Information and advice for pregnant women during the COVID-19 Pandemic

My heart is with all the pregnant mama’s out there right now and I’m here to support you. I would like to give you the updated evidence on COVID-19 in relation to pregnancy, birth, and breastfeeding. Giving birth in a world with NO pandemic is one of the most powerful things you will do in your life, so add the stress of this pandemic, and you’re now faced with additional challenges. I am convinced that you and your family will emerge even stronger and with more confidence due to the fact that you now have to rely on yourself and your partner more than ever bfore. You were put on this earth to achieve your greatest self, to live out your purpose, and to do it courageously. Imagine… If we changed the rhetoric from one of fear to one of bravery?

1. How should I be looking after my pregnancy to avoid Covid-19?

Until we come up with a vaccine for this virus, the best way you can protect yourself is with physical distancing (stay 2-3m) from people in the community and avoiding public spaces. Washing your hands often for 2 minutes and avoiding touching your face, while frequently wiping down surfaces. These measures have been drilled into us and should be common practice by the time you’re reading this! Avoid hospital appointments where possible, complete your antenatal appointments via telehealth and find an online childbirth education course that suits your needs. Stay at home as much as possible! It is also important to report any symptoms early so that you can get tested and treated as soon as possible.

2. What is your advice on looking after mine and my baby’s health in a time with reduced antenatal appointments and NO face to face education classes?

Staying healthy and relaxed is more important now than ever. As you will have seen in the media, the infected non pregnant population who are a bit older and have comorbidity’s, like diabetes and high blood pressure have worse outcomes than those fit and healthy younger ones! Therefore, putting pregnancy induced hypertension, pre-eclampsia, and gestational diabetes into a higher than normal risk category for women who acquire the COVID-19 infection.

Early diagnosis and treatment will be vital for maintaining your health and the health of your baby and with the reduction in antenatal appointments, my fear is that these conditions may “slip through the cracks”. If possible, I would recommend buying a blood pressure monitoring device from your chemist to take your own blood pressure. It is only necessary to take it once a week, but you should write down your findings and discuss them with your OBGNY, midwife, nurse or GP. It is also important that you keep on top of your scheduled blood tests and GTT (glucose tolerance test). But, the best indicator of your baby’s health is their movements, so become familiar with their movement patterns, and check out the following website. http://movementsmatter.org.au/information-for-women

Getting enough sleep and eating a well-balanced diet are vital for cell function, both of which will boost your immune system. Start by increasing your intake of fruit and vegetables and limit processed food and sugar, step one done! Meditation and pregnancy yoga are a great way to relieve stress and improve sleep. Practicing mindfulness is another way to achieve a calm state, and there is now emerging research showing that this can lead to a calmer newborn. Walking for 30 minutes a day is now more important than ever, due to our social isolation, we are becoming more sedentary. The added benefit of walking in the sunshine is the boost to your Vitamin D levels. Studies have linked vitamin D deficiency during pregnancy with an increased risk of preterm birth, gestational diabetes, preeclampsia (very high blood pressure during pregnancy), and bacterial vaginosis. So, if you are not able to get into the sunshine for a walk each day, you should consider using a vitamin D supplement. And lastly, what about doing your childbirth education online? Consider your birth plan, and then find a suitable course to watch with your partner. My online classes are a mix between mindfulness and evidence – based education, feel free to check them out. https://themindfulmama.com.au/mindful-childbirth-education/

3. Is there any evidence of Mother-to-Baby transmission of COVID-19 during pregnancy?

This is known as “vertical” transmission. Currently (12th of April) there is only one case that is being investigated, but this case has still not confirmed that it was vertical transmission, instead the science is investigating if the newborn could have acquired COVID-19 from either the health care worker or the infected mother immediately after birth, not necessarily during the womb or during birth.

