EDITORS’ NOTE: The news and advice about coronavirus is changing quickly. This story was originally reported in March and was updated on May 24.
With the coronavirus still spreading around the world and halting the regular routines of daily life as we know it, a big question that has emerged: Should women delay getting pregnant because of COVID-19?
The answer isn't a simple yes or no. Here are the factors you should consider when making this life-changing personal decision.
Pregnant women appear to be at no higher risk of contracting coronavirus, says Vanessa Poliquin, an obstetrician and reproductive diseases specialist at University of Manitoba in Winnipeg. And if they do get COVID-19, she says they have no increased likelihood of bad outcomes, such as needing to be hospitalized or ventilated, compared with their non-pregnant counterparts of the same age.
Poliquin, one of the experts working on new guidelines for dealing with COVID-19 during pregnancy for Canada’s Society of Obstetricians and Gynaecologists, adds: “Medically speaking, we have no signals that this is harmful for pregnancy.”
Although the studies on this topic are limited and small, the risk of vertical transmission from mom to a fetus appears to be very low, although it can't be ruled out. An analysis of nine infected pregnant women who delivered earlier this year, for example, didn’t detect the virus in cord blood, amniotic fluid or breast milk. That said, one case report which looked at 33 pregnant women with COVID-19 found that three of their newborn babies were infected and were symptomatic. However, it remains unclear whether the babies caught the virus in the womb or after birth.
According to the CDC, there's been no documentation of increased risk of miscarriage or fetal malformations in pregnant women who are infected with COVID-19.
There is no doubt that care for pregnant women is different in the age of coronavirus. Some in-person appointments have moved to a virtual platform. In most ultrasound departments, pregnant women are being asked to come to their appointment without a partner. Occasionally, moms are being asked to do some things at home that a doctor would normally do, such as self-administered symphysis fundal height (SFH) measurements (put simply, measuring the size of your belly). And when you deliver, you may only be allowed to have one visitor, and there may be restrictions on how long that person stays with you.
But rest assured that if you do get pregnant, obstetrical care will remain a priority, says Poliquin. “There is usually nothing about pregnancy that is elective. It remains a non-elective urgent piece of our healthcare puzzle and at most centres, there’s a lot of prioritization going on to keeping those obstetrical-care services afloat.”
If you have a low-risk pregnancy and access to a midwife, you may want to consider having a home birth to minimize any additional risks of contracting the virus. However, home births are obviously not for everyone, notes Poliquin. “It’s got to be a global assessment that’s individualized. For somebody who is a low-risk delivery who potentially has had a baby before without complications...you might do as well at home with a midwife,” she says. But there are still many situations where a hospital birth is preferable. What's more, you'll have to find out if home births are available in your area. In Nova Scotia, for example, home births were cancelled in April and the first week of May. They have now resumed.
It’s important to ask yourself how a pregnancy (or even having a newborn) would look for you right now amid the fallout of the outbreak.
Caitlin Beukema, a clinical social worker and psychotherapist in Toronto who specializes in reproductive and maternal mental health, says she’s been getting a lot of frantic questions about this decision, and in each case, women should take the time to reflect on what a pregnancy or baby would mean for their family right now and how they would fit into their world. “Everyone is facing more uncertainty and anxiety right now, and with this virus especially, we may see a rise in perinatal mood and anxiety disorders. Think about how you would manage some of those anxieties.”
Perhaps there is never a “right” time to have a baby, but Beukema says you should decide how important the timing is for you. Would you be OK with altering your ideal birth plan if you go ahead? What supports you can lean on, at least virtually, and would that be enough? Has your financial situation changed?
“With pregnancy, timing is obviously critical. If someone is in their late 30s and feeling this is their time, perhaps for them it’s worth it,” says Beukema. “If they feel confident they can socially distance and stay healthy, perhaps it’s something they want to go ahead and do.”
If you do get pregnant, Beukema suggests drawing on a list of people you can call on. One of her clinics will be offering group support programs for new moms where they can meet face-to-face with their babies online, and she expects a lot of services including lactation support have moved to virtual platforms as well.
“This is not just a medical question; we’re seeing the financial system being affected, people’s jobs being affected, and just like at any other point in time, the decision to get pregnant is a multi-factorial problem that people need to consider their individual situations. But there’s no medical reason that I can see tell women that they should avoid getting pregnant right now,” says Poliquin.
“Each woman has to look at why it’s important for her to get pregnant now," she adds. "I don’t think there’s any blanket right or wrong.”