As a pregnant woman, am I more at risk from the coronavirus than other women?
At the time of writing, at an international level there are no clues to suggest that pregnant women are more at risk from the new coronavirus (SARS-CoV-2) than the general population. It is expected that the vast majority of pregnant women will show only mild or moderate symptoms similar to those of a cold or the flu. More serious symptoms, such as lung infection, seem to be more frequent in older people, people with a weakened immune system or long-term diseases. If someone has an already existing heart or lung disease prior to pregnancy, respiratory infection complications may be more likely to occur than coronavirus infection complications.
What effects will the coronavirus have on my baby should I be diagnosed with an infection?
Since this is a very new virus, we’re only just getting started learning about it. There are no signs of an increased risk of miscarriage. There are also no signs that the virus can be transmitted to the baby during pregnancy (this is known as vertical transmission). With this, it is considered unlikely that the virus will lead to anomalies in the foetus. So far, only 20 pregnancies have been reported on internationally – they all happened in China. No newborn child was infected in any case. No abnormalities with mother or child were reported.
What can I do to lower my risk of getting ill from the coronavirus?
The most important thing is that you wash your hands regularly and effectively as soon as you enter your home or place of work, entering from public areas. You should absolutely avoid contact with all other persons, including family, in the event of any symptoms of a common cold or a fever. Here you will find some useful tips as to how you can best reduce risk of infection:
- https://www.bundesgesundheitsministerium.de/coronavirus.html
- https://www.infektionsschutz.de/cv/
- https://www.infektionsschutz.de/hygienetipps/
What travel guidelines apply if I am pregnant?
As a matter of principle, you should keep your distance from fellow passengers in order to avoid transition – in everyday life, not just when you’re on trains, buses etc. If you are in Germany, you should follow the advice provided by the Federal Ministry of Health (www.bundesgesundheitsministerium.de) together with additional Federal Ministries and the RKI which is regularly updated according to developments with the situation. Before travelling, all persons, including pregnant women, should ensure that they have appropriate insurance. You should also check whether your travel insurance policy covers the birth and care of your newborn child in case you should give birth while abroad. As far as being abroad goes, travel risk for pregnant women is no higher than that applicable with other passengers. Please view the website of the Foreign Office, which contains travel warnings for specific areas (www.auswaertiges-amt.de).
What applies if you have had close contact with persons who have tested positively for COVID-19?
A corona infection is marked by flu-like symptoms, such as dry coughing, fever, runny nose and fatigue. But breathing problems, sore throat, head and body aching, nausea, diarrhoea and chills have also been reported. You should get in contact with your doctor over the phone; they will clarify all additional measures. You can also reach your local health office over the phone immediately and regardless of symptoms (this can be determined here: https://tools.rki.de/plztool/ ), or call the medical on-call service on the phone number 116117. At the time of writing there are no known treatment options or vaccinations. Diagnosis is done with a swab in the mouth / throat area.
What should I do if I have tested positively for the coronavirus?
If you have tested positively for the coronavirus, you should contact your gynaecologist over the phone to make them aware of your diagnosis. If you have no (or mild) symptoms and there are no risk factors hinting at complications with you or other persons in your household (e.g. relevant chronic underlying diseases), you can recuperate at home under the supervision of a treating doctor. Should you have more severe symptoms, you may be treated in a hospital.
When should you be isolated?
An isolation is recommended if:
- You have come into contact with anyone who suffers from a coronavirus infection;
- You have visited a specific region or country where COVID-19 cases are prevalent or which has been designated as a risk area;
- You have shown symptoms which suggest a coronavirus infection and are waiting to be tested or for your results;
- You have tested positively for the coronavirus and it has been recommended to you that you recuperate at home.
Criteria for repeal of isolation measures and for discharge from hospital
Based on current knowledge, cease of isolation at home / discharge from a clinic is acceptable no earlier than 10 days after the emergence of symptoms and the satisfaction of ALL the following criteria:
- Free of fever for at least 48 hours;
- Free of symptoms for at least 24 hours in case of acute COVID-19 disease
and
- 2 negative SARS-CoV-2-PCR examinations (24 hours apart, with mouth / throat swabs).
What should I do if I am asked to isolate myself?
Pregnant women who have been asked to isolate themselves, should remain at home and avoid contact with others for 14 days. The RKI provides specific recommendations in this regard: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/ambulant.html
What this specifically means:
- Not going to a school or work premises, or in public areas;
- Not using public transport – remain at home and prohibit any visits;
- Ensure ventilation of the rooms in which you find yourself;
- Keep as far away as possible from other people in your household, and use your own towels, crockery and utensils and eat at different times;
- Ask friends and family, or make use of delivery services, to run errands for you. The handover should then be done without direct contact.
