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What to expect when you’re (not) expecting (Covid)

Having a baby in the time of Coronavirus: What you need to know, and what you should expect

Pregnancy is a beautiful time.  Your growing body and growing baby should be nourished and celebrated.  While everyone will tell you to relax and enjoy the moment, it is human nature to worry.  It is also human nature to share every speck of information about every possible thing that could happen – whether it is true or not.  In fact, one simple Google search will result in about a million different scare tactics. 

Covid-19 has produced a lot of anxiety for expectant women and families in 2020.  Many recent clients have expressed concern about the unknown factors of the virus, hospital visitor policies and potential risks of being in the hospital itself.

I want to dispel some myths and perhaps ease the minds of expectant families.

 

Breast milk: Ready-made protection

Throughout history, breast milk has been the preferred choice for infant feeding.  The choice to breastfeed has many advantages.  While infant formula will promote healthy growth of your baby, the immune-boosting and protective benefits of breast milk cannot be ignored.   

Human milk contains many properties that will help protect your baby from harmful bacteria, allow for maturation of the stomach and gut linings, help with important hormonal responses, and promote growth of healthy tissues and cells.   

One very important, and almost miraculous, fact is that the protein in human milk changes according to the needs of the infant.  The cells in your baby’s saliva actually communicate with mom’s cells, and tell her body exactly what baby needs at any given time.  During illness, immune supporting factors actually increase! Isn’t that amazing?!

 

They are on your team

Just a few of the numerous immune-boosting compounds in human milk include (and I apologize in advance for my weak hockey analogies):

Immunoglobulin (sIgA)
      • This is your defensive line.  It coats the intestines and prevents harmful bacteria and viruses from entering.  It also encourage the growth of a healthy bacteria flora, which will prevent pathogens from adhering.
Lactoferrin
      • These would be your offensive line.  They are antibacterial, anti-fungal, AND antiviral.  Just like the opposing team needs control of the puck to get stronger, bacteria require iron to grow.  Lactoferrin binds to iron and prevents bacteria from using it.    
Lysozyme
      • This is your team’s “goon” (which is the word my husband uses to describe the big guy who beats up guys on the opposing team).  It damages bacterial cell linings, which prevents them from attaching to your baby’s cute, healthy cells.
Oligosaccharides
    • These are the goalie for the immune system.  Essentially, these carbohydrates act to block receptors on gut lining causing bacteria to be swept away, moving through the gut intact and unattached to healthy cells.

 

Covid: The basics

Some basic facts about Coronavirus and Covid-19:

  • Coronavirus (COV-2) consists of an oily lipid membrane, studded with proteins that help the virus stick to and enter cells.
  • It is a very small molecule, measured at 5 microns (for comparison, a human hair is 60-120 microns).
  • Incubation period (time from exposure to symptom development) is 2-14 days.
  • You are most contagious 1-3 days before symptoms develop and soon after symptoms develop.
  • It can live for up to 72 hours on flat hard surfaces such as glass, plastic, and steel.
  • It can live for up to 24 hours on surfaces like paper, cardboard and fabric.
  • A cleaning solution must contain at least 70% alcohol to be effective (in other words, don’t waste your vodka by using it as a surface disinfectant!).

  

Covid considerations in pregnancy, labour, delivery, and postpartum:

  • Current recommendations are constantly being developed and are being studied on a case by case basis

  • Normal pregnancy symptoms may mask signs of Covid-19
  • 20% of pregnant women experience rhinitis (stuffy nose, post-nasal drip)
  • Third trimester: baby increases in size, which increases oxygen demands (and thus breathing rate); some mild shortness of breath is expected during later weeks of pregnancy 
  • Based on a study done on 5700 women in NYC: risks of Covid-19 associated complications increased in pregnant women with diabetes and hypertension.