4. Am I at higher risk of contracting Covid-19 because of my pregnancy?

So far, there is no evidence that pregnant women are at greater risk of infection or severe illness with COVID-19 compared to the general population. A recent study of pregnant women in New York support these findings from China and Italy, which is reassuring.
From a sample of 43 pregnant women who tested positive for COVID-19…
86% had mild symptoms
9% were severe
5% critical
Interesting … 14 (33%) reported NO symptoms on arrival to the birthing unit: Of these asymptomatic women, 10 did end up developing mild symptoms over the course of their stay, giving rise to the question of why we are not testing all pregnant women on arrival to birth suite?

5. Why is pregnancy considered an “at risk” population during this epidemic if the evidence states pregnancy is not a risk factor?

During pregnancy your body goes through some physiological changes that can put additional pressure on your heart and lungs. Usually these do not present any problems. We know from previous influenza infections, that pregnancy predisposes women to respiratory complications when they get infected. But this has not been proven with the COVID-19 virus and currently the research is showing us that
contracting influenza while pregnant poses a higher risk in pregnancy than contracting the COVID-19 virus. When a virus is this new and large groups of populations have yet to be studied, the scientists look at similar patterns with similar virus’s, so they are treating the risk the same as if it was an influenza outbreak. I guess the medical community feel it is better to err on the side of caution. A study by the WHO in February of 147 pregnant women who were suspected or confirmed infected with COVID-19, showed that the percentages of serious illness was no different to the population of non-pregnant people who contract COVID-19, leading them to put out a statement that the category of “at risk” was purely a precautionary measure.

6. When do you start being contagious?

The average incubation period is 5 days, with the longest being 12 days. So, once you have caught Covid–19 from another person, you will most likely show symptoms after 5 days, but it could take as long as 12 days to show infection. Meaning that for those 5 – 12 days you could potentially be transmitting the disease to everyone you come into contact with. Hence why the isolation periods were set at 14 days. It is the long incubation period that has us midwives questioning the issue of TESTING among other things…

• How do we know that a woman presenting in labour, has the infection but has not yet showed any signs?
• And, therefore do we treat everyone in labour as a potential risk of having Covid–19 or just those who are showing symptoms (however mild)?
• It is very common for women in labour to develop mild fevers. This can be related to epidurals, synthetic oxytocin, and chorioamnionitis.So therefore, it will present a problem in discriminating between a Covid-19 infection and an obstetric fever.
• For midwives to better support women in labour, testing with quick results would be optimal. If the primary care midwife tests negative and the woman and support person test negative, then the labour and birth can continue as it would have prior to the pandemic.
And again, this might have changed as testing is now becoming widespread in the fight against COVID -19.

7. What can I expect when I go to hospital to give birth to my baby?

Many of the changes you will encounter upon arriving at your chosen place of birth will be procedures that have been put in place to protect yourself, your family and the midwives and doctors who are caring for you. You might see health care workers walking around in masks, you might find the environment more “clinical” than it used to be. You might be asked to wash your hands frequently or shown to your room using physical distancing. These are all very counterintuitive to our role as a midwife. Usually we would do whatever it takes to make you feel safe, comfortable and cared for and this used to involve a lot of touch! The staff may be more stressed than usual, and they may also be more sensitive. As a community, I feel that becoming more aware and “in tune” to other people’s feelings and sensitivities can be a new way of expressing compassion and understanding. So, as much as it should be all about you on your special day, it may be worth considering the simple task of showing up for work now takes on a whole new meaning for midwives and doctors.

The biggest change for any woman who is giving birth in this current pandemic, is the limited support network during labour and in the postnatal period. This does vary from hospital to hospital, but in my research for this article, most hospitals around the world are only allowing 1 support person through labour and into the postnatal period. Understandably, this is causing much anxiety, particularly to first time mothers, with many women having to choose between parents, doulas, and partners. It is not easy to know who would best support you during labour, and if it is not your partner, imagine having to ask them to move aside and miss seeing the birth of their baby, in favour of a more emotionally supportive person? Touch choices ahead. I firmly believe that it is vital and empowering to take the positives out of this issue of “support”. My philosophy is always one of “what can we learn from this?” And my gut feeling is, we will learn how to depend more on the people who truly love us and show up to support us in any way we need. It might bring more closeness to the family unit and allow more time initially to bond with your baby, leaving all the distractions at the door!
If you have tested positive or are suspected of COVID-19 infection the guidelines are listed below….

