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Pregnancy: keep updated on COVID-19 (Coronavirus)

Birds of Paradise, Women’s Health Clinic hope to provide our staff, patients and local health community update information on Novel Coronavirus 19 (COVID-19). See below for further information.

The Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG) update for patients can be located here: RANZCOG Patient Information. As obstetricians, we are guided by a series of recommendations from RANZCOG, Queensland Health, WHO, RCOG, CDC and local hospital guidelines. Please find the links below to these organisations to ensure you receive information that is up-to-date and accurate.

What is Coronavirus? 

Coronavirus is a respiratory illness spread between people. It is a virus which commonly can causes flu-like symptoms and would be a very uncommon cause of serious infection. But, as of December, a new strain emerged which is causing very serious infection and behaving in a different way to previous strains of coronavirus. This strain is called Novel Coronavirus 19 (COVID-19). COVID-19 is the most recent strain which can cause a much more serious infection compared to the more common, less severe strains.


Can I get coronavirus in pregnancy?

Yes. Coronavirus is a common virus that is regularly seen in pregnancy. Previous strains have not been a recognised cause of complications in pregnancy.  Current evidence suggests the COVID-19 strain can affect pregnant women as frequently as non-pregnant women of the same age.


Will COVID-19 be different to other types of coronavirus in pregnancy? 

For some women, yes COVID-19 will be different to other strains of coronavirus, but for most women it will be a mild condition still. In pregnancy, women have a degree of immunosuppression. This means that they are more vulnerable. With COVID-19, serious infection is more likely in immunocompromised people, such as pregnant women. So whilst a pregnant women is just as likely as a non-pregnant woman to get COVID-19, unfortunately the illness may be more likely to become a severe disease if you are pregnant.


Is there a difference between my baby being infected or affected? 

Yes


Will my baby be
 *infected* with COVID-19 if I have the infection in pregnancy? 

Babies born to mum’s with COVID-19 are unlikely to be infected at birth. After a baby is born, it is vulnerable to infection as it has an immature immune system. Babies need to be protected from many types of infection through a range of measures. This includes, frequent hand washing, avoiding crowds, minimising the number of people who handle your baby, avoiding unwell contacts, ensuring very good hand hygiene of your other children and limiting visitors who come to meet your baby in hospital (preferably to your partner only).

Can my baby be *affected* by COVID-19 if I have the infection in pregnancy? 

Babies can be affected mostly if their mother suffers a serious complication of COVID-19, such as pneumonia or respiratory failure. If a pregnant woman becomes  particularly unwell, pregnancy complications such as preterm birth and growth restriction of the baby can occur. Complications such as miscarriage, stillbirth or death of a mother, are possible but very unlikely to occur with early detection and medical intervention. To date, the rate of miscarriage in early pregnancy has not been seen to increase with COVID-19. Of note however, fever in early pregnancy has been associated with some adverse outcomes,and therefore, again prevention is the best management.

What can I do to prevent acquiring Covid 19? 

You can follow the public health updates through your local public health area. Queensland Health has a daily update via this link.

Our recommendation is frequent handwashing, social distancing from unwell contacts, avoid crowds (eg. shopping centres, public events) and avoid all unnecessary travel. Children are unlikely to be severely infected with COVID-19 and will more than likely just have flu-like symptoms, if at all. Unfortunately, children are also a common way to acquire COVID-19. Ensure your children frequently wash their hands and face, sneeze into their elbow, avoid other unwell children and always wash hands if you are continuing to use public playground equipment. Please look to make other arrangements rather than bring your child to your medical appointments and to the hospital. As a community, we need to help protect each other, especially our more vulnerable in the community – keeping children apart from other pregnant women, the hospitals and the elderly is a key way to do this.

Does which trimester I am in matter if I get infected with COVID-19?

Yes it can.

Early pregnancy (less than 20 weeks gestation), the biggest risk is of fever. High temperatures can be associated with some developmental concerns, regardless of the cause. We advise you to ensure you take a pregnancy folate bought from a chemist. If you have fever, taking regular paracetamol, fluids and considering a higher dose folate supplement would be first line.

Late pregnancy has increasing evidence of being associated with preterm birth and adverse pregnancy outcome for a small number of women who get a severe infection after 28 weeks. For this reason, there has been a change in recommendations.

Should I work in pregnancy?

If you can work from home in pregnancy during the COVID-19 pandemic, you should. If you are unable to work from home, your circumstances should be individually assessed by your health care provider. If you are after 28 weeks gestation, if you are unable to work from home, you should contact your healthcare provider on the decision to continue working in pregnancy. For health care workers in pregnancy, there is a comprehesive RCOG advice for women and employers on working in COVID in pregnancy.