For women with risk factors for Covid-19, many experts are recommending a planned birth at a hospital or accredited birth center, both for the protection of the patient, as well as the protection for labour and delivery staff

  • 10-32% of low risk attempted home births require hospital admission, often under emergent circumstances.
  • If you are Covid positive or experiencing symptoms, consider an epidural to decrease the more pronounced respiratory exhalations in labour (again, this is for protection of both you and your healthcare staff- it helps to decrease your respiratory load during labour and protects us from exposure); having an epidural significantly decreases your risk of general anesthesia (being “put to sleep”) in the event of an emergent cesarean section 

Yes, you will be allowed only one support person while you are in the hospital

  • If you were planning on doula support, see if they can be available by Facetime or Zoom
  • Many of them are! During my nursing shifts, I have been surprised many times with a calming and friendly voice “popping” up from a laptop in the back of the labour room
  • Perhaps your doula could do a pre-labour “class” with your partner or support person, teaching them common massage, breathing, and pain management techniques
  • Ensure you can have extra support via Facetime, Whatsapp, or Zoom for the postpartum period: make sure your parents and family members know how to use your preferred method
  • After you are discharged from the hospital, you should be mindful to carefully manage the visitors you allow into your home.  This may mean that many friends and family members may have to wait to meet your baby in person. 

Other hospital considerations

  • Nitrous oxide (“laughing gas”) is not being routinely offered due to the unknown nature of cleaning, filtering, and potential aerosols occurring with such systems in labour and delivery.
  • Ensure that all individuals who enter your room are washing their hands or using hand sanitizer.
  • Even if you are positive for Covid-19, you will only be advised to have a cesarean section if there is a medical reason
    • I have recently come across a few online myths about people thinking c-sections are being encouraged only because Covid-19.  The truth is: a cesarean delivery requires significantly more staff in attendance, and requires a longer hospital stay than if you had had a vaginal delivery.  If an obstetrician is recommending a c-section, it is most likely for a reason other than just Covid-19.   
    • Hospital policies and procedures regarding Covid-19 are ongoing and are constantly being updated based on the most current knowledge and research.  Just know we are all in this together, you are not alone! If you are feeling scared or anxious in the hospital environment, let your nurse know!  We truly want this to be the happiest, most memorable time for you.  Your mindset plays a huge role during labour. We want to alleviate as much stress as we possibly can.
  • Most importantly: Covid-19 has not been found to transmit across the placenta, and to date has not been found in cord blood, amniotic fluid, or breast milk.

 

Best feeding practices now

The great news about this is that you can and should continue to breastfeed. 

  • Everyone should be washing their hands before and after feeding. To paraphrase Bonnie Henry, the BC Health Officer, wash your hands like you’ve been chopping up jalapenos and you need to change your contact lenses.
  • Disinfect surfaces in your home and car, especially if you have been to the grocery store, or in any public place
  • Washable breast pump parts should be washed regularly (daily) in hot, soapy water; the non-washable parts of your pump should be wiped down with disinfectant after each use.
  • For moms with symptoms, be very diligent about hand washing and wear a cloth mask while breastfeeding. 

 

Takeaways

    • Some aspects of your labour and postpartum experiences will be different in the face of Covid-19 (i.e. visitor policy in hospital, managing visitors to your home after baby arrives, extra diligent hygiene practices)
    • Remember that there are numerous members of your healthcare team who are here to answer your questions, ease your worries, and dispel the copious online myths

Please contact me for any of your breastfeeding-related queries!

email: sheena@milkbudlactation.ca

phone: 780-266-3700

 

Resources 

The following sites are regularly updated with current and accurate information.

Public Health Agency of Canada

Pregnancy, childbirth, and caring for newborns: Advice for mothers during Covid-19

https://www.canada.ca/en/public-health/services/publications/diseases-conditions/pregnancy-advise-mothers.htm

 

Canadian Pediatric Society

Breastfeeding when mothers have suspected or proven Covid-19

https://www.cps.ca/en/documents/position/breastfeeding-when-mothers-have-suspected-or-proven-covid-19

 

World Health Organization

http://www.emro.who.int/nutrition/nutrition-infocus/breastfeeding-advice-during-covid-19-outbreak.html

 

Centre for Disease Control: Disinfecting surfaces

https://www.cdc.gov/oralhealth/infectioncontrol/faqs/cleaning-disinfecting-environmental-surfaces.html

 

University of California San Francisco: Pregnancy Coronavirus Outcomes Registry

You may self-register for this study or be referred by your physician

The purpose is to better understand how pregnant women are affected by Covid-19 including what their symptoms are, how long they last, and how COVID-19 may impact their pregnancy and/or delivery.

https://priority.ucsf.edu/

– Sheena