8. What can I expect after the birth of my baby?

Most hospitals only 1 support person on the ward, so again it is the issue of support that is most affected by birthing during the pandemic. Many hospitals can arrange a 6-hour discharge to home for low risk births, that had no interventions. This might suit mothers who have done this all before! The usual classes that you expect on the postnatal ward, like breastfeeding and mother-crafting, will be delivered one to one from your primary midwife. If anything, you might find that you receive a more personalised service in a quieter environment!
Although controversial, what we as midwives have noticed on the maternity ward, is a sense of calm. Often women can get inundated with visitors, and it is up to us to advocate for women and ask the visitors to leave. We have noticed in the last month, increased skin to skin and breastfeeding on demand. Plus, additional education and support by midwives as they are not tiptoeing around visitors! I personally feel like it enables a postnatal midwife to support a new family in the way which we were taught!
If you or your baby have tested positive for COVID-19 then the guidelines are below.

9. Do I have to have a C-Section or Induction if I am confirmed to be COVID-19 positive?

No, the WHO/RANZCOG/AGOG/RCOG states that your mode of birth should be individualised based on your current preference and the obstetric indications. Performing a C/S or induction should only be used when medically indicated. The indications for an induction should be based on gestational age of your unborn baby and the severity of your infection.

10. Can I breastfeed my baby if I test positive or are suspected of having COVID-19?

Yes, women with COVID-19 can breastfeed if they wish to do so. There is no evidence of the COVID-19 in the breastmilk of infected mothers.
The advice for breastfeeding follows:
• Wash your hands before and after touching your baby
• Routinely clean and disinfect surfaces you have touched
• The current guidelines (see below) are in favour of “rooming in”, as the benefits of skin to skin and breastfeeding outweigh the risk of your baby contracting the virus.

11. Current Guidelines for COVID-19 Positive Pregnant Mamas (updated April 9th)

The current worldwide evidence is based on small sample groups and the following list is the source of information for maternity care providers.

WHO: World Health Organisation
ISUOG: International Society of Ultrasound in Obstetrics and Gynaecology
RANZCOG: Royal Australian and New Zealand College of Obstetrics and Gynaecology
RCOG: Royal College of Obstetricians and Gynaecologists
CDC: Centre of Disease Control
ACOG: American College of Obstetrics and Gynaecology

Below are the guidelines for the care of women in labour who have a suspected or confirmed to have COVID-19 infection.

All pregnant women, including those with confirmed or suspected COVID-19 infections, have the right to high quality care before, during and after childbirth. A safe and positive childbirth experience includes:
• Being treated with respect and dignity
• Having a companion of choice present during delivery
• Clear communication by maternity staff
• Appropriate pain relief strategies: the research is not clear on the risk of using Entonox gas and the spread of the virus, so each health care facility is using their best judgement on this, most say it is OK to use. Epidurals are safe.
• Mobility in labour where possible, and birth position of choice
• No water immersion due to the possible transmission through faecal contamination.
**(RANZCOG guidelines are the only ones who support water immersion) **
• Delayed cord clamping still recommended
Although, these organisations have been consistent in their advice around managing the birth of a COVID positive woman, there has been    much debate about the potential risks of mother-to-baby transmission and how this should be managed. Until a few days ago, the recommendations for the care of her newborn were inconsistent. The CDC, ACOG were more concerned with mother–to–baby transmission of the virus and RANZCOG, RCOG, WHO were looking at the risk of separating mother and baby. They believe the research on the benefits of “rooming in” outweighed the risk of transmission. Thankfully, the CDC and AGOG have come into line with the other world organisations and updated their policy from the 9th of April. Recommendations are now consistent and stated below. This is a big win for all the infected mothers who were scared of being separated from their newborns.

