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COVID-19: Information for Providers

In these unprecedented times, many of our patients / clients are turning to us with questions about COVID-19 and how it affects their pregnancy and their family.

 

So far, it appears that pregnant women have a similar risk for contracting COVID-19, and of developing severe illness, as the general population.  However, since pregnancy has been associated with more severe illness with similar viruses (e.g. SARS, MERS) and influenza in the past, pregnant women are still considered to be at potentially higher risk from COVID-19.  Infected women may have a higher risk for adverse pregnancy outcomes, including preterm birth.  So far, the virus has not been found in amniotic fluid or breastmilk.  Although most babies of COVID-19 positive women studied so far have not been infected, there are a few reports of COVID-19 infection in newborns, so vertical transmission (transmission from the mother to the baby in utero or during labor and delivery) cannot be ruled out.  Although there have been recommendations to separate newborns from COVID-19 positive mothers at birth, there are also guidelines for how to feed the infant breastmilk, breastfeed, and/or have the mother room together with the baby.  Practice advisories and FAQs from ACOG, AAP, and the CDC are updated frequently.

 

Many of us are getting creative about the ways in which we deliver care and are using telephone and videoconferencing to reach our patients. Here are a few additional tips on how we can help our patients/clients to deal with concerns, anxiety, uncertainty, and feelings of grief related to COVID-19:

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  • Elicit your patients' feelings and acknowledge that they are normal.

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  • Encourage patients to focus on things they can control and do something about.

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  • Keep track of preexisting mental health conditions. People with depression and anxiety are likely to experience a worsening of their symptoms: help them reactivate their support network or connect to their mental health supports including their counselors, therapists or psychiatrists.

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  • Even people without diagnosed mental health problems experience pregnancy-specific anxiety with worries such as: “Will my baby be healthy?” and “I am worried about giving birth.” These may worsen in the current situation. Encourage your patients to discuss this with you. When anxiety levels are persistently high and they cause significant distress and interfere with functioning, a clinical disorder may be present.

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  • Identify risk factors for pregnancy related anxiety including low income, age (teenage pregnancies and older women) and those with low social support. Be aware that some communities may experience stigma related to COVID-19 in addition to the risk factors listed above.

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  • Risk factors for negative psychological outcomes following quarantine or self-isolation include duration of quarantine, fear of infection, frustration and boredom, inadequate supplies, and inadequate information. While there is little we can do about the duration of social distancing, we can address the other risk factors. We can educate our patients about how the virus is transmitted and how they can help reduce the spread. Repeated, brief, education works best. Direct patients to reliable sources of information such as the CDC. We can ensure that they have information to connect them to food and medication as needed and encourage them to maintain social connectedness through phone or video calls.

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  • Encourage your patients to use coping strategies that have worked in the past. These include exercise, (virtual) contact with supportive people, taking a bath or shower, using breathing and meditation apps like Headspace (Android, Apple), activities such as gardening/reading/crafts, preparing for the baby, etc. For more, check out our brief patient handout here.

 

Many of the above strategies, including acknowledging feelings of anxiety and grief, seeking virtual social support, and taking time to practice coping strategies 

 

References:

ACOG Practice Advisory (updated 4/21/20)

https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/03/novel-coronavirus-2019

 

AAP COVID-19 Clinical Guidance (4/2/20)

https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/

 

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet.

https://www.sciencedirect.com/science/article/pii/S0140673620304608?via%3Dihub#bib11

 

CDC FAQs about Pregnancy and Breastfeeding (last reviewed 4/15/20)

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fpregnancy-breastfeeding.html

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