Can I still attend appointments prior to when I give birth if I have self-isolated?
You should turn to your doctor and inform him / her that you are currently in self-isolation on account of a possible or confirmed coronavirus infection. It is likely that routine pre-birth appointments will be delayed until the isolation period ends, without any harm to you or your child.
If your midwife or doctor states that your appointment cannot wait, the necessary precautions will be undertaken so that you can go ahead with the appointment.
What do I do if I feel unwell or worry about my baby during the self-isolation period?
Your outpatient doctor and the competent health department should determine the procedure to follow in the event of an emergency condition worsening / a condition worsening which is beyond the capabilities of those normally accessible in advance together with you and (if appropriate) your care person. The procedure should account for the receiving hospital, the documents that must be supplied and the appropriate means of transportation to a hospital. Pregnant women are recommended not to turn up during general office hours, or at any general clinics, unless they urgently require medical care. If during your self-isolation phase you should have any concerns regarding the well-being of yourself or your unborn child, please consult your gynaecologist. If admission in a hospital is recommended, pregnant women are requested to travel using private means of transportation or to arrange for transportation to the hospital and to inform the clinic over the phone before they are admitted into the hospital.
Will my condition of self-isolation in light of a suspected or confirmed infection with COVID-19 affect where I will give birth?
As a precautionary measure, pregnant women with a suspected or confirmed virus infection and who are in labour are recommended to look for a clinic for the birth, where the baby can be continuously electronically monitored and oxygen supply can be checked hourly. Continuous monitoring of the foetus has the purpose of checking how your baby will respond to labour. Since continuous monitoring of a foetus can take place only in an obstetric department with the presence of doctors and midwifes, it is not recommended to give birth at home or at a birth centre, with the presence of only midwifes.
Will my condition of self-isolation in light of a suspected or confirmed infection with COVID-19 affect my giving birth?
At the time of writing, there is no evidence to support the notion that you are incapable of giving birth vaginally, or that a Caesarean section would be safer in the event of a suspected or confirmed coronavirus infection. However, if your respiratory disease (breathing) suggests that an urgent delivery is necessary, a Caesarean section birth can be recommended. There is also no evidence suggesting that women with a suspected or confirmed coronavirus infection cannot receive epidurals. However, the application of nitrous oxide can increase the aerosolisation and spread of the virus – this is expressly not recommended.
What happens if I enter into labour during my self-isolation phase?
If you enter into labour, you should ask your maternity ward for advice, and inform them that you have a suspected or confirmed coronavirus infection. Your birth team will advise you on your possibilities.
Could I transfer the coronavirus to my baby?
As this is a new virus, there is only limited information available on treatment of coronavirus infections with women who have already given birth. However, there are no reports indicating that women who were diagnosed with a coronavirus infection in the third trimester of pregnancy, transferred the virus to their babies while they were in the womb. The database here is a very small one; in 20 cases, there was no virus detected in the newborn child. All infections took place in the third trimester.
Is my baby tested for the coronavirus?
Yes. If at the time your baby is born there is any suspected or confirmed coronavirus infection with you, your baby will be tested for the coronavirus.
Can I remain with my baby if there is any suspected or confirmed coronavirus infection with me?
Yes, if you want. Provided that your baby is well and it does not need to be cared for in the newborn ward. There should take place a discussion about the risks and disadvantages between you, your family and the doctors caring for your baby. This recommendation may change in the event that knowledge about this new virus develops further.
Can I breastfeed my baby?
Yes. At the time of writing there is no evidence to support the notion that the virus can be transferred via breast milk. As such it is assumed that the recognised benefits with breastfeeding outweigh the potential risks of transmission of the coronavirus. During breastfeeding, infected mothers / suspected cases should prevent transfer of the virus through droplet infection before and after contact with the child, with hygiene measures such as thorough hand-washing and wearing a mask. This recommendation may change in the event that knowledge about this new virus develops further.
If you want to breastfeed your baby, the following precautionary measures are recommended:
Wash your hands for long enough before you touch your baby or a breast pump or bottle;
- Wear a face mask during breastfeeding;
- Follow the pump cleaning recommendations after every use of it;
- If you want to feed your baby with milk or milk-based nutrition, strict observation of the sterilisation guidelines is recommended;
- If you are pumping breast milk in the hospital, a special pump should be used.
If a mother is unable to breastfeed her child, breast milk can also be pumped and fed to the infant via an additional person. Here too, hygiene conditions should be observed, and the pump and the bottle should be sterilised after use.
Coordinated with the Royal College of Obstetricians and Gynaecologists © 2020 and the German Society for Gynaecology and Obstetrics (reg. ass.).