Below are the guidelines for the care of a newborn by a mother who has been confirmed or suspected of COVID-19.

When caring for your baby, if you have tested positive or are suspected of having COVID-19, skin to skin contact and early and exclusive breastfeeding should be supported to help your baby to thrive.
This includes:
• Breastfeed safely, with good respiratory hygiene, consider wearing a face mask and if you are feeding your baby with expressed milk, have your support person feed the EBM to your baby.
• Hold your newborn skin-to-skin, and initiate breastfeeding within the first hour of birth.
• Share a room with your baby
• Below are is the evidence to support skin to skin and rooming in.
• The evidence for supporting skin to skin and rooming in for babies is as follows: More effective suckling during the initial BF session. Less crying – babies who received skin to skin care were 12 times less likely to cry during the observation period. Heart rate, breathing, oxygen levels were more likely to remain stable if rooming in. Beneficial for the baby’s blood sugar levels.

What we do know today: 11th of April
• 1 maternal death
• No evidence on outcomes related to infection in the 1st or 2nd trimester
• No confirmed cases of vertical transmission during pregnancy. Samples of amniotic fluid, placenta, cord blood, and breastmilk have so far been negative in pregnant mothers who tested positive of COVID-19
• UNSURE whether there is a higher incidence of preterm birth in COVID-19 positive women.

This is where you come in…
Intuition: your rights as a mother, who do you listen too…
I hope that the information, advice and some of my own opinions have helped you to navigate your birth plan in such a stressful situation!
As we face these inevitable challenges, we will realise that deep down we already possess the strength and insight to deal with them. Here is a little poem I found on Inner Strength…

“You have to strength to change and evolve.
You are constantly growing into a better person.
Listen to yourself first.
Know you are safe and secure when you are true to yourself.
Believe in your own answers.
Resisting pressure in order to do what feels right empowers you.
Giving yourself what you need makes you stronger for others.
You are a strong, independent woman.
You can choose to reject limitations.”

I wish you well on this journey and I encourage you to find ways to gather this inner strength. I have always said, it is the parenting journey that requires the most of us, the birth is just one day. Times like this help us to put life into perspective and the lessons of the Corona Virus will hopefully remind us what we value and what we know is real and true.
My hope for the future is that the world will remember what it was like to…
STOP – SLOW DOWN – VALUE FAMILY – APPRECIATE THE SIMPLE THINGS IN LIFE

The world of midwifery has evolved into an evidence-based practice where research is needed before we can implement new ways of providing care. After experiencing how mindfulness helped me prepare for my own journey into motherhood, I made a professional decision to incorporate mindfulness into all aspects of my maternity care.

Personally, I can vouch for the positive influence that mindfulness has on the women I support, but obviously, it is impossible for me to determine the long-term impact on their growing infant! This makes me determined to compile as much evidence-based research on the subject, so I can make mindfulness in pregnancy common place in our Maternity Units.

When you do a medical publication search on “The Effects of Maternal Stress on the Unborn Child” you get endless amounts of journal articles. But… when you search “The Effect of Maternal Mindfulness on the Unborn Child” the research is limited, but thankfully growing!

One such study conducted in the U.K assessed 79 infant’s neurocognitive functioning at 9 months of age. These infants where categorized into a group born from mothers who did not practice mindfulness during pregnancy and the ones who did practice mindfulness during pregnancy, both from 20 week’s gestation.

Now… I have to use a few fancy words to give the correct impression and information, so bear with me! Science can test what is called ERPs (Event Related Brain Potentials) in infants by measuring their auditory attention. Auditory attention in infants is a key aspect of early neurocognitive functioning. Simply put, “using sound to determine an infant’s response to that sound while measuring their brain function at the same time”.

What this study found; was the infants whose mother practiced mindfulness during pregnancy devoted fewer attentional resources to frequently occurring irrelevant sounds. So, they did not use their brain function on sounds that do not matter or sounds that are irrelevant to teaching them something! Showing that positive traits and experiences of the mother during pregnancy can affect the unborn child.

