[SPECIAL EP] Coronavirus (COVID-19) and Pregnancy: What You Need to Know

I have a special, timely episode for you today about COVID-19 (also known as coronavirus). Some listeners asked me what they need to know about how coronavirus could affect their pregnancy and baby, so this episode should help answer some of those questions.

In this episode, I'll give you an overview on what this coronavirus is, how this outbreak has spread so far, and what symptoms to watch for. We will also talk about how to take care of yourself and help prevent the spread of COVID-19.

And most importantly, I'll share some research about the impact of coronavirus on pregnancy and babies. There hasn't been a ton of research yet, so it's crucial to stay up to date as more information becomes available. But overall, the information in this episode should reassure any parents who are feeling worried about coronavirus. 

I'll be sharing more information in the All About Pregnancy and Birth Facebook Group as the situation develops, so follow along there for updates on the relationship between COVID-19 and pregnancy. You can follow the Centers for Disease Control (CDC) for general updates, too. 

In this Episode, You’ll Learn About:

  • What the coronavirus is and how it spreads
  • An overview of the coronavirus outbreak up to March 10th, 2020
  • Symptoms of coronavirus and who is most at risk from the disease
  • What we know about how coronavirus affects pregnancy and babies
  • How to help prevent the spread of coronavirus
  • Why you should stay calm and where you can find up-to-date information as the outbreak changes
  • Why consent absolutely must be received before a provider conducts an episiotomy



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Transcript

Speaker 1: This is a special episode of the podcast where I'm talking about coronavirus and pregnancy.

Speaker 2: Welcome to the All About Pregnancy & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, certified integrative health coach and creator of The Birth Preparation course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. You see the full disclaimer at www.ncrcoaching.com/disclaimer.

Speaker 1: Hello and welcome to another episode of the podcast. Thank you for being here today. This is a special episode of the podcast where I'm talking about coronavirus and pregnancy. Obviously the coronavirus is beginning to be a serious public health problem, so I wanted to take a minute and kind of explain some things to you in more detail about how it relates to pregnancy. So what you're going to learn today is just an overview of the coronavirus and the outbreak up until the time of this recording. As well as how the coronavirus is transmitted, the symptoms of it and how it affects people in general, and then more specifically how the coronavirus affects pregnancy and babies and then finally what you can do to protect yourself from the coronavirus. Now this information comes from the Centers for Disease Control as well as ACOG, the American College of Obstetricians and Gynecologists and then the few articles that have been published so far.

Speaker 1: I do need to state a disclaimer that this information is only as up to date as of the date of this recording or release of this, which is March 10th, 2020. Things are constantly being updated. If you want the most updated information, you can go to the Centers for Disease Control website and we'll link to that in the show notes. And then I will continue to provide updated information specific to pregnancy in my free Facebook group, All About Pregnancy and Birth. You can search for that on Facebook or I will also link to that in the show notes.

: Okay. So let's start off with just kind of a general overview of what the coronavirus is and what's going on with this outbreak. So coronaviruses are a large family of viruses that are common in people. They also happen in some species of animals including camels, cattle, cats and bats, and rarely animal coronaviruses can infect people and then spread from person to person.

Speaker 1: That is the case for what happened with the SARS virus back in 2004. That was also a type of coronavirus and it started in bats and then went to people and then spread from person to person. And that is the same thing that has happened with this current coronavirus, where it also appears to have the origins in bats and then spread to people and is now spreading from person to person. So the actual scientific name of this current coronavirus that's causing an outbreak is SARS-COV-2. And the disease that this virus causes has been named coronavirus disease 2019 and that is abbreviated COVID-19 that's what you see on the news. Now COVID-19 and that's what I'll call the disease in the episode. I'll go back and forth between COVID-19 and coronavirus, but I mean the disease that is caused by the coronavirus.

: So COVID-19 disease was first detected in the Chinese city of Wuhon in December of 2019. It has since however spread to more than 70 countries. There have been more than 94,000 infections worldwide and 3000 deaths. So that's about 3% of people who are infected have died from COVID-19 disease. And most of those infections and deaths have occurred in China. But as we know, the epidemic is now shifting outside of China and is becoming more of a global problem including cases in the United States. And the United States so far doesn't have nearly as many cases, obviously, as China. So far in the US there have been 164 cases of COVID-19 disease and 11 deaths. So of the 164 cases, there have been 11 deaths. That is 7%.

