Giving birth during the coronavirus pandemic

Pregnancy is naturally a worrying period for any woman and if it is in the time of a pandemic the stress leave is doubled.

Doctor Punam Krishan who has recently given birth provided guidance for those preparing to do the same during the pandemic, reported Al Jazeera.

Pregnancy brings with it many anxieties, especially for first-time mothers. This is something I regularly see in my practice as a family physician, she said.

Even when everything is going to plan, expectant mothers tend to hold their breath until their babies are safe and well in their arms. However, for women who are navigating their pregnancies during this global pandemic, this stress and worry have been heightened to unfathomable levels.

Covid-19 is a new virus and one we still know very little about. There is no identified cure on the horizon which is very unnerving for all.

The evidence so far, limited to a small number of cases, seems to suggest that pregnant women are not at a higher risk of developing complications from coronavirus compared with their non-pregnant counterparts, which is reassuring. However, we do not yet know what long-term impact, if any, coronavirus could have on their babies, if they catch the virus during pregnancy.

It was previously thought that vertical transmission - the virus being passed from an infected mother to her unborn or new-born baby - of coronavirus was not a risk.

However, according to the latest guidelines from the Royal College of Obstetrics and Gynaecology (RCOG) in the UK, there is a "probable risk" that a baby can contract the virus from the mother if she is Covid-positive.

This is based on two UK cases where both babies were confirmed positive for coronavirus after birth. But this is too small a sample, and we need more data.

Another factor contributing to the anxiety of pregnant women right now is the constantly evolving set of guidelines and rules about how much risk they are facing, their birthing rights and options, or safety at work. 

Following lockdown, many pregnant women will be feeling conflicted about going out, particularly to their place of work.

The RCOG recommends that women who are at less than 28-weeks gestation, with no underlying health problems, should practise social distancing but can continue to work in public-facing roles, provided the necessary precautions are taken, including using personal protective equipment (PPE).

As we know, there is a mass shortage of PPE in the UK and many other countries, so many women, including me, have ended up working during our pregnancies without adequate protection.

The advice for those over 28-weeks gestation is to stay at home and practise social distancing where possible. This comes with its own challenges, particularly if your employer is less than understanding, and therefore places yet another stress and cause to worry on women at an already vulnerable time in their life.

To add to the mix of it all, restrictions on birth partners are being introduced in many places. In the UK, birth partners are only allowed to accompany the mother during the birth itself. They are not allowed to attend any other appointments during the antenatal and postnatal periods.

If the partner is in a high-risk category or indeed has symptoms of Covid-19, then they are not permitted to attend the birth either, for obvious reasons. Women are being encouraged to have a back-up choice for birth partner just in case.

As someone who has just been through all this, I know how upsetting this will be for many women. It is, of course, necessary as we all want to minimise risk to ourselves as well as to the healthcare professionals who are looking after us, but that does not make it any easier.

Having to do much of the journey alone - not by choice but out of necessity - is challenging and can be traumatic: not least when it comes to deciding where and how you wish to give birth.

As demands on healthcare staff increase, birthing options are being reviewed as well.

The priority right now for maternity services anywhere is to deliver babies in the safest and most efficient way possible.

With the rising rates of transmission, healthcare staff generally are required to help out wherever the need is highest.

As a result, birthing options may be limited and those hoping for home births may have to go to hospital instead. Each case will be reviewed independently, but the key is to keep the channel of communication open with the antenatal healthcare team.

Some women may feel that birthing at home is safer, but doing so carries risks, too, and may not be a safe option if a midwife cannot get there, for example.

The hospital, therefore, is still likely to be the best and safest option as that is where medical teams can monitor and facilitate as satisfying a birth experience as possible for all mothers.

Understandably, many women will struggle to come to terms with the options being restricted, but safe delivery is the priority. 

I certainly felt all of this panic in the run-up to giving birth. However, what it all boiled down to in the end, for me, was that I wanted to get in and out of hospital as quickly as possible with my baby in my arms, safe and well, Dr Punam said.

While I was alone for much of my birth, the amazing NHS staff made up for it all. The entire team that took care of me, from the midwives, the anaesthetist and the obstetrician, to the healthcare assistants and porters, never let me feel that I was alone. Instead, they were calm, joyous and supportive and delivered my baby safely, making me forget that there was anything else going on in the world.

As I sat afterwards in my room, alone with my baby, I felt peaceful and safe. Coronavirus was out there in the world, but in my room, there was no threat of it entering thanks to everyone's excellent adherence to the rules.

Dr Punam Krishan is a general practitioner doctor and honorary senior clinical lecturer at the University of Glasgow.