It is important if you are working from home, particularly in late pregnancy, that you exercise social distancing. You should limit or stop visitors to the house, ensure items coming into your home are wiped down with gloves on, do not go to areas with a lot of people (eg. shopping centre) and consider the arrangements of your other children and partners. If you are in late pregnancy, consider social distancing and remaining at home with all of your family if able to reduce your COVID-19risk.

What else can I do at home?

If you are social distancing at home, it is important to continue to as many of your normal activities as possible. Apart from connecting with family/friends online, and preparing your house for your baby’s arrival, it is important to commit to a small amount of time for your mental health. Mental health experts recommend establishing a routine that you can do for a small period of time every day. The routine chosen should not require much effort to change from your current lifestyle; it should ideally be away from digital devices and ending with a small amount of exercise. An example of this would be: wake up and have a coffee on your balcony for 10 minutes every day at a committed time, then do some gentle exercises at home for 10 minutes (like swimming, go for a walk, garden). Simple, achievable and regular.

Will my Caesar date change because of COVID 19?

It is unlikely, although with the redistribution of health resources, it may be possible in the coming months. For our patients at Birds of Paradise, minor variation in the time of your Caesar, but unlikely the day, would be the biggest change we would anticipate at this time.

Should I have a Caesar for COVID-19?

You should not alter your birthplans currently for COVID 19 in the absence of infection. We firmly recommend AGAINST home birthing during COVID -19. Home birth in Australia is associated with significant risk of harm to both the mother and the baby.

Should I have an induction of labour for COVID-19?

At Birds of Paradise, we offer elective induction to all women planning vaginal birth from 39 weeks. Your individual birth plan and timing of delivery will be discussed in detail and can be adapted to the changing circumstances as needed in COVID 19.

Will Cairns Private Hospital let my partner in to the delivery room and throughout my stay?

Yes. However, there are now restrictions on visitors to maternity in order to protect the vulnerable pregnant and postpartum women on our ward, and especially new born babies. For the protection of staff, mothers and babies on our wards, Cairns Private advises only 1 visitor per patient from delivery through your postpartum stay. All visitors entering the hospital are now screened with a single entrance point.


What happens if I go into labour with COVID-19?

If you go into labour with COVID-19 you will likely be advised to have continuous monitoring of your baby, to have a drip placed into your hand, and to wear a mask and/or gown during your labour. Staff entering your room will wear personal protective equipment and visitors in your room during labour will be minimised. Following birth, your paediatrician will likely need to closely monitor your baby for signs of illness. The decision on skin-to-skin and breast feeding postnatally will be discussed between the woman and her maternity health care providers.

If you do not have COVID-19, staff may still be required to wear personal protective equipment (such as gloves, a mask and gown) during your delivery.

Each hospital will have a specific protocol for their birthsuite and the staff working in the facility to ensure the safety of patients, partners, babies and staff. This is likely to evolve over the next few weeks.

Can I birth at Cairns Private Hospital if I am suspected, or have tested positive for COVID-19?

At this time, all suspected and positive COVID-19 patients are treated at the designated COVID public hospital, The Cairns Hospital. This also applies to pregnant and labouring women requiring hospital admission in their pregnancy, meaning, if you are suspected or are positive for COVID-19 in your pregnancy, you may require transfer of care to the Cairns Hospital.


Should I remain home and not go to my appointments in pregnancy to protect me and my baby?

No! It is important when you are pregnant to ensure you and your baby continue to be well and monitored. At an antenatal appointment, you are regularly assessed by an expert pregnancy care provider (midwife or obstetrician) to not show signs or symptoms of conditions that may require further management of assessment. Examples include looking for signs of labour, bleeding, rupture of membranes, fetal head engagement, hypertension of pregnancy, to name a few. You should talk to your health care provider about how often you should be reviewed and what management will be in place if social distancing rules are enforced. Recently, RANZCOG advises that antenatal reviews are limited to less than 15 minutes, that telehealth reviews are considered and to consider early discharge from hospital, in addition to other recommendations provided on this page.


Is the information given here 100% up to date and accurate? 

No. Whilst we have attempted our best to provide a simple summary of the common questions and answers for COVID-19 in pregnancy, there remains the possibility that with more information and time, our understanding of COVID-19 in pregnancy will change too. We will attempt to update as soon as possible. This information does not replace your own personalised health care provider’s advice in pregnancy. For further information, please see the below:


STAY SAFE AND WE WILL UPDATE THIS WEBSITE OR EMAIL YOU, AS MORE INFORMATION EMERGES.

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