: Okay, 7%, so when you look at those numbers, they're not a lot of people that have been infected in the United States. Of course that is going to rise, but there are things that are being done in order to help contain that. So I say that to say this, that while the outbreak is of course a serious public health concern, please, please do not panic. Panic is not helpful and it's causing unnecessary stress. So again, although this is a serious public health problem, do not panic. It is not that widespread in the United States, although there will be more cases. It's not that widespread. And the majority of those who contract the coronavirus do not become seriously ill. Well over 90% of people do not become seriously ill from the coronavirus. So do not panic.

: All right, so how is the coronavirus transmitted? Well, we believe that the virus is spread mainly from person to person. It seems to spread fairly easily and the most vulnerable groups are those who have some underlying issues. So elderly people, especially men, at least based on the information out of China so far. Also people with underlying diseases like heart disease, lung disease or diabetes tend to be a bit more susceptible. And the way it's transmitted is when people are in close contact with one another, within about six feet or so. And the respiratory droplets that are produced when an infected person coughs or sneezes, those droplets can then land in the mouth or the nose of people who are nearby or they can possibly be inhaled in the lungs. It's also possible that you can get COVID-19 by touching a surface or object that has the virus and then you touch your own mouth, nose or eyes, but it's not thought that this is the main way the virus spreads.

Speaker 1: It's believed that the virus mostly spreads is from someone who has it coughing or sneezing and then those droplets land on someone nearby, within about six feet. Now people are most contagious when they are the sickest, but it may be possible that it's spread before people show symptoms. There have been some reports of it being spread without people actually showing symptoms of being sick, but that is thought to be a very small, small minority of cases.

: Now what are the symptoms of COVID-19 disease? Well, the symptoms are fever, cough and shortness of breath and they can appear anywhere between two and we believe up to 14 days after exposure. That's why folks on cruise ships and who've been exposed have to do that 14 days of quarantine because symptoms can show up during any of those days. Now those symptoms of fever, cough and shortness of breath are pretty nonspecific and common for most respiratory illness.

Speaker 1: So I don't want you to get paranoid or freak out because you have a cough or a mild fever and get concerned that you have COVID-19. In order for you to be tested, you have to have fever, cough, shortness of breath, and have been in close contact with a person who is known to have COVID-19 or you live in an area or recently traveled to an area that has an ongoing outbreak of the disease. Okay, so not just those respiratory issues, a fever, cough, shortness of breath. You also have to have been in contact with someone who has the disease or recently been in an area that is concerning for the disease.

: Now as far as how the disease affects people, it can be as mild as common cold like symptoms, sniffles, runny nose, that kind of thing, to more flu like illness with body aches, malaise, just not feeling well, fevers, chills to severe illness like pneumonia or pretty severe pneumonia that requires hospitalization. And then in rare cases, COVID-19 can also cause death. Now when we look at the effects of COVID-19 in pregnancy, I have to be honest, we actually don't know a lot about how coronavirus affects pregnancy because quite frankly, there haven't been a whole lot of cases. So data collection is ongoing about how the disease will affect pregnancy. The good news is that what we know so far is that unlike other viruses in the past that have caused pandemic, things like the flu and SARS, this virus so far doesn't appear to be more severe in pregnancy. There was one study of about 150 pregnant women who got the disease in China. And of those women, 8% had severe disease, 1% were in critical condition, so 90 plus percent did not have any severe disease.

Speaker 1: Now there's some caveats to that study. All of the women were late in pregnancy. They were all in their third trimester. So we don't know a lot about the effects of the disease in early pregnancy. So we don't know a lot about how COVID-19 effects early pregnancy. What we do know is that the disease can be associated with a high fever and that high fever in general is associated with increased risk of miscarriage, whether it's caused by this disease or another condition. So it's possible that because COVID-19 causes women to have a high fever or causes anybody to have a high fever, that it may increase the risk of miscarriage. But again, we don't have enough information to tell for sure. Now with that being said, the good news so far that it doesn't appear to affect pregnant women more severely. We do have to be careful because based on how other coronaviruses have behaved like SARS, like the SARS epidemic of 2004, that virus actually did affect pregnant women more severely.

Speaker 1: So, although right now things look, we have to be on the lookout and be prepared for the possibility that once we collect more information, collect more data, that it may affect pregnant women in a different way than what we're seeing now. We also know that pregnant women have a weaker immune system. So again, that's another possibility or reason why pregnant women may be affected more severely. But looking on the bright side, what we know so far, pregnant women do not appear to have more severe disease compared to non-pregnant people. Now when we look at babies who are born to moms that were infected with coronavirus, the babies appear to be born healthy. Now of those 150 or so women in that study I mentioned, I will say almost all of them had a cesarean section in order to reduce the risk of transmission.

