Pregnancy and Covid-19

to the mix, and those questions multiply fast. Pregnancy during the time of COVID comes with a whole new set of questions and concerns, a whole new set of challenges, even a reimagined model of care, and a very different experience. From changes in standard prenatal visits to changes in your guest less in the birthing room, from attending your childbirth classes via zoom to getting your due support on FaceTime. It's a whole new normal for pregnant moms and their partners.

Not to mention the grandparents waiting not so patiently in the quarantine wings for their first snuggles with baby. Is that new normal here to stay? Is it likely to change over the months to come well, pregnancy and childbirth and for that matter, parenting ever, go back to well normal. Today we're going to find out what you can expect when you're expecting during a pandemic. I am here with my good friend and go to Obie. That is, I definitely go to her if I ever needed an Obie again.

Maternal fetal medicine specialist Dr Sarah Baton, who is a medical director of Mother to Baby Florida and Assistant professor at the University of South Florida. Hey, Sarah, are you doing Hi? Thank you for having me. Oh, I'm so happy you're here because we need you now more than ever. How are you? How are you doing? Like? How is life practicing during a pandemic? Well, it's hard. It's busy. We are busier than we ever worth. Life is harder

and more challenging, um at times more interesting. Right, Juggling family life and medical life work is tough, but we're doing it with some great colleagues here. So what are the biggest concerns that you're hearing from your patients since the pandemic started. Well, it's hard for everybody, our patients included. Being pregnant is hard. There's so many challenges to overcome, so many differences in our bodies and and things to worry about. The worrying about the pandemic is just so

much at its stress. The stress level has certainly gone up in our patients. Now. We've been talking to what to expect moms about how COVID nineteen is an impacting their pregnancy since the pandemic started. It and some things have changed, some things have stayed the same, and lots

and lots of things are still unknown. And what I love about your advice, besides the fact that it's reassuring and reasoned, which is my favorite kind of advice, is that you're always first to say that we don't know what we don't know, and at this point in the

pandemic that is still a lot. So the pregnant immune system is slightly compromise, and that's normal, but a lot of moms are wondering if that puts them at greater risk for contracting COVID nineteen, And if it puts them at greater risk if they do contract it, are they more likely to be hospitalized as they are with seasonal flu? Yeah,

great question. So that has changed a little bit through the pandemic time and the CDC had come out with some different burbage on that, meaning that initially we didn't think it was as tough for our patients, but we didn't know as much. Now, knowing from the history from stars and prior mers, we knew that this would be a higher risk, but we didn't have the evidence for that, And it turns out that it is more risky for patients who are pregnant again, possibly because of the immune

system changes. Um the question that becomes, well, how risky and how much does that impact the pregnancy, and that is still where the data is being hashed out through time. Also, the effects in the first trimester versus second and third trimester are changing, But overall we are telling our patients that they absolutely have to take care of themselves and their families that will then in turn and take care

of them while they are pregnant. Other ways that a mom can boost her immune systems so that she's less likely to get sick and have a more severe case.

This is at times where the simple things matter most, right, So getting a decent amount of sleep that is always important, that is good for so many functions of our body and immunity as well taking care of yourself wearing a mask and being socially distanced, making sure that your family is socially distanced, making sure that you eat a healthy diet, take your nutrients through your food and your prenatal vitamin. Other than those things, that really isn't a magic bullet.

I mean the classic things of hand washing and masking is the best thing that you can do for yourself. And we should still stay away from supplements that have not been recommended by Europe or midwife. Yeah, that's the thing is that the supplements. We are a society that would love to just have a pill that's going to take care of so many things, right, but it's it's not like that. I mean, a healthy lifestyle and healthy diet and getting enough rest is where we're at right now.