If the research continues to study the “unborn child” not just the pregnant mother, then it will be easier to educate women on the importance of mindfulness in pregnancy. If we can emphasize the beneficial effects that a positive psychological state during pregnancy has on their unborn child, this may promote healthier behavior’s in pregnant women.

If you are unsure of how to practice mindfulness, it can be as easy as going for a walk on the beach. Mindfulness can be a state of mind, or a physical activity that you schedule into your daily life. We can make a conscious choice to practice mindful activities and we can also spend time working on our emotional reactions to the world around us. If we keep the physical and emotional practice of mindfulness in balance, we are on the way to living a more positive life!

5 Tips for Emotional Mindfulness:

• Stay in the present moment.
• Don’t over analyze every situation that makes you feel uncomfortable.
• Accept that there is only so much that can be done. If you cannot control things that are outside your control, try working on the ones you can change.
• Trust in something bigger than yourself.
• Find the beauty in every moment, even the horrible ones.

5 Activities That Can Help You Stay Connected to Your Physical Self:

• Go for a walk – in nature.
• Join a Yoga class.
• Listen to an inspiring podcast.
• Practice meditation in your daily life, see below for a useful free app.
• Harness the power of creativity. You might like to paint a picture, write in a journal, or for the non-creatives try some colouring in!

MINDFULNESS TO ME…

Being aware and responsive to everything around us. The more aware we are of our thoughts and how these thoughts control our emotions and our behavior the easier it is too self-reflect and grow.

I aim to find the beauty in all things, even if it is difficult. I fight with myself to control negative emotions, so that I can be free at of any ego.

I want to teach my kids not to be afraid of their emotions, but to acknowledge good thoughts and bad thoughts, but to move on and not be critical.

Move forward each day and grow as compassionate human beings.

That’s what I hope for as a mother and as myself, I will practice every day to live a mindful life…

Written by Amy Read (RM/RN/IBCLC) Owner of The Mindful Mama Co.

• https://themindfulmama.com.auhttps:
• //www.mindthebump.org.auhttps:
• //www.ncbi.nlm.nih.gov/pubmed/24925904

This is for the DEVOTED DADS who support the mindful mamas. If all the dads in the world could show their kids how to be kind, imagine the impact. Happy Father’s Day!

Mindfulness in kids can start with getting in touch with their more sensitive side. As parents we can start by teaching them the importance of kindness. Learning to share toys with their friends, being gentle with pets and encouraging lots of cuddles are great ways to learn kindness. You could also read stories that focus on inspirational people in history who encouraged kindness and equality. Discuss the Diary of Anne Frank and her famous quote “despite everything I still believe people are of good heart” or how Martin Luther King, Jr., lead peaceful and powerful demonstrations to support civil rights. Look for opportunities to develop positive role models in their own life and make time for close relatives. Once every couple year try and get involved with a volunteer program, like a day in a soup kitchen or taking part in Clean Up Australia Day. Celebrating compassion and love can make a young kid feel better, even when nothing is wrong.

I feel like this is a common question that interviewers like to ask celebrities, influencers, and entrepreneurs. As a midwife and lactation consultant, I say to myself on a daily basis, “Geez, I wish I had known that when I was pregnant!” You see I was NOT a midwife when I had my first 2 babies and I was NOT a lactation consultant when I breastfed any of my babies, it sure would have made life much easier if I knew then what I know now! I totally GET that part of the growing and learning is in the journey, but these 5 things could have made the journey so much more rewarding!

Here goes….

