Pregnancy and birth in times of Corona

As of May 6, 2020

The novel coronavirus has spread rapidly around the world, suddenly transforming our daily lives through social distancing measures, school closures, working from home, homeschooling, event cancellations, restrictions on social contact, and much more. Expectant mothers are now particularly prone to feeling worried and uncertain. How can I prepare for childbirth during the coronavirus pandemic? Will I be able to give birth normally? Will my partner be allowed to be present at the birth? We’ve compiled the latest information for you on Pregnancy and childbirth during the COVID-19 pandemic.

Am I at particular risk as a pregnant woman?

Based on current knowledge, pregnant women and newborns are not considered high-risk groups. If they do become infected, they usually experience only very mild symptoms.

Is there a risk that I might infect my unborn child?

At this time, there is no evidence that the virus is transmitted to your baby during pregnancy. An observational study from China suggests that the fetus is not infected, as the research team reports in the journal *The Lancet* (Chen 2020). The researchers concluded that SARS-CoV-2 is not present in amniotic fluid, umbilical cord blood, or breast milk, nor can it be transmitted through these routes. Other studies also support these findings (see Zhang 2020; Schwartz 2020; Rasmussen 2020).

In mid-March, it was reported that a newborn in London tested positive for the coronavirus just minutes after being born to a mother who was also infected with the virus. The mother gave birth to the baby vaginally. In this case, however, there is no evidence that transmission actually occurred in utero. The baby could also have been infected with the virus from the mother during or immediately after birth, according to Dr. Schaffner, professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine (Bryner 2020). This is currently an isolated case.

Concerns about infection in the hospital are unfounded

The longer the coronavirus pandemic lasts, the more concerned expectant parents are about the risk of infection during and after childbirth in a hospital. In a press release issued by the Professional Association of Gynecologists (BVF) and the German Society for Gynecology and Obstetrics (DGGG) on March 22, 2020, it was stated that concerns about an increased risk of infection in the hospital are unfounded, regardless of whether patients with COVID-19 are being treated there or not. Even during the coronavirus pandemic, pregnant women should seek care related to their delivery at a hospital. This is emphasized by the German Society for Gynecology and Obstetrics and the Professional Association of Gynecologists.

Home births as an alternative?

The topic of “home births” also seems to be gaining momentum in the wake of the coronavirus pandemic. As early as mid-March, midwives in Thuringia noticed a growing interest in home births among pregnant women. Out of fear of contracting the coronavirus in a hospital, more and more pregnant women are now considering avoiding a hospital stay altogether and giving birth at home (alone) despite symptoms or illness, against the advice of their obstetrician, even though the applicable risk criteria are not met or a midwife may not even be available for a home birth. This often reflects two distinct needs. On the one hand, pregnant women want to avoid the risk of infection from others. On the other hand, in the era of COVID-19, they fear a less satisfying birth experience that is compromised by protective and hygiene measures (Ärzteblatt.de, April 8, 2020).

Risks and Complications

However, refusing necessary hospital care carries a significant risk that delayed treatment could result in serious harm to the health of both mother and child. In cases where prenatal diagnosis indicates that a home birth is not appropriate or would have to take place without midwifery care, completely unnecessary birth risks come into play—regardless of COVID-19—that no mother would wish for her child or herself. These include, for example, unforeseeable complications such as arrest of labor, bleeding, or risk to the child due to oxygen deprivation, which in turn can result in serious health complications for the newborn, such as brain damage, arm paralysis, lung problems, or bone fractures (press release from the DGGG and BVF dated March 22, 2020). However, in the case of a healthy child following an uneventful birth and a healthy mother, there is no objection to an outpatient birth provided that postnatal care at home is ensured by a midwife.

Childbirth Preparation During the COVID-19 Pandemic

Currently, prenatal classes cannot be held in groups as usual because general social distancing restrictions are still in place. Many midwives are therefore now offering online courses to ensure that pregnant women still receive the care they need. If the courses meet certain criteria, your health insurance will cover the costs. If you have already booked a course, it’s best to inquire about a digital alternative. Postnatal exercise classes will also be offered digitally on a temporary basis until June 2020. If you’re looking for a midwife, the Find a Midwife of the German Midwives Association or the List of Midwives This is helpful for those with public health insurance. After the birth, your midwife is allowed to visit you at home for postnatal care. However, social distancing guidelines should be followed and/or face masks worn during the visit. Whether your midwife is still making home visits in general is up to her to decide. Therefore, please check with her in advance. Due to the difficult situation, many maternity hospitals are also offering virtual tours with live chats through the delivery rooms, so you can get a sense of the facilities and ask your questions at the same time.

Giving Birth During the Coronavirus Pandemic

Please check with the hospital where you plan to give birth in advance to find out about their specific guidelines and safety measures. Even if the expectant mother is infected, she will be cared for by medical staff and can give birth at the hospital as usual, provided she follows hygiene protocols and wears a face mask.

In many cases, expectant fathers are no longer excluded from the delivery room. The German Society for Gynecology and Obstetrics (DGGG) stated in its press release dated March 26, 2020: “Partners in the delivery room fulfill important roles during childbirth.” The DGGG thus recognizes the incredibly important role of the partner during childbirth. Ultimately, the decision on whether partners can be present during childbirth rests with the hospitals themselves, so it is important to inquire about this in advance. Visitors are not currently permitted in the maternity ward. Most hospitals currently have a general ban on visitors.

Should I have a C-section instead?

Many pregnant women wonder whether a C-section would be better for the baby right now to avoid potential infection. However, from a medical standpoint, there is currently no reason to do so. C-sections should still only be performed in medically justified cases. The coronavirus does not qualify as such a case.

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References

Ärzteblatt.de. April 8, 2020. COVID-19: Veto on home births. https://www.aerzteblatt.de/nachrichten/111827/COVID-19-Veto-zur-Hausgeburt

Bryner J. 2020. Newborn tests positive for COVID-19 in London. Live Science. https://www.livescience.com/newborn-has-coronavirus-london.html

Chen H. et al. 2020. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. DOI:https://doi.org/10.1016/S0140-6736(20)30360-3

German Society for Gynecology and Obstetrics (DGGG) and Professional Association of Gynecologists (BVF). No need to fear hospital treatment or giving birth in a hospital during the COVID-19 pandemic. Press release dated March 22, 2020. https://www.dggg.de/presse/pressemitteilungen-und-nachrichten/covid-19-keine-angst-vor-krankenhausbehandlungen-oder-klinikgeburten

German Society for Gynecology and Obstetrics (DGGG). DGGG recommends: Allow fathers to be present at the birth—even during the COVID-19 pandemic. Press release dated March 26, 2020. https://www.dggg.de/presse/pressemitteilungen-und-nachrichten/dggg-empfiehlt-vaeter-bei-der-geburt-zulassen-auch-in-zeiten-der-corona-pandemie

Rasmussen SA et al. 2020. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2020.02.017

Schwartz DA. 2020. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Archives of Pathology & Laboratory Medicine In-Press. https://doi.org/10.5858/arpa.2020-0901-SA

Zhang L et al. 2020. Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province. Europe PMC. DOI:10.3760/cma.j.cn112141-20200218-00111