We don't have enough data on supplements there. So there are some pre existing conditions and complications of pregnancy that put moms at a generally greater risk. And what would those include? Things like obesity, high blood pressure, diabetes, comorbid conditions that make pregnancy any way more high risk, will

make us more high risk during a pandemic. Uh, those are the things that I come off right at that maybe some other immuno logic disorders for a pregnant mom, which in those patients it's even more important how they take care of themselves. And when you say obesity, do you mean coming into pregnancy obese, not as much gaining a lot of weight during pregnancy. Yes, well, both are

really important for a good pregnancy outcome. We know that significant weighty during pregnancy has higher rates of c sections, higher risk of gestational diabetes which may increase those risks, and pandemic as well. But certainly pre gestational weight is very important here as well. So you should be also getting your exercise as you can and as recommended. Absolutely, we do think movement is very good in pregnancy in general.

We are not saying to go on the weight lush or any during your pregnancy, but actually some movements, some very small weights, if you have that discussion with your healthcare provider. I think it is very good for the good pregnancy outcomes. Yeah, and it's great for your immune system and gives you those endorphins, those happy hormones that make you feel better overall. So brown and black moms seemed to be facing a higher rate of infection and

a higher rate of severe illness. Some of that due to higher rates of those comorbidities that you were talking about, like hypertension, gestational diabetes, but also due to racial disparities in care, something that we haven't talked enough about but really really need to. So should moms of color be more alert to symptoms of COVID and what can we

do to reduce those disparities? Yes, I love the nationally we are doing a little bit of a better job of talking about this, and we should push this and push this to the forefront because we do know our moms of color are suffering more and that should not be the case. There has been too long of a discussion to minimize that or to say it's because of something else genetics. It's ridiculous. We really need to take

care of all of our moms. Now, you're right, I mean one of the things that this is not a one There's not a magic wood that's going to fix all of this, right, This comes from multifaceted problem and therefore multifaceted solution. I think. So, I think moms need to be their own strong advocate to know what they believe and if they have symptoms to always feel to need to speak up and people are not listening to you, go somewhere else. I think us as physicians we have

to be better about really listening to our patients. There are so much data on just women being different than men. Are symptoms. For example, for our heart attack are different than men. We need to pay attention to that, right. Our pregnant patients are different, are different, moms are different.

So not listening to concerns is a big one. But this is again a multi past of problem that needs institution wide changes and protocols that are put into place, which are now being done across the US, and hopefully we can push more through our big institutions and also through our big bodies where like a COG and SMFM

that are putting things on the forefront there. So personally, what women should do is really fight for what they have in terms of their symptoms and make sure that they're being heard, because a mom knows her body better than anyone else. Yes, it's a great Many of the symptoms of COVID nineteen seem to be at least somewhat similar to those of normal pregnancy symptoms, so lots of moms get a cough when they're pregnant, especially at night, or feel shortness of breaths, or have stuffy noses. So

how do you tell the difference? Is the line blurred? Lines are definitely blurred because those symptoms, if you've think about it, are hard to tease out of their pregnancy or they're just a common cold or their allergies or asthma or COVID. So it makes things very challenging, especially in lieu of that. Some patients have no symptoms. Some patients have very varied types of symptoms, so it is it's hard, and so if we have any kind of inkling, any one of those things come up, we have those

patients tested. And you'll find more and more that a lot of labor and delivery units are testing all patients who are coming into labor and delivery, and that's for a different reason. It's not only protect you as the patient, but also the healthcare providers and making sure that you are COVID negative and give you the appropriate treatment. So

what do we know about the risk to babies. We don't know as much as we'd like to at this point about the risk of a mom having contracted COVID during her pregnancy, whether it's early or later on exactly. We still don't have all the information we would like for sure, and we're hoping for more even by this time. But there is a potential that there is some transfer of the virus. The question is, let's say the viral

particles are there. The question then becomes what effect could that have on the fetus and then babies later on. That's the stuff that we don't really understand quite well. So even if it does pass, if that's a possibility, what will be effect eventually be Could it possibly be that they have antibodies of some kind. It's possible it might be in the sense that I may try to be helpful, But of course we're always worried about the

negative equit its final growth restriction, anything like this. You know, we were so worried about ZEKA and first trimester effects of general nonalies all that we don't see that at this time. Those are all the things that we're watching out for in the months to come. When we come back, we're telling you what to expect when it comes suprenatal care during the pandemic. I'm back with Maternal fetal medicine specialist Dr Sarah Obaton talking about pregnancy and COVID nineteen.

