We will continue interviewing experts and updating this piece as more information becomes available.
coronavirus (Covid-19) continues to spread across the UK, concerns are growing as to how the infection affects the body longterm and the implications of those effects on more vulnerable people." data-reactid="34">As coronavirus (Covid-19) continues to spread across the UK, concerns are growing as to how the infection affects the body longterm and the implications of those effects on more vulnerable people.
pregnant women are among the group of 'at risk' people who should take ‘particular care to minimise their social contact’ for 12 weeks." data-reactid="35">When it comes to pregnancy, the government has stated that pregnant women are among the group of 'at risk' people who should take ‘particular care to minimise their social contact’ for 12 weeks.
That said, pregnant women do not appear to become more unwell than other healthy adults who contract the virus. The BBC reports that Christoph Lees, professor of obstetrics at Imperial College London, has stated: 'If there were huge risks, we would have seen them by now.'
Naturally, this has been a greatly concerning time for pregnant women.
Amy O’Brien-Wright, 30, is currently 37 weeks pregnant with her second child and is concerned about her birth plan: ‘The pace at which the virus is spreading leaves me less certain that current arrangements and practices in my maternity hospital will remain the same,’ she tells ELLE UK.
‘It feels like things will be open to change with potentially little or no warning which will certainly lead to me being more anxious about the birth and after care.’
In order to dispel some of the worry and to give as much practical advice as possible, we've interviewed a range of experts - from doctors and midwives, through to women considering the implications of their maternity - to give you the most up-to-date information for all stages of pregnancy and we will continue to update this guide as and when the situation develops.
Our Plan To Rebuild', it is still essential that those 'at risk' of the virus continue follow social distancing guidelines.
" data-reactid="42">Despite lockdown measures easing from Wednesday May 13, as recently stated in the government's 'Our Plan To Rebuild', it is still essential that those 'at risk' of the virus continue follow social distancing guidelines.
The plan states: 'It remains the case that some people are more clinically vulnerable to COVID-19 than others. These include those aged over 70, those with specific chronic pre-existing conditions and pregnant women.
'These clinically vulnerable people should continue to take particular care to minimise contact with others outside their households, but do not need to be shielded.'
On Monday March 16, the UK’s Chief Medical Adviser Chris Whitty spoke about the situation concerning pregnant women during the outbreak of the virus at a live press briefing.
Royal College of Obstetrics and Gynaecology (RCOG), which is the professional body who reviewed the evidence – it’s on their website – and it makes clear that in the very small number of pregnant women who delivered at or shortly around the time they had [Covid-19], there were no complications.’" data-reactid="46">‘We’re very early in what we know on this,’ Whitty told viewers. ‘The Royal College of Obstetrics and Gynaecology (RCOG), which is the professional body who reviewed the evidence – it’s on their website – and it makes clear that in the very small number of pregnant women who delivered at or shortly around the time they had [Covid-19], there were no complications.’
The news came hours after a newborn baby in north London, born to a woman with coronavirus, had tested positive for the virus too.
Whitty continued, noting that with all infectious diseases, ‘there is a small but appreciable, additional risk and we will not know that until a lot more women have had children’.
‘The information we have is relevant to people in the third trimester of pregnancy, but not in the earlier stages of pregnancy… There is no evidence from other cases of coronavirus that this is, particularly in the way that the Zika virus was, dangerous to pregnant women.'
Whitty said that women who are pregnant are included in the list of vulnerable, or ‘at risk’, groups of people as a 'precautionary measure'.
On Wednesday March 18, a baby tested positive for Covid-19 in Norfolk at the James Paget University Hospital in Gorleston and is being treated in isolation.
The Independent, that: ‘An extensive contact tracing exercise is now under way by Public Health England to trace anyone who might have had close (face-to-face) contact." data-reactid="76">A hospital spokesperson said, via The Independent, that: ‘An extensive contact tracing exercise is now under way by Public Health England to trace anyone who might have had close (face-to-face) contact.
‘Close contacts will be given health advice about symptoms and what to do if they become unwell in the 14 days after they had contact with the confirmed case.’
Should pregnant women have a flu jab?
The Royal College of Obstetricians and Gynaecologists and Royal College of Midwives are urging all pregnant women to have a free flu jab as soon as possible during the ongoing pandemic.
