If, in itself, we are all concerned about the situation we are experiencing, uncertainty increases in the case of pregnant women who are going to give birth in the next few days or weeks. There is no evidence about the transmission of the virus from mother to baby during pregnancy, and that is good news, but what are births like during the COVID crisis? .
With the intention of reassuring them, based on the information available so far, and with the help of the midwives we have consulted, we will try to give you information about what births are like in times of coronavirus and everything you need to know to have a positive birthing experience.
Before going on to the questions, keep in mind that each hospital and center has its own protocol, and that these change to adapt to circumstances. And of course, a hospital with the saturation that exists in Madrid, for example, is not the same as others in cities not so affected where there is less income.
What happens if I go into labor?
When a woman goes to the hospital with signs of labor, the first thing to do is determine if the patient is infected with coronavirus or may be infected to take the appropriate isolation measures.
Aroa Vaello, treasurer of the Andalusian Association of Midwives and specialist at the Hospital de Jerez, explains that in the event that the mother is infected by the virus, or it is suspected that she may be, she is isolated from the beginning in a room special waiting period to carry out the pertinent tests: “If she is in labor, she goes to a dilation room set up for them where she continues her birthing process in the same conditions as mothers who are not infected, taking extreme precautions to avoid contagions ”.
The objective is that the circuits of healthy mothers and infected mothers do not mix at any time.
For his part, Ignacio Brunel, gynecologist at Hospital Quirón Málaga explains to us that “no pregnant woman is screened for COVID, unless she has highly suspicious symptoms. In any case, the results take time, so if she has a high suspicion is treated as if it were COVID positive. “
What protective measures are being taken during labor?
María José Remesal, midwife at the Virgen del Valme Hospital in Seville, tells us that in her hospital, “in mothers who are negative for COVID, we act as usual. Enter with your companion -which is only one and no changes are allowed- , at the time of delivery the same, skin to skin and everything as always “.
Since the pregnant woman enters the hospital to give birth, she must wear a mask at all times, both she and her companion. Disposable straps will then be used for monitors and staff will always try to maintain a safe distance.
Since a safety distance of less than two meters cannot be maintained during delivery, all personnel attending the delivery must wear special protective suits (PPE) , consisting of a waterproof gown, mask, gloves and goggles.
The midwife points out that “in the event that the pregnant woman is positive for COVID-19, she remains isolated. The delivery, even if vaginal, is in the operating room, and does not do skin-to-skin with the newborn. The baby is admitted to neonates for observation. “.
Can I enter with a companion?
Pregnant women are concerned that they will not be able to be with their partner in that special moment, but in most hospitals they allow a companion to enter the delivery room, unless it is positive for coronavirus or it is suspected that it may be. Likewise, this will depend on the protocol of each hospital and the circumstances of each one (such as, for example, the lack of protective equipment).
The midwife Carla Quintana, founder of ‘Matrona for me’, explains that “if the father (or companion) is positive, the mother must remain alone at all times. And if the mother is positive, delivery care must be done with all the appropriate protection measures by the doctors (EPI), and immediately the mother is separated from the baby, who happens to be admitted to neonates for observation. If the father is negative, he can visit the baby. “
If the companion is negative, he or she can stay with the mother during hospitalization, although there are hospitals that only allow it in case of cesarean section, as it is the hardest recovery for women.
Will the cesarean delivery be vaginal delivery?
There are no scientific recommendations on this subject, it will depend on each case, regardless of the coronavirus. Each case must be individualized, making the decision based on the mother’s condition and obstetric conditions.
In the case of a mother infected by coronavirus in serious condition, it will be necessary to end the pregnancy by the fastest route, and this way is usually cesarean section.
In our country, deliveries have already been attended both vaginally and by cesarean section in patients with positive COVID-19.
And the anesthesia?
According to the recommendations of the Gynecology and Obstetrics Service of the Puerta de Hierro University Hospital, there is no evidence that epidural or spinal analgesia or anesthesia is contraindicated in the presence of coronavirus.
