Having a Baby During a Pandemic? Part One: Pregnancy, Delivery, and Feeding.

The coronavirus pandemic has turned our world upside down. It has changed our life experience as quickly as… having a baby! So, what happens when we combine the two? Questions. Lots of questions.

Here are some tips to help prioritize newborn and parent safety as well as wisely manage the first few weeks at home with a new little one during the pandemic. 

Understanding coronavirus in pregnant people.

A common concern for many of my pregnant parents is the risk to themselves and their babies if they get sick with COVID-19 during pregnancy. It’s a fair concern since pregnancy is considered a “high-risk” condition for, well, nearly everything. The worry stems from early data that suggested COVID-19 disease increases a person’s risk of pre-term labor, C-section rates, and pregnancy loss. There is nuance here, of course. The number of pregnant people studied has been really small. Data is still rolling in. Applicability to all person groups is not really there. But, it is still something that researchers are actively assessing. You might be interested in this video by Dr. Danielle Jones (AKA Mama Doctor Jones) for additional insight on pregnancy and COVID-19.

More recent data from the CDC suggests that pregnant people are not more likely than non-pregnant people to get infected with the COVID-19 virus, but infected pregnant people are more likely to be hospitalized and need intensive care. This conclusion is still based on a relatively small amount of data and consensus for best care is simply not there. Of note, there are numerous studies that are currently happening regarding COVID-19 and pregnant people. If you are pregnant and have tested positive for COVID-19+ or are a PUI, you can register for this study at UCSF.

Bear in mind, there is a ton of stuff we don’t understand about SARS-CoV-2. It will take many months to years to get a large, international group of pregnant people in order to make solid recommendations. It’s important to have some grace and flexibility as more information is being released. Until then, please keep those prenatal visits! I want to make sure you and your partner have all the current information from your doctor to make good decisions. And here's a quick resource of common questions about pregnancy and COVID-19 from the Harvard Health Blog. 

Understanding coronavirus in children.

One of the fascinating trends throughout this pandemic is the consistent reporting that novel coronavirus is causing limited illness in infants and children. This is remarkable because viral and bacterial illnesses typically cause aggressive disease in young children. Although we are still unsure why this is the case, as a pediatrician and a parent, this news continues to provide reassurance and comfort. 

Of note, babies under the age of one year are at a slightly increased risk of significant illness than older children. Infants can get infected with SARS-CoV-2 during childbirth or from ill caregivers after delivery. There have also been case reports suggesting transmission of the virus through the placenta, although the significance of this finding is unclear. The rare complication called Multisystem Inflammatory Syndrome in Children (MIS-C) does not seem to be occurring in infants. The babies who do develop COVID-19 disease are typically supported in the NICU during their most critical days. 

At the hospital. 

Be sure to understand your local hospital’s current hospital visitor policy. Policies are changing quickly based on local infection rates. In addition, be sure to bring any needed paperwork, your infant car seat, and any personal items at the time of admission. It may not be possible for your partner to run out to grab something you forgot during the stay. 

Be prepared that at many hospitals across the country and our local KC hospitals, all pregnant women are offered coronavirus testing upon admission. I recommend all my moms get admission testing. 

Initially, there was a rumbling rumor suggesting that refusing the admission screening test is the safest for your baby. The origin of this rumbling was early and isolated experiences of COVID-19 positive mothers who were automatically separated from their new babies. The argument was that if you don’t get tested, you can’t be positive, so no one can take your baby away. Automatic separation based on maternal COVID-19 status is not currently happening.

To be clear and concise - No one is trying to take your new baby away and no one is going to force you to comply with orders to separate. Rather, testing all pregnant people allows for appropriate levels of caution during the hospitalization and improved care plans for after discharge. Specifically, knowing a parent is positive will provide better direction for the first few weeks at home, how to navigate visitors, and be on increased awareness for late-onset neonatal infection. 

But, Dr. Natasha, I’ve heard that many of the COVID tests suck. If the results of the test are not accurate, why bother with the test? Great question. And, yes, some of the tests suck. Please talk with your OB/Gyn about the type of test that would be used and the expected accuracy of that specific test. Test types can vary wildly in different areas of the country, so it’s okay to ask for more details about what is being used in your hospital system. 

Newborn feeding plans.

At this time, the CDC, WHO, and the Academy of Breastfeeding Medicine report that the novel coronavirus has not been found in breastmilk. For mothers choosing to breastfeed, it is possible the virus can be spread through respiratory droplets from mom to baby during the act of breastfeeding. It is recommended that COVID-19 positive moms use meticulous hand hygiene and wear a mask or facial covering during close contact. For mothers too ill to breastfeed or require separation from their baby after birth due to illness, consultation with a lactation specialist is highly recommended to support feeding goals. Alternatively, a mother could choose to pump breast milk to feed her baby while COVID-19 positive. Routinely sanitizing the pump parts remains important and routine storage of the milk is suggested.

For families choosing to formula feed, safe supply will be available to you during your hospital stay and there are currently no shortages of formula in the US. Prepare formula according to package directions.  Using sterile water, “infant water,” or distilled water is not needed for formula preparation. Routine bottle care (dishwasher or hand-washing) is usually all that is required. Sterilization of bottles is only needed in special situations. 

Early discharge. 

Many hospitals are allowing new parents to be discharged from the hospital earlier than the typical routine. This is to limit the time you are in an area of potential exposure. Before that happens, however, all babies should still have procedures completed including newborn lab work, hearing and cardiac screening, and protective medications.

What about first doctor visits? Early visitors? Thoughts on maternal mental health planning? Continue reading in Part Two of this series. 

A version of this post was originally published on US World and News Report’s parenting blog.