you the epidural.
And when my baby is born, will I be able to do skin to skin? Will I be able to breastfeed him?
Everything will depend on your symptoms, so each specific case will be evaluated at the moment.
If you have no symptoms or they are very mild , you can
- Make skin-to-skin contact
- Perform delayed clamping of the umbilical cord (if desired)
- Be the two in the same room (as long as there is a separation of 2 meters)
- You can breastfeed, taking into account some protective measures: hand hygiene, use of a mask, or avoid coughing / sneezing on the baby.
If you have symptoms , we have to ensure the well-being of your baby so we will have to be more strict
- Early clamping of the umbilical cord
- Mother-child separation
- Recommendation not to breastfeed.
- Yes, you can feed your baby with your milk, but expressed with a breast pump (with hygiene measures) and administered by a healthy family member.
When I’m in the maternity ward, can I have someone with you?
According to the latest instructions issued by the Ministry of Health in this regard, you can be accompanied, always following the security and isolation measures (in the room itself).
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