Let's talk about what pregnant women should expect when it comes to their care. Clearly there have been more virutual visits. How has prenatal care and screening changed? And do you think there are benefits of telemedicine when it comes to prenatal care or more risks or a little bit of both. I think if it's done well, telemedicine it could be an incredible asset to maternal care. The question is how

it's being done. Every office is different, every part of the country is different, depending on what are the numbers in the community. But I think tell medicine can be helpful if it's done correctly, meaning you're able to see your patients maybe sooner than you could otherwise. It helps patients do not have to drive in, they don't have to get a ride, they don't have to struggle through the traffic. You know, if they're even at work but they can't leave work, they can go always somewhere for

fifteen minutes and talk to the doctor. There's so many things that are helpful. I think in that scenario, the worries sometimes becomes us are we going to miss something? Right? I can't do a physical exam for a patient, even though I see them and I can assess a little bit of how they're doing, I may not have some of those clinical parameters like how is the blood pressure, how is the patient swelling? You know, those kind of things.

If we are able to provide models with a blood pressure cuff, for example, or a way for them to let's say, dip their urine for proteins, some of those things, those may be really helpful in taking care of even some of our hard risk patients. I think you've done well in the combined model. It works exceptionally well. So is that something you're doing. Are you providing the dipsticks

and blood pressure cuff? Yes, when feasible for patients, we do give blood pressure cuffs for that evaluation at home, but you you've done that previously too, for higher risk patients. For our lowrist patients we still don't have that. We still have them come in maybe every second or third visit. But for our higher risk patients, I think that's very helpful. How can we keep dads more involved in the process, even though they're often being left out of screenings or appointments.

That's hard, right, It's hard to get um a family member with you to some of those appointments, and that's done in order to protect the rest of our patients and the healthcare providers are snographers who are taking care of all these patients every day. It's tough. Sometimes We allow our patients to well in our unit. We allow our patients to FaceTime, the dads to be able to see the baby, to be present for some of those

really crucial conversations with our patients. We obviously allow them in the hospital for timing of delivery and other surgeries that are needed, but it is significantly less. They are a little bit more marginalized than we would like because we like the dads to be involved if they can. It is a strong but we are looking at all these different I T modalities that we can get patients more involved, but it is definitely hard for the months. I guess when they're having their virtual visit at home,

then he can be there, so that's a plus. Potentially it is a plus. And I do have a lot of dad's join in now for those virtual visits, which is really nice. Even if we're when we're not doing ultrason. We're doing this online. It's fantastic to see them actually present with their wife, and then they're able to ask questions, which inevitably I find ads asked as many questions as moms do. Sometimes they're more scared than the months. Yes, that's true. Well it's not happening in their bodies, so

they worry more about not having control. What about routine vaccines? This is vaccination awareness months too, so super important time to be talking about it. The te tap and the flu vaccine are super important during any pregnancy. You know, if you're going to be pregnant during flu season, why should get them? And when should you get them? So

so so important. I think just because we are in a pandemic doesn't mean that you lose sight of the important screening, or that we lose sight of the important vaccinations TEA DAP and the flu vaccine. I should every patient should get TEE tap and the third timester That is important. It gives baby a little bit of immunity. You don't really want your baby to have protests. This wouldn't be ideal at all. You don't want to get the flu and pregnancy. Women with the flu don't do

as well. I've often have patients in the ICU with the flu, and you don't want to have the ability to get both. You can get flu and COVID. That is not a good combination. So absolutely protect yourself as much as you can. Make sure that your family members are protected. So this way they protect you more and they also protect that baby that is coming into this your bubble, your family. So it's all about cocooning. Yes, they are cocooning you, and everybody is concooning the baby.

