Pregnancy is a time of mixed emotions and it is not uncommon to feel excited and exhilarated but also confused, overwhelmed and even anxious, at times. Concerns about contracting the coronavirus and its effects on you and your baby’s health, changes to your doctors’ office hours and practices and altered hospital policies, will understandably add further stress during pregnancy. And while information regarding pregnancy and COVID-19 is continually evolving, this article provides a framework to help pregnant women better understand how to evaluate what might be going on and to provide practical information and tips to support good mental health during pregnancy.
Our current understanding about COVID-19 effects during pregnancy
Although little is know about Covid-19’s impact on pregnant women, this is what we understand at the time of this blog:1
- There is no evidence to suggest that pregnancy increases a women’s risk for getting Covid-19 or for developing more severe symptoms is she has the disease.
- It appears that pregnant women who are healthy will develop mild to moderate symptoms that are similar to non-pregnant women of the same age and health status. Further studies need to be done to elucidate these preliminary findings.
- To err on the side of caution, the United Kindgdom declared pregnant women a vulnerable patient population, even though there is no available evidence to demonstrate an increased risk to pregnant women from Covid-19. Such a statement is based on data gathered from other viral infections.
- According to the CDC, there is no evidence that women with Covid-19 have an increased risk of miscarriage or other complications, if they are otherwise healthy. Pregnant women who had other coronaviruses such as SARS and MERS had a higher risk for preterm birth, as noted by the American College of Obstetricians and Gynecologists. Further studies need to be done to elucidate these preliminary findings.
- There have been several small studies that have shown limited or no transmission of Covid-19 from pregnant women to their newborns. Further studies need to be done to elucidate these preliminary findings.
If you have cough or shortness of breath or at least two of the following symptoms: fever, chills, sore throat, muscle pain, new loss of taste or smell, headache, contact your doctor, nurse or midwife.
Questions to ask your doctor
Due to the pandemic, many pregnant women are uncertain about how mandated changes in hospital practices and social distancing will impact their birth plan and experience. If you haven’t already, contact your doctor, nurse, or midwife prepared questions to ensure that you have the necessary information to revise your birth plan. Here’s a brief list of questions to include:
- How does one contact the office and what are the office hours? What happens in case of an emergency? What is the protocol for prenatal visits and ultrasound visits?
- How does one access online antenatal classes to meet and talk to other pregnant women?
- What measures have been put in place to ensure my safety when visiting the doctor’s office or going to the hospital?
- How will changes in hospital practices due to COVID-19 treatment at the hospital affect my birth plan, labor and delivery? (This question will obviously require careful detail of information of the different steps involved in labor and delivery).
- Will there be changes in protocol, anesthesia or other medications due to Covid-19 and be explicit about what they are?
- Who will be able to be present in the delivery room? If no one can be present, how and where can my significant other or loved one, attend the birth? From another room, nearby?
A word about anxiety
Anxiety symptoms are relatively common during pregnancy. A recent study of 2,793 pregnant women showed that 9.5% of women met criteria for generalized anxiety disorder (GAD) at some point in their pregnancy, with the first and third trimester having higher prevalences than the second trimester.
Although anxiety is generally more prevalent in women with a pre-existing condition of anxiety, it can certainly rear its head in women without any prior anxiety, during this time of great upheaval. Cognitive behavioral therapy and relaxation techniques may be helpful for treating anxiety symptoms and may reduce the need for medication. Various other treatments such as yoga, massage therapy and acupuncture may be adjunctively helpful. In some cases, medication is needed, and it is important to choose an effective treatment with a good safety profile.
Although most women can become more forgetful and have heightened emotions that include anxiety, it is important to recognize when the degree of anxiety is affecting your pregnancy. Some signs and symptoms to look out for include:
- Interrupted or poor quality sleep
- Recurring nightmares or disturbing dreams
- Change or loss of appetite
- Frequent binge eating
- Trouble concentrating
- Panic and feelings of fear worry
- Obsessive rumination about the pregnancy, delivery and postpartum period
If you are experiencing these symptoms on a frequent basis, it is vital that you speak with a doctor, nurse, midwife or counselor to help support you through this challenging time. Depression and other mood issues can also increase and should be discussed with your healthcare practitioner if it is affecting your daily functioning.
Stress-relieving tips and practices
To help relieve stress and anxiety during this special and challenging time of a pregnant woman’s life, we recommend focusing on the things that you can control that include taking care of yourself and your developing baby, avoiding those things that may cause additional stress and anxiety, and whenever possible and reaching out to others for connection, support and love. Toward this end, here are a few key suggestions abbreviated as the “SEEDS” to help reduce anxiety:
- Structure each day by planning for success and fun: shower, dress, think of healthy meals to prepare, and plan one fun thing to do for yourself- take a bubble bath, play an instrument or pick up an old hobby, work on a blanket or other project for the baby’s room, watch a funny movie, read an old letter or diary, connect with an old friend are just a few suggestions.
- Eat: Maintain a healthy diet of vegetables, fruit, whole grains and adequate proteins. Ask for extra help from your partner or friends and neighbors in taking care of other children or going grocery shopping. Drink plenty of water and fluids and supplement with a multi vitamin and other basic supplements (refer to Joanna’s article).
- Exercise and mindfulness: Engage in regular exercise and practice deep breathing, relaxation and/or meditation. A little time for mindfulness goes a long way towards helping relax you and your baby. Spend some time in gratitude for the life that you are living and acknowledge the challenges and emotions that you are facing and feeling.
- Diversion: Allow for diversion with family members and connect with loved ones and friends. Allow others to enjoy the growth of your baby through video sessions. Allow yourself an occasional splurge, choosing healthier snacks (e.g., low calorie ice creams, fruits, nut butters).
- Sleep: Make sleep a priority and keep regular bed and wake times that allow you ample time to wind down, and get 7-8 hours of sleep. Turn off blue light on your technology and limit screen time close to bed. Limit exposure to all media and news, especially around bedtime.
For further references related to COVID-19 and pregnancy please refer to the following link from the Harvard Medical School health blog post on April 2, 2020.