On Monday October 12, the Royal College of Obstetricians and Gynaecologists tweeted: ‘We are urging all pregnant women to get their free flu vaccination this winter to protect themselves and their baby from complications caused by the flu virus.’
We are urging all pregnant women to get their free flu vaccination this winter to protect themselves and their baby from complications caused by the flu virus. To find out more speak to your pharmacist, GP or midwife. Read more: https://t.co/8E6hsad1Dv pic.twitter.com/SV6Iog08O6
— RoyalCollegeObsGyn (@RCObsGyn) October 12, 2020
website reads: ‘Some of the symptoms of flu including fever, cough, shortness of breath and fatigue, are similar to those of COVID-19 and that is why during the COVID-19 pandemic, the RCOG and RCM strongly recommend that pregnant women take up the offer of free flu vaccination." data-reactid="82">A statement on the RCOG’s website reads: ‘Some of the symptoms of flu including fever, cough, shortness of breath and fatigue, are similar to those of COVID-19 and that is why during the COVID-19 pandemic, the RCOG and RCM strongly recommend that pregnant women take up the offer of free flu vaccination.
‘It is possible to get infected with flu and COVID-19 at the same time, and Public Health England’s research shows that if you get both at the same time you may be more seriously ill.’
Dr Edward Morris, President of the RCOG notes: ‘We are keen to reassure pregnant women that flu vaccination is safe for women to have at any stage in pregnancy - from the first few weeks right up to their due date, and while breastfeeding.
‘Over the last 10 years, the flu vaccine has been routinely and safely offered to pregnant women in the UK. The vaccine can also pass some protection to babies, which lasts for the first months of their lives.’
here." data-reactid="106">You can find out more information about the flu jab in pregnancy here.
What effect does Covid-19 have on pregnant women?
Given that Covid-19 is a new virus, the full and longterm implications of the resulting illness are still somewhat unknown.
However, the RCOG states that ‘pregnant women do not appear to be more severely unwell if they develop coronavirus than the general population’.
guidance published on April 17 reads. 'This is particularly true towards the end of pregnancy. The absolute risks are, however, small.'" data-reactid="111">'It has long been known that, whilst pregnant women are not necessarily more susceptible to viral illness, changes to their immune system in pregnancy can be associated with more severe symptoms,' its guidance published on April 17 reads. 'This is particularly true towards the end of pregnancy. The absolute risks are, however, small.'
The organisation says that it expects that the large majority of pregnant women will experience ‘mild or moderate cold/flu like symptoms’ and that there is no evidence to suggest an increased risk of miscarriage.
The RCOG also states that emerging evidence suggests that ‘transmission from mother to baby during pregnancy or birth (vertical transmission) is probable.
website reads." data-reactid="114">‘There has been a report of a single case in which this appears likely, but reassuringly the baby was discharged from hospital and is well,’ a statement on the organizstion’s website reads.
‘In all previously reported cases, infection was found at least 30 hours after birth. It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the baby was well.
Current evidence suggests that it is ‘considered unlikely that if you have the virus it would cause problems with the baby’s development’.
It is important to remember, however, that pregnant women are more vulnerable to getting infections than women who are not pregnant and so should be ultra-observant of the preventative measures like hand and face washing.
‘If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you have coronavirus,’ the RCOG adds.
UK Obstetric Surveillance System (UKOSS) launched a registry for all women admitted to UK hospitals with confirmed COVID-19 infection in pregnancy." data-reactid="119">On Friday 20 March, the UK Obstetric Surveillance System (UKOSS) launched a registry for all women admitted to UK hospitals with confirmed COVID-19 infection in pregnancy.
How can pregnant women protect themselves from getting Covid-19?
As per the NHS’ instructions, pregnant women should follow the same protocols as the general public to avoid infection.
Centre for Disease Control and Prevention (CDC) states that actions to be taken to avoid the spread of the virus include:" data-reactid="123">The Centre for Disease Control and Prevention (CDC) states that actions to be taken to avoid the spread of the virus include:
- Cover your cough (ideally into the crook of your elbow)
- Avoid people who are sick
- Clean your hands often using soap and water or alcohol-based hand sanitiser
And of course, wherever possible, heed the government's advice to stay inside with minimal contact.
How would a pregnant woman be tested for Covid-19?
