COVID-19 & Pregnancy: Q&A with Dr. Dustin Costescu
Concerned about COVID-19 and pregnancy? OB/GYN Dr. Dustin Costescu shares information and advice.
I’m currently 36 weeks pregnant and kinda freaking out. Am I going to be ok?
People’s pregnancy plans are changing rapidly, and you should know that you will, at most, have one support person during labour. In a local outbreak, even this may be restricted. So have conversations about how you will communicate and what your “big three” birth hopes are.
Even at the end of pregnancy, if you are well, do not come to the hospital if you are isolating or have mild symptoms. Call ahead for advice.
You should always go to the labour assessment area if you are bleeding, have pain, do not feel fetal movement or you think you’re leaking amniotic fluid. If isolating or sick call ahead so we can be ready to isolate you.
Patients with COVID-19 have higher rates of C section, largely due to symptoms. But if you’re well, plan for a vaginal birth if that was plan A (anything can happen).
Can I work while pregnant?
Countries are divided on this issue, but pregnancy is not a high risk condition when it comes to COVID-19. Pregnancy is special because of the unique physical demands it places on pregnant people and the concern about harm to potential children.
In Canada, we are not recommending that pregnant women stop work during the pandemic as a *medical* issue or condition. It is up to employers to determine their risk tolerance in asking pregnant women to work.
If you cannot do front-line work and you’re pregnant, your employer may be required to accommodate you – we all have a role to play in the pandemic and most people want to help.
When deciding whether work is a good idea, consider:
1) Do my pregnancy symptoms put me at risk of injury?
2) Does my work place me or my pregnancy at risk due to safety or exposure?
3) What alternative tasks could I do or modify to work safely?
4) Am I emotionally safe to work?
Finally, if you are a pregnant healthcare worker, make sure your PPE works. If it doesn’t fit, sit out. You may need to refit your N95 if your weight has changed.
Is it OK to get pregnant?
This is the most common question I’m asked. This one is tough and multi-pronged.
Currently fertility societies are recommending that fertility services be put on hold once these cycles are done. Keep in mind these pregnancies have higher risks (ectopic, preterm, multiples) than spontaneous conceptions.
If you have medical issues where pregnancy puts you at high risk, remember that resources may be unavailable to you that would otherwise reduce your risks.
For low/average risk people, the decision at this point is personal and there is no recommendation for or against pregnancy, but consider:
1) Would deferring trying for a few months give us more time to decide and plan?
2) Am I ok with a pregnancy with limited prenatal care?
Am I comfortable with the unknown risks of COVID-19 and pregnancy? Am I okay pursuing pregnancy with the unknown risks to me and my family regarding any COVID-related complications, including the loss of loved ones? Am I comfortable delaying knowing things may get worse?
No one is recommending ending a pregnancy due to COVID risks, nor is that likely to change. The existential question is whether or not to proceed with a planned pregnancy or not and we will do our best to maintain high-quality care.
Should I keep going to prenatal appointments?
Yes, but work with your care provider to decide which visits can be skipped and which ones can not.
The WHO recommends 8 visits per pregnancy, including initial assessment, anatomy scan, and ongoing prenatal care. A dating/NT scan can be done at 12 weeks and anatomy at 20.
Between visits, you should do a daily assessment of fetal movements, especially after 24 weeks, and present for care if there is a decrease. Blood pressure checks may be advised if you are at risk – use a calibrated cuff.
Do not request additional ultrasounds for reassurance.
Do not attend a visit if you are asked to isolate or are sick, no matter how mild. Infecting healthcare workers will cause significant pressures on the system.
Keep a notebook and write questions down to make the best of your appointment – it’s hard to remember in the moment.
Most postpartum visits can be deferred.