That's right. When is the flu shop recommended? What month is flu season officially beginning, so early September we usually get the vaccines, but it just depends on when the vaccine is sent to your community. And honestly, as soon as the vaccine is sent to the community, I go and get it. My husband gets and my kids get it. So that I protect obviously my patients, but then also I recommend that for the patients as well, so everyone

over the age of six months. Yes, what if I do have for pregnant frontline healthcare workers and other essential workers like teachers and women who work in restaurants and grocery stores, or moms whose partners are frontline workers. Yes, yes, this is a discussion. I think that's been happening in a lot of offices across the country. I have asked some of my colleagues and anticipation to this question, what are we doing across the nation? And there's different answers

to this question. Some some physicians are getting letters and most of them are not getting letters to be awful work, but they are recommending that moms do communicate their pregnancy to their workplace so that there there's an availability to either work online or to not be as exposed. But that might be an option for them. Unfortunately, this is one of those times where being really forthcoming in explaining to your workplace that this is happening in your life

is important. But it is different and different parts of the country and I find in different offices are doing different things. Yeah, and all of that protective equipment is definitely a heavy load for pregnant woman to carry it eating. Yeah, for sure, we are. We actually looked at some of this data wearing an M ninety five mask here at USF for pregnant healthcare workers and surprisingly they did actually

very well. There wasn't a lot of changes physiologically for women wearing AN ninety five masks who were pregnant, and they tolerated it rather well. It's one of those things that once you were a little bit more, you end up tolerating more. But we are are looking further into that question. Um as we speak, we're trying to get this approve of the i RB UM. I think it

is an important question to talk about. But absolutely there's no way that you should not be protected or really where the full gear if you do have to be in the hospital and be exposed. So let's take a quick break and when we come back, Dr Oberton and I are answering your biggest questions about pregnancy in the time of COVID nineteen. I'm back with my friend, maternal

fetal medicine specialist Dr Sarah Oton. Now Sarah I asked moms on social media for their biggest questions and concerns about being pregnant during the pandemic, and I'm sure you've heard a lot of these before. One of the questions they had is it important to take childbirth education and breastfeeding classes as well as something I always post the baby CPR classes our hospitals offering them on zoo. Oh sure, sure, hospitals are being really innovative with the type of classes

we're doing. I mean, this has really been the I T era. I guess when it comes to all these classes, it is possible we are offering them, certainly. I bet you a lot of hospitals around the country are offering just make sure you ask about it. I think all of those classes are really important. I agree with you on the CPR one as well, and I think so much focus on the pandemic, you've got to also prepare for child birth. I think that helps a lot, oh

for sure. And this is actually one of those situations where your partner can be there with you, your mom can be with you, right, I mean, it's really nice kind of opportunity to get a lot of people in the room to take that class with you. So is it safe to deliver at a hospital? Now? Lots of moms are wondering whether they should consider a home birth instead. What are your thoughts. I would not consider a home were instead of going to the hospital because of the pandemic.

I mean, when it comes to childbirth, there are so many things that can go wrong during the time of labor and delivery for moms and for baby. You really want to be in the best place that's going to help you and your future baby, right, this is so so important, And while the pandemic has made things harder, undoubtedly surely we are doing honestly everything we can to keep you and your your little family United State as possible.