The RCOG states that only people with ‘severe symptoms who require overnight admission to hospital’ are currently being tested for the virus.
And the same guidelines apply to pregnant women. As per the government's instructions, an RCOG spokesperson tells us that if you start to experience mild symptoms such as a fever above 37.8 degrees and a dry cough, you should immediately self-isolate. You should not share a bed with a partner, use separate towels and cooking equipment and treat cautiously with paracetamol only.
However, if a pregnant woman starts to develop more grave symptoms such as difficulty breathing, she needs to contact the NHS on 111, to make arrangements for an assessment and testing. She will be tested at the hospital in the same manner as any other individual.
The test currently involves swabs being taken from your mouth and nose. A person might also be asked to cough up saliva and mucous.
Women are advised to attend via private transport where possible or call 111/999 for advice as appropriate, by the RCOG. If an ambulance is required, the call handler should be informed that the woman is currently in self-isolation for possible COVID-19.
The individual will be met at the maternity unit entrance by staff wearing appropriate personal protective equipment (PPE) and be provided with a surgical face mask.
What should you do if you are pregnant and test positive for Covid-19?
If you test positive for the virus, the RCOG advises pregnant women to contact their midwife or antenatal team to inform them of the diagnosis as soon as possible and ask further advice.
The RCOG states that pregnant women have been advised to reduce social contact by the government based on the theoretical risks to pregnancy posed by COVID-19.
The organisation recommends that, where practical, appointments should be conducted on the telephone or using videoconferencing, provided there is a reasonable expectation that maternal observations or tests are not required.
Once a pregnant woman has recovered from the virus, an ultrasound scan will be arranged 14 days afterwards, to check on the health of both mother and baby. However, this time period might be reduced once more is learned about the virus, the RCOG explains.
If a pregnant woman has Covid-19 during pregnancy, will it hurt the baby?
Given the early stages of the pandemic, medical professionals are still unable to confirm for sure whether or not there is a risk that a developing baby will contract the virus from its mother (otherwise known as vertical transmission).
Victoria Derbyshire programme: 'So far there is no evidence coronavirus can harm an unborn baby.'" data-reactid="185">However, on Monday March 16, GP Rosemary Leonard stated on BBC Two's Victoria Derbyshire programme: 'So far there is no evidence coronavirus can harm an unborn baby.'
While there have been a small number of reported premature deliveries for babies born to mothers who tested positive for the virus during pregnancy, it’s not yet clear whether this was as a result of the infection or the result of a doctor’s decision to deliver early because of the mothers’ health.
Once born, a child will be tested for the virus if their mother has tested positive.
When questioned about the child that tested positive in London earlier this month, a spokesperson for The Royal College of Obstetricians and Gynaecologists told us: 'It is not known at what stage the baby was infected with the virus. Currently there are no confirmed reports of women diagnosed with coronavirus passing the virus to their babies while in the womb.'
Should pregnant women without virus symptoms cancel their antenatal appointments during the outbreak?
Royal College of Midwives, says that the organisation understands that this must be an 'unsettling time for pregnant women'." data-reactid="191">Gill Walton, CEO of the Royal College of Midwives, says that the organisation understands that this must be an 'unsettling time for pregnant women'.
That said, Walton wants to emphasise that 'attending antenatal and postnatal care when you are pregnant and have a new baby is essential to ensure the wellbeing of pregnant women and their babies.
'We would urge all pregnant women who are well to attend their care as normal.'
Sarah Murray, registered midwife and owner of Cambridge Midwives, agrees, noting that it is imperative for women who don't present symptoms of the virus to stick to their antenatal schedule as laid down by their midwife or antenatal team as much as possible.
‘Don’t be tempted to delay anything, particularly appointments like first scans and blood results,’ she says. ‘While results will usually be fine, it’s at this point that certain health issues can be picked up early on in pregnancy.’
The RCOG adds that if a pregnant womanhas a routine scan or visit due in the coming days, they should contact their maternity unit for advice and to agree a plan.
'You may still need to attend for a visit but the appointment may change due to staffing requirements,' it says.
'If you are between appointments, please wait to hear from your maternity team.'
Should pregnant women with virus symptoms, or those who have tested positive, cancel their antenatal appointments ?