5 Things I Would Tell My “FIRST TIME” Mummy Self!

1. “Go to Childbirth Education Classes, don’t be so stubborn, you may tell yourself that you don’t need to go, or that you will just take it as it comes”. BUT what you might actually be experiencing is fear of the unknown, fear you may be judged, or just fear of sheer embarrassment. If you are anything like me, extremely self-conscious, then you must address this prior to walking into the labour room. I was living away from my family and friends when I fell pregnant with my first baby. My hubby was working on a bridge with a deadline, so he couldn’t get the time off to go to classes. My fear was going alone and being judged for being alone. I thought people would think my husband didn’t love me enough or was not supportive enough. I had so much self-doubt about going to these antenatal classes alone, that I didn’t go at all. The reality of turning up to the hospital not knowing anything, was actually more embarrassing and it affected my birth story!
2. “Listen to the Advice of Others”. I am sure you already hate this advice! But what if the advice was just to “listen and accept that we are not all the same and you may not want to do half of what is being advised” But what if half the advice DOES resonate with you and helps you to change something which makes a huge impact on the rest of your life. You don’t know what you don’t know! Imagine 10 years of study, 25 years of work experience, and 12 years of being a mother, that is something worth listening to, right? Just imagine the education that I could give a first- time But, do they want to listen? Sometimes but not always.I thought my baby would sleep through the night from day one. No matter how many times I was told that newborns need to be fed every 2-3 hours, I would not believe it, somehow thinking I must be giving birth to a robot that sleeps 12 hours a night! And I could have saved myself a lot of grief and instead organized my new life as a mother who was definitely NOT going to get much sleep!
3. “Practice Yoga Throughout My Pregnancy” This one could be my number one! What I know now about the benefits of optimal fetal positioning, which is just a fancy name for Yoga… WOW! The position of your baby in the womb when you present in labour, is the single most important variable on how your labour will progress. And then knowing that there is something you could do about it; I wish I had known this! Not to mention the benefits to your own mind and your baby’s nervous
4. “Bring Whoever You Damn Well Want into Your Birthing Space” This advice is for my second time “mummy” self! Look, let’s be honest, I think we all know how supportive our other halves are going to be in labour and maybe we are too scared to admit it to ourselves. OR, we hope they are going to miraculously change once the labour starts! My husband was pretty good, but he was not vibing with me! There was no boost of the much – needed oxytocin (apart from the drip) no back rubs, no staring longingly into each other’s eyes, no changing into board shorts so he could get as wet as me in the shower! What he did do was protect me when I needed the strength to stand up for myself and he never once left my side.But what I knew I needed was my mother or my sister, which would have been uncomfortable for him. Only in an embarrassed, private sort of way. I did need to give my wonderful husband the chance to be amazing and supportive in my first birth, but once I worked out that this is NOT his thing, I should have had my mumor sister in the room for my next 2 births. As a midwife you start being of the opinion that birth is “woman’s business” and that few men are really good at it. If Russell Brand was my husband, well than it would be different! You might be lucky enough to have a man that sees birth and the birth space as a spiritual and ritual rite of passage into the physical world. My husband does not share this view, for him it is traumatic, watching someone you love going through such pain without being able to control it, but my mother, she would have shared my view!
5. “Join a Mother’s Group”. Again, my egoic mind was in control and I must have thought, “I have enough friends, I don’t need to go   and mix with strangers for support”. I have watched as all my friends developed amazing friendships with the girls from their mother’s groups! And the babies have all grown up to have great childhood friends, even sometimes tackling prep together. Mothers groups are a way to off load to others around you who get you. There is no need to have to explain yourself to people who do not understand. I feel like this is even more important in today’s society, where social media is such a huge presence, and women are checking out instead of checking into the “real” world. We need human connections, and your growing baby needs to watch you making these connections, so that they can see the importance of women supporting other women!

I will leave you with my favorite celebrity quote to this question as I think it is relevant to the journey ahead. Good luck and try and enjoy the ride!!

Jada Pinkett Smith

“I wish I had known then that pain is just a part of your journey and it’s not because you’ve done something wrong or because you’re cursed or you’re a bad person, we’re all going through it”, Jada revealed to ET. “We all have pain; we all have a story. And, so, all we need to do is support each other through it and I wish I had known that, ‘Jada, it’s just a part of it, baby. It’s going to be okay.’”