But you have the availability for blood products if you need it for surgery, if you need it for any kind of care that you may otherwise not be able to do. And if something comes up during a home birth and you have to be rushed to the hospital and securing the emergency transportation that you might need might be more challenging during a pandemic, for sure, a lot more challenging. One more mask. I'm so overheated all the time, and wearing a mask makes me feel like I can't

catch my breath. Does that mean I'm not getting enough oxygen for the baby. That's a common question. But wearing a mask actually is not detrimental to you. We've looked at this data even for an N ninety five masks, and most of our patients are not wearing N ninety five masks. If you can imagine with an N ninety five or the equivalent. It's much harder to breathe than because it's so dense. It is really keeping out really

small particles. With a cloth mask or with any kind of other surgical grain masks that it's a little bit lower than and I find that will still give you some protection, but it should not give you so much shortence of breath. That being said, for sure, pregnancy is tough, right, It's harder to breathe. There's so much more volume of fluid in your body. It's harder to catch your breath. That is normal, but you are getting enough oxygen as long as you are doing that for a limited periods

of time that you feel okay. It's hard to exercise with the mask, but certainly if you're in public places, you should be wearing it. And the worst thing that's going to happen is that you're going to feel overheated. Right, Yeah, you're not gonna feel great. Sure mom wants to have a duela, but she's afraid that you won't be able

to have one if her partner is with her. I know in New Jersey they've issued an executive directive that mandates duelas as essential birth support, which I think is awesome, but in many cases moms aren't allowed to have them.

So are they able to use FaceTime to be with their duelas that's true in different parts of the country, there are different rules, and yes, if you are not able to bring two people with you, and you choose to bring your partner, then you can have a duela with you on some sort of I T device, computer, or phone, and we encourage that. I think that is

completely reasonable. Uh, we just have to kind of follow within the rules depending on where you are how many people you can have with you, or potentially you could have your mom on FaceTime or your mother in law and they won't have to fight about who's actually in the room with you. That's true, Claus. One of the benefits is it safe to breastfeed if you test positive for COVID? Great questions. So we understand breastfeeding is very important and we encourage that for all our moms. Having

that discussion with your healthcare providers really important. But breastfeeding is reasonable. We always talk to moms about making sure that they're protected with the mask, making sure that they're constantly washing their hands, washing their breasts. If they're pumping. To always wash their parts. We should be done anyway, but certainly wash their parts in between each of those pumps, just to minimize some of those risks. And then when

your babies around you get there, there's some distance. How hard is that? It's hard, but just to have the baby a little bit separated so it has a lower chance of attracting the virus. I guess the same challenges would apply if you were bottle feeding your baby. You'd still have to maintain some kind of protective measures. Yes, absolutely, and those things don't have to last forever. They're now in your guidelines. This sometimes these times are like shorter

and shorter as we understand more and more about this virus. Right, but looking at those guidelines and just checking that often to make sure that you're doing the right thing and while you're early in those early positive days, that you really protect yourself and your baby. Some doctors seem to be recommending some form of quarantine or you know, stay at home in the last few weeks before your due date. What do you think about that? I think that sounds reasonable.

So things done just to minimize all of your risks. I say that to every single pregnantation, no matter what, just part of gestation they're in, right, just minimize the risk of getting this. You don't want to be exposed to this if you don't have to. It's certainly in the last two three weeks. It will negate all those questions that we're answering right now. Can you recipee while you have COVID? You know who's going to be around you. I mean, how do you take care of yourself if

you have COVID. If you are securing yourself and you are minimizing your risk, then the chances to be contracting it are low, and therefore you're going to have less of these questions to deal with and you had your baby. Yeah, if only we could all have family leave starting before the baby is born and then continuing after and make it a lot easier. That is a completely different podcast. That is we need to be fighting. Yes we do, Yes, we do now, cord blood banking and collection is everything.

Business is usual when it comes to that during COVID, and most of my colleagues around the country say yes, I have not heard differently. Um, there might be some difficulties with maybe some private or public eye. I'm not I'm sin sure, but we're here for us, we would still collect it and for a lot of our at least the contacts of different parts of the country, they are still as business as usual in terms of collecting the cord blood. Okay, good to know. What do you

think about family visits when the new baby arrives. Yes, so, I think every time we have a baby, our job is to for checked that baby and pro checked our little family unit. I think you should be really tough on deciding who gets to visit your baby, and you should have the same expectations of them as you had of yourself and your partner in terms of really making sure that you're socially distance, that you're amasking that you had your tetap and your flu vaccine, even pre COVID.