Firstly, Walton states that if 'you are pregnant and have symptoms of possible coronavirus infection, you should call to defer routine visits until after the [14 day] isolation period is over'.
The RCOG explains that it is likely that ‘routine antenatal appointments will be delayed until isolation ends’.
It adds: ‘If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect other patients.’
During self-isolation, pregnant women are also advised by the RCOG ‘not to attend maternity triage units or A&E unless in need of urgent pregnancy or medical care’. Where possible, stick to separate outpatient maternity units.
Of course, if you have any concerns about your health or that of your child during the self-isolation period, you are advised to contact your midwife, out-of-hours services, or your maternity team for more advice.
What if you've just found out that you are pregnant?
local NHS maternity services in order to telephone them or you can seek an independent midwife in the UK. For further support, NCT.org.uk may also be able to offer advice through their helpline: 0300 330 0700." data-reactid="226">If you have yet to register your pregnancy with the GP or a hospital and you do not want to go to your GP surgery unnecessarily, you can find your local NHS maternity services in order to telephone them or you can seek an independent midwife in the UK. For further support, NCT.org.uk may also be able to offer advice through their helpline: 0300 330 0700.
Can you give birth as planned if you do not suspect Covid-19 at the time of delivery?
Association of Radical Midwives, says that pregnant woman shouldn't need to take any extra precautions when giving birth in a hospital. However, they should abide by the government’s advice on social distancing and the RCOG's suggestions on limiting social contact as much as possible when they go into the hospital." data-reactid="228">Katherine Hales, National Coordinator at the Association of Radical Midwives, says that pregnant woman shouldn't need to take any extra precautions when giving birth in a hospital. However, they should abide by the government’s advice on social distancing and the RCOG's suggestions on limiting social contact as much as possible when they go into the hospital.
As for the possibility of staff shortages on maternity wards or in birth centres, the midwife says that pregnant women 'shouldn’t be too concerned'.
She explains: ‘Some midwives are registered nurses so [hospitals] wouldn’t be wanting them working with pregnant women, and working in high risk areas of the infection and switch between the two. They’ll be trying to keep as many midwives doing midwifery as it’s difficult enough to provide midwifery care in the first place.'
A spokesperson from the RCOG adds that all labour wards in the UK have facilities for women to give birth in private rooms, 'and this will continue during the epidemic, with each woman cared for appropriately regardless of if she does or does not have confirmed or suspected coronavirus infection'.
As for women who don't present any of the virus' symptoms and want homebirths, Hales says there is 'nothing wrong' with them proceeding as planned.
Murray agrees, adding that while homebirths are fine 'in principal', as is common practice during pregnancy anyway, women should ‘make contingency plans in advance with their midwife to prepare for a birth at home, a birth in a midwifery centre or in a delivery unit’ and 'ensure they have a birth pack from the community team'.
The RCOG warns: 'If you have chosen to give birth at home or in a midwife-led unit that is not co-located with an obstetric unit, it is worth noting that these services rely on the availability of ambulance services to allow for rapid transfer to hospital, and the right number of staff to keep you safe.
'If these are not in place, it is possible that your Trust or Board may not be able to provide these services.'
If a midwife feels that they are extra susceptible to the virus or have underlying health issues, this might play a factor as to whether they will attend a homebirth, regardless of whether a pregnant woman has the virus or not.
Murray also warns that those wanting a homebirth who live in an urban, populated area with increasing pressure on staff, might find that the community team (homebirths require two midwives) 'may not come out as midwives could be required at nearby hospitals'. As a result, it is imperative pregnant women discuss birth options as far in advance as possible.
The Positive Birth Company, tells us that her colleagues are currently seeing a rise in the number of women considering a homebirth which they presume to be as a result of Covid-19." data-reactid="258">Siobhan Miller, founder of The Positive Birth Company, tells us that her colleagues are currently seeing a rise in the number of women considering a homebirth which they presume to be as a result of Covid-19.
‘Women are telling us they are keen to avoid going to hospital for fear of contracting the virus,’ she says, noting that in 2017 there were over 13,500 homebirths (approximately two per cent of all births) and that they’re 'expecting to see a significant increase in this number this year as a result of the virus'.
‘We believe it might be the catalyst in changing the way we give birth in the future by making more women aware of their options,' Miller adds.