: So all those babies were born via cesarean birth, but they all appear to be born healthy and they tested the amniotic fluid for coronavirus. They also tested the breast milk for the coronavirus and it did not show up in either of those places. So that is excellent evidence that there is no vertical transmission, meaning it doesn't appear that a mom who's infected with COVID-19 will transmit the infection to her baby. Okay, so no evidence of vertical transmission, so that's good. Again, that caveat that we don't have a lot of data, but so far this looks promising. Now there were some instances of preterm birth among those women. However, it's not clear if the preterm birth was related to something else or if their preterm birth was specifically related to the virus. It's not really enough data to tell. So that's something to be on the lookout for.

: Now if babies get COVID-19 there's also promising evidence and this was only 10 babies so far, so keep in mind not a lot of babies, but babies do not appear to be severely affected, which is also a good thing. Okay, so if a baby catches the disease, babies do not appear to be severely infected. So overall reassuring evidence regarding the effects of COVID-19 in pregnancy doesn't appear to be as severe, does not show up in amniotic fluid or breast milk, doesn't appear to get transmitted to babies. If babies get it, they don't appear to have severe disease. So all reassuring evidence so far, but again, we have to collect more data and as things evolve, we'll see how things go.

: All right. Now how do you prevent getting COVID-19 and how do we prevent transmission? Well, pregnant women need to do the same things as everyone else. There are no specific recommendations. Now we'll mention very quickly about the possibility of a, there currently is no vaccine available to prevent COVID-19 and even if there were a vaccine that became available fairly quickly, pregnant women are always excluded from early vaccine trials just because we don't always have a lot of information and we don't want to expose the population of pregnant women to a vaccine until it's been really, really, really rigorously tested in a large population.

Speaker 1: So pregnant women are not eligible to get vaccines in the early parts of development so you have to fall back on the same old tried and true things that we know to prevent illness and exposure to viruses. Same stuff that we do for any spread of respiratory diseases. And the number one thing of course is to wash your hands, wash your hands, and then wash your hands. Wash your hands with soap and water. Putting water on your hands without soap is not washing. That is rinsing. So it needs to be soap and water for at least 20 to 30 seconds and you need to do it, especially after using the bathroom, before you eat, after you blow your nose, you cough or sneeze, you want to wash your hands for 20 to 30 seconds. Now 20 to 30 seconds is actually a little bit longer than you realize.

Speaker 1: It's the equivalent of singing Happy Birthday twice. And I'm going to do a quick little demo here. If you are in a place where you can pause for a second, don't do it in the car actually if you're driving, but if you're walking, if you're sitting and listening, I am going to turn on a timer for 30 seconds and I'm going to show you how long it is that you need to wash your hands. Okay? Ready? Here we go. Happy birthday to you. Happy birthday to you. Happy birthday dear Nicole. Happy birthday to you. Happy birthday to you. Happy birthday to you. Happy birthday dear Nicole. Happy birthday to you.

Speaker 1: Okay. You hear that? The timer just went off. All right, so that was 30 seconds. Okay, so it needs to be a good 30 seconds and you don't have to listen to my singing. I don't actually sing well obviously and you can come up with whatever song you want. I have seen people like come up with 30 seconds to tick tock songs to listen to in their heads or sing in their heads or like, for old school kind of rap fans, I've seen articles of like hip hop songs that you can sing to that are 30 seconds, so find a creative way, but make sure you do it enough time so that you're washing your hands thoroughly. Now if soap or water is not readily available, then you can use an alcohol based hand sanitizer. It has to have at least 60% alcohol in it in order for it to be effective.

Speaker 1: And at least as of this recording, finding hand sanitizer is like crazy hard, people are sold out of it. You know people are snatching it up like crazy. So you may not be able to find hand sanitizer, but that is an option if soap and water aren't readily available, keep in mind you have to do that for at least 20 seconds too. So almost for the same amount of time as washing your hands. And also remember that if your hands are visibly dirty, if you visibly have stuff on your hands, hand sanitizer does not cut it and you need to use old fashioned soap and water. I tend to be more of a soap and water kind of girl because hand sanitizer, actually I feel like it drives my hands out. So I'm biased towards soap and water. But just wash your hands, please wash your hands, wash your hands, wash your hands.

Speaker 1: Other things that you can do of course are avoid close contact with people who are sick. That's kinda common sense. Avoid touching your eyes, nose and mouth. That's a little bit harder to do. It's harder to do than you realize, but if you can avoid touching your eyes, nose and mouth, that will decrease the risk of you inadvertently infecting yourself with anything. And you can also clean and frequently wipe off objects and surfaces with just a regular household cleaning spray or wipe. You don't have to get fancy and do straight up bleach or anything like that. I know at work in my call room, I tend to, when I come on, wipe it down with those hospital sanitary wipes. Like I'll wipe down the computer, mouse, the desk, the computer, keyboard, the chair, the remote control, the phone.