Early analgesia is recommended in women with suspected or confirmed COVID-19 to minimize the need for general anesthesia in an emergency.
The use of Nitrous Oxide for pain control can increase aerosolization and the spread of the virus, so it is not indicated in women in labor with suspected or confirmed COVID-19.
Will I be able to do skin to skin after delivery?
There is still little scientific evidence, so there is no consensus answer and it will depend on the procedure of each hospital. There are different protocols (which are being updated) on how to act when a mother with COVID-19 gives birth:
- The Spanish Society of Neonatology talks about assessing skin-to-skin if correct mother-child isolation can be guaranteed. In symptomatic mothers with confirmed infection or under investigation, it does recommend admitting the newborn isolated and separated from its mother.
- The Spanish Society of Gynecology and Obstetrics, in the case of an infected mother, recommends immediate clamping of the umbilical cord and avoiding skin-to-skin contact after delivery. It should be considered to separate the mother and the baby temporarily, while the mother has the possibility of transmitting the infection. In the event that they remain in the same room, the newborn must be at least two meters away from his mother; If the mother must take care of him, she should wash her hands before and after any contact with him and wear a surgical mask when he is less than two meters away.
- The WHO, on the other hand, defends, verbatim, that “mothers and babies should be able to stay together and practice skin-to-skin contact, care for the kangaroo mother and stay together and practice joint accommodation during the day and night, especially immediately after birth during the establishment of breastfeeding, whether they or the infants are probable or confirmed COVID-19 cases. ” They should exercise extreme hygiene and wear a surgical mask . This is also the opinion of the BFHI, which defends skin-to-skin after childbirth and favors spontaneous latching in the first hour of life, as well as maintaining breastfeeding in any case (directly if the mother’s health so allowed and delayed if this is not possible).
- According to the protocol of the Ministry of Health for the Management of pregnant women and newborns with COVID-19 , “if an adequate isolation between mother and child can be guaranteed, late clamping of the cord and skin contact with skin after birth “.
The gynecologist Ignacio Brunel, tells us that in Quirón Málaga they do not restrict skin to skin in a generic way , except in cases of high suspicion of positive COVID.
Will I be able to breastfeed my baby at birth?
Due to its immune benefits, the WHO recommends maintaining breastfeeding from birth, both for cases of positive mothers and in research, taking the necessary safety measures to prevent contagion (mask and frequent hand washing).
In the case of mothers with serious illness, it recommends resorting to expressing milk.
The SeNeo (Spanish Society of Neonatology) in its latest review also advises maintaining breastfeeding from birth , even in the case of infected mothers.
The midwife María José Remesal explains to us that in her hospital, in the case of a positive mother, “the milk is extracted with all hygienic measures and it is another person who gives the milk to the baby until the mother is cured.”
What about visits?
Postpartum visits are not allowed . Although family and friends want to meet the newborn, and it is frustrating for grandparents, uncles and relatives not to be able to meet the baby on the day of its birth, it is something that must be avoided for prevention. Parents will have to introduce the baby remotely via video conference.
When will I be discharged?
The midwife Carla Quintana explains that in the case of vaginal delivery, it is intended that the hospitalization does not last more than 24 hours to reduce risks. In the case of cesarean section, discharge is being brought forward at 48 hours instead of 72 hours.
Once the baby has been discharged, the mother or father (only one adult) is summoned to go to the hospital or center indicated with the baby, to perform the heel test.
What will the control be like after delivery?
In general, and unless there are stitches or staples that have to be removed, the control of the mother after giving birth is done by phone .
The mother is asked how the bleeding is, if she has any discomfort … Control blood tests are not being done unless the situation requires it (anemia or any other medical reason).
And the baby’s first check-ups?
As for the baby’s first visit, at seven days to monitor its evolution and weight gain, it is usually also being done by phone.
In Babies and more | Could my child have Coronavirus? What to do when suspected in babies and children
