World Health Organization (WHO) declared a public health emergency of international concern on 30th January 2020. Suddenly the whole world was focusing on the prevention and treatment of COVID 19 infections. Most of the people were expecting this pandemic to end within 3-4 months. Unfortunately, the cases are continuing to soar, and the resurgence of Coronavirus cases are occurring even in countries that had achieved success in containment earlier. Pregnant women are in a dilemma about whether to attend the prenatal clinics and put themselves at risk of getting infections or taking the risk of not getting attention for some high-risk factors. Where to go for confinement, whether to breastfeed their babies or not? Whether to vaccinate their newborn babies or to postpone a routine immunization schedule? Women with fertility issues are stressed due to delays in fertility management and treatment. The crux of the situation is that even their treating Obstetricians, Gynaecologists, and Pediatricians have no concrete answers. Research and clinical studies have not yet proven anything due to a lack of data, short duration of studies and the number of cases enrolled for studies. I will try to address some of the concerns people who are planning for families/children might be having.
My article is based on the available information from the American College of Obstetrician and Gynaecology (ACOG) and the Centers for Disease Control and Prevention CDC. I have added a few points based on my own experience in real-life scenarios.
If you plan to have a baby, it may be better to postpone until the infection rate in your local region is under control. Pregnancy at this trying time may increase your risk of contracting COVID 19 infection. Once you are pregnant, you will need to pay frequent visits to your health care facility. It will increase your exposure risk to the COVID 19 infection. If you cannot postpone the family planning, you should have unprotected intercourse only during ovulation. You and your partner should observe all the protocols for the prevention of contracting the infection. To learn your ovulation time, you can either download the Application (Know your ovulation) in your mobile device or consult your doctor over the phone.
If you are undergoing any infertility management, your infertility centers might have given you instructions and their approach depending on your area's COVID situation. In my experience, infertility couples are usually impatient due to years of trying to conceive fruitlessly, social stigma, financial burdens, and physical and emotional trauma. IVF centers are in a difficult situation, whether to continue management and relieve themselves of their overhead expenses or put themselves, staff, and patients at risk of getting COVID. Common sense says that if centers comply with all the preventive measures, they can continue treatment for those who are already enrolled or in the middle of their treatment. New enrolment of couples can be avoided for now.
If you are already pregnant and have done the required investigations, Ultrasound scan, and received prescriptions, the preferable step is to consult your doctor by telephone. If your doctor thinks that you have no high-risk factors, they may suggest that you skip your prenatal visits. If you have any symptoms or signs related to pregnancy or unrelated, contact your doctors. The limited studies have concluded that pregnant women are not at high risk of catching COVID 19 infections compared to other non-pregnant women considering that they are following all the local guidance given by the health authority. Similarly, there is no increased rate of mortality in pregnant women infected with Coronavirus. There is no increased rate of hospitalization and the need for ventilators as well. In normal-risk pregnant women, the COVID infection rate is as significant as developing any seasonal flu or upper respiratory infections. It is advisable to get in touch with health care professionals. If needed, you would be given a preference for COVID testing.
Pregnant patients with co-morbidities such as obesity or any other chronic medical disorders are likely at the increased risk for severe illness as it is with the general non-pregnant population with similar co-morbidities. There is a need for enhanced care, precautions, and immediate attention. Your doctor or health care professional will counsel you about the potential risk for severe illness from COVID-19, and measures to prevent infection with COVID will be emphasized for you and your family. You should take all available precautions to optimize health and avoid exposure to COVID-19. If you are working, you must use PPE along with other necessary protections.
You must gather information from your healthcare professionals regarding preventive measures taken by the facilities and availability of services. Try to get telehealth services to avoid unnecessary visits to the hospital for false labor pains or in very early labor stage, at the same time avoiding unnecessary delay and delivery on the way.
If you have no symptoms of Coronavirus infection, you should be able to breastfeed your infant. If you have any suspect of COVID 19, you can still breastfeed your baby with extreme care. If you are positive for COVID 19 infection, it is better to express breast milk manually or by breast pump. Then it can be given to your baby by family members. The limited studies have not revealed any evidence of passing COVID infection through breast milk. Do not put a mask or any cloth to cover your baby's nose or mouth.
Do not miss any scheduled immunization to you and for your baby. It is advisable to confirm your appointment for the vaccination to avoid unnecessary visits to the immunization clinic.
Dr. Haseena Hamdani, MBBS, DGO, PGD Endocrinology and Diabetes (USW)
I am a Gynaecologist, currently practicing in Gaborone, Botswana for the last 17 years. Prior to setting up the clinic in Botswana I worked as a Gynecologist and Obstetrician in both India and Zambia and associated with an Infertility center. I am also an online tutor for the University of South Wales. I have nearly three decades of clinical experience. My research field of interest is Preventive Oncology. In my free time, I enjoy playing Sporcle games, swimming, and brisk walking. It is my firm belief that healthy lifestyle choices can prevent any number of diseases. There are various myths, social pressure, media pressure, and busy lifestyle elements, which hinder even those who are believers and followers of a healthy lifestyle. Doing my part to spread scientific knowledge and awareness brings me immense pleasure.
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Dr. Haseena Hamdani, MBBS, DGO, PGD Endocrinology and Diabetes (USW)
Dr. Haseena Hamdani is a gynecologist currently practicing in Gaborone, Botswana for the past 17 years. Her research field of interest is Preventive Oncology.
Prior to setting up her Botswana clinic, she ...
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