When I had my second child and I asked my mom to get her tetap and her flu vaccine. It's one of those things where again we're trying to cocoon this family as best we can. So what's the bottom line on whether expecting moms should be around their families, assuming they like their families, excuse not to be around your family? If you're not so much you're on the fence. No. I always talked to my patients about really you know

listening to that. I mean obviously your partner, your kids, maybe your mom, dad, somebody that you're a close knit unit. But this is probably not the time to visit some

distant cousin sur aunts. It's not the time to meet forty or fifty people at a family wedding, because even though you are taking care of yourself and your you know, intimate family members are taking care of themselves, perhaps you don't know what the rest of the forty or fifty people are doing and how they are socially distancing, etcetera. So it's really important to really be very um, pretty picky about who you let into your good right. I

think that's good advice under any circumstances. But that's just me and my family. I've been hearing a lot of moms who seemed to be more anxious and stressed, understandably, so during the pandemic, are you seeing more patients who are presenting with clinically diagnosable mood disorders during pregnancy and postpartum with anxiety disorder depression that is related to be feelings so isolated and maybe even being robbed of the

kind of magical experience of pregnancy. In some respects. You don't have your baby shower, at least not in person. You can do it virtually, but you don't get to show off your bomp and and celebrate openly as you otherwise would. Yes, it's really hard for our pregnant moms. We certainly have heard a lot more discussion of you know when when women come in them or chearful. Uh, they're just more challenge at home. It's harder with the

kids at home. It's it's harder with relationships at home and not being able to work, I mean being worried. This is this is pervasive for sure, and the data on this is going to come out and I think I think it's going to be a staggering It is is so tough and right now that social support is lacking.

Right I always talk to my mom's and and when I see them, just to provide some of that physical comfort of being close to them and even though we're masked, you know, to actually be physically present, but for them to seek out their friends online, to seek out their families, to cocoon their families and really be a tight you know, unit. This is the time where we're supposed to be the strongest, and it's quite the challenge for our friend. So you're

dealing with a pregnant pod. Yeah, it's a good Yeah. I think we need a silver lining. We all desperately need a silver lining to this pandemic. For me, it's that parents have more of an opportunity to hunker down with each other, um as a couple, and and with any other children, and also with their new babies, and to spend more time as that little pod instead of inviting a whole lot of other people in to their homes that you know are fun to see the baby.

It's all very exciting, but also it's a lot of work, and it's a lot of stress, and you've got a lot of people telling you what to do. And this gives you an opportunity to do it just as a little family unit, which I think is nice. What's your

silver lining? I do think life is simpler. You were just running around us and they're now there's just a higher I guess there's higher thought given to really the things that are important, so family and your kids and just yourself and taking care of yourself, and those things are really more important than anything else, and that has been deposited now. I do worry about my women who may be experiencing domestic violence and not being able to

have an outlet and things like this. And if I can tell any moms who are struggling with this to please reach out to anybody that can help you or your doctor. I mean, we are We're here for that. And I do worry about those who may be experiencing more intimate partner violence. And now that we're through going through a pandemic, yeah, sometimes sheltering at home is not the safest option for some moms. Yes, Unfortunately that's a reality, and we all need to be there for each other

and support each other through this. It's said too often, but it's also true. We are all in this together. Yes, thank you so much, Sarah. I'm interviewing Dr Obaton regularly for what to expect I g t V, so please make sure to check in regularly for the most up to date recommendations on pregnancy and COVID nineteen. Thank you who babylove my baby belove. I need you, Oh how I need you. Thanks for listening. Remember I'm always here for you. What to Expect is always here for you.

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