Speaker 1: So just kinda wipe things in my workspace area. And you can do the same thing at home, you know, wipe your surfaces at home or wipe your surfaces at work in order to reduce transmission. If you are already sick, then stay home when you're sick and you should do that anyway. Like we don't do a good job of promoting that anyway. So stay home when you're sick. And then when you cough or sneeze, cough or sneeze into a tissue, not into your hand and then throw the tissue in the trash. If you don't have a tissue, you can use the elbow method where you cough or sneeze into your elbow. If you cough or sneeze on your hand, then go back to my number one recommendation, which is to wash your hands. Okay. Wash your hands, wash your hands, wash your hands.

Speaker 1: Okay now let me say a word about face masks, because I've seen people running out snatching up face masks, you know, trying to reduce the risk of infection and let me tell you, it's not recommended that people who are well wear a face mask in order to protect themselves from any respiratory disease including COVID-19. Those typical surgical masks usually don't help protect you from inhaling the virus. They are too loose. Face masks should really be reserved for people who are showing symptoms of COVID-19, it helps prevent the spread of the disease to others. So the face mask helps to capture those respiratory droplets when that person cough or sneezes into the face mask. Face masks are also really, really important for us healthcare workers who are taking care of someone like in a health care facility or even at home that has the virus in order to reduce the risk of transmission in that setting. So face masks are really reserved for people who are showing symptoms or people who we know are indirect close contact with people who have the virus.

: Okay. All right. Now the last couple of things that I want to say before I close are please don't do silly things like look at Asian American people or people of Asian descent and if they cough or sneeze, look at them kind of funny like, Oh my God, are you the transmitting the disease? If they don't live in or if they haven't recently been in an area where there's the spread of the virus, they haven't been in contact with anybody. Same sort of things. They are not at any greater risk of spreading COVID-19 than any other American. So please don't do silly things like look at Asian American people when they sneeze or cough any more so than anybody else.

: Okay. And then the last thing I'll say is that the flu, influenza, is actually still a much bigger problem than coronavirus. So if you have not gotten vaccinated against the flu, go ahead and get vaccinated against the flu. You are way more likely to contract the flu than you are to contract coronavirus. Okay, so just to recap, COVID-19 is a serious public health problem, but most people who are infected will not have severe disease. Also, it does not appear to be spreading nearly to the same degree in the United States as other conditions such as influenza. So please do not panic. COVID-19 is spread via person to person contact via respiratory droplets. The symptoms are fever, cough and shortness of breath. Those are pretty common symptoms of respiratory illness in general, so you only need to get tested if you've been in contact with someone who is infected with COVID-19 or you live in or traveled to an outbreak area within the last couple of weeks.

Speaker 1: So far, the good news is that pregnant women and babies do not seem to be more severely affected by COVID-19 but this is an evolving situation, so we have to keep tabs on things very closely. And then finally prevent transmission the same way everyone else does. The same way we should do to prevent transmission of all diseases. Wash your hands, wash your hands and wash your hands. Also, avoid sick people. Avoid touching your nose, eyes, mouth. You want to wipe down surfaces with regular household cleaning spray or wipes. If you're sick, stay at home, and then cough or sneeze into a tissue and throw it away or use that elbow method like I talked about. And one more thing. If you live in an area where there is currently an outbreak, you may be getting slightly different recommendations, so be sure to check with your local health officials.

Speaker 1: All right, so that is it for this episode of the podcast. To get the latest updates regarding coronavirus in general, also coronavirus and pregnancy, you can go to the CDC website and I will link to that in the show notes. It's a www.CDC.gov/coronavirus. I will also continue to post regular updates related to pregnancy specifically and coronavirus in the All About Pregnancy and Birth Facebook group, my free Facebook group. You can search for that on Facebook or I will also link to it in the show notes. Now be sure to subscribe to the podcast in Apple podcast or wherever you listen to podcasts like Spotify or Google Play. And now that you are more informed and hopefully at ease about coronavirus and pregnancy, you can get back to getting ready for your birth.

: So check out my free online class on how to make a birth plan. In that class, you will learn some great information on how to make a birth plan that works to help you have the birth that you want. Questions you need to ask your doctor, how to approach the process, how to get people to listen and pay attention to it. You can register for that free class at www.ncrcoaching.com/register and I will put that in the show notes as well. All right. Do come on back next week I'll be back to regularly scheduled programming and until then I wish you a healthy happy pregnancy and birth.

Speaker 2: Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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