COVID-19 and pregnancy: Some moms self-isolate at 37 weeks

As a precaution due to COVID-19, some local pregnant women are receiving medical advice to isolate at home two weeks before a planned delivery or at 37 weeks.

At least one Spokane OB/GYN group is recommending this step to minimize risk of exposure to the novel coronavirus as expectant mothers are somewhat immunosuppressed due to their pregnancy, a Spokane physician said.

“The idea is to protect the newborn and to protect mom when she is most vulnerable when she is in the hospital and undergoing the stress of labor,” said Dr. Cate Cairney, OB/GYN with MultiCare Rockwood Clinic Women’s Center.

“We are recommending that to our pregnant moms who are near the time of delivery – so it’s close to the time when they’ll be bringing an infant home – that they isolate for the 14 days or so before.”

Generally, the precautions are in place because pregnant women are at risk for more complications from many viruses.

“That goes from your average cold that you get, and pregnant women often will get that same cold, but it lasts longer, or she has worse congestion,” Cairney said.

“So similarly, when we’re looking toward a more aggressive virus, we worry that pregnant women who are somewhat immunosuppressed because of their pregnancy will be at risk of further complication or a worse case of COVID.

“It’s notable to say we do not have any evidence that it is putting the baby at risk. We’re not seeing that the virus is causing miscarriages or birth defects or complications to the baby.”

Cairney is in a group practice that includes seven midwives and four physicians. She said they started around April to offer the stay-home advice for that third-trimester period. As only a recommendation, the group recognizes some women can’t isolate at home because of work or other reasons, and its providers continue ongoing care for them, Cairney added.

The recent spike in COVID-19 cases regionally is reinforcing that the virus is still present, “and we need to continue these same recommendations.” She said the advice is softer regarding other household members. “Each individual case is going to be different, and we recognize it isn’t always feasible to completely isolate an entire family.”

CDC information

In June, the Centers for Disease Control and Prevention issued new information from a recent report that pregnant women might be at increased risk for severe illness, due to COVID-19, such as intensive care admission and mechanical ventilation, than nonpregnant women.

The American College of Obstetricians and Gynecologists said in a statement that the overall risk for many pregnant women remains low, and there doesn’t appear to be increased risk of death.

The CDC says much remains unknown about pregnancy and the virus, so the agency is gathering more data: “CDC is collaborating with state, local and territorial health departments and external partners to better understand COVID-19 during pregnancy,” Cairney said.

Cairney also emphasized a positive, that this group of women at least regionally tends to be at relatively younger ages and in good health generally.

“I would venture to say that the majority of pregnant patients are younger and so are less at risk in that way. The complications tend to be a little bit fewer because of the age group of women and in general, a subset of women who are somewhat healthier.”

The illnesses known as Severe Acute Respiratory Syndrome and MERS had significant complications for some pregnant women, such as increased hospitalization and poor outcomes, she said.

“That has not been echoed as much with coronavirus, but it is still forefront in our minds as we’re caring for these women,” she said.

Prenatal, hospital and postnatal

In the care of pregnant women and for postpartum checkups, caregivers also are paying closer attention to the expectant mom’s stress level and explaining what the birth and a hospital stay will look like. COVID-19 testing has become standard at the hospital either when women arrive for delivery or before a scheduled admittance, Cairney said.

During prenatal visits, patients are reassured that all people entering a hospital are screened. Heightened disinfection measures remain.

“We’re also trying to spend more time in each of our prenatal appointments talking about what the hospital stay looks like, who gets tested and when, what do positive or negative tests mean while pregnant, during delivery or postpartum,” she said.

One support person can be present at every birth. She said the group’s practitioners tell patients to expect COVID-19 testing about two to three days before a planned admission or at the time the expectant mom comes in for spontaneous labor. As information evolves, health care providers try to monitor the stress of a pregnant patient, Cairney said.

“We definitely recognize that it’s stressful for pregnant women, so we’re also taking into account their psychological well-being and that of their family,” she said. … “We’re trying to check in more frequently, especially right after delivery, to ensure that moms who have delivered haven’t developed postpartum depression or anxiety.”

Low risk for newborns

“It’s very reassuring that it doesn’t seem to transmit to the baby,” she said. “In a woman who has COVID-19, we do not see the virus in the placenta. We do not see it in the amniotic fluid, and, in the vast majority of times, they haven’t seen it in the nose and mouth of a newborn.”

After birth, a risk for the infant would be from close contact and respiratory droplets if the mother is infectious, so there would be precautions.

“As soon as that kiddo comes out and starts breathing your same air, that’s where your risk comes in,” Cairney said.

If the mom has COVID-19, doctors discuss options for reducing exposure to the baby. The newborn might be isolated and cared for in a nursery by caregivers. Moms also are given the option that the infant remains in the hospital room while the mother would mostly stay physically distanced but wears a mask for feeding or nursing, Cairney said.

Possible baby boom

Spokane-area OB/GYNs saw that pregnancies noticeably increased after the region’s 2015 windstorm caused extended power outages. Cairney said there are already signs that the pandemic may have equal or greater impact on a potential baby boom.

If a recession occurs, that might slow the trend a bit, she said, but not so far.

“We definitely saw the windstorm spike and are expecting a quarantine spike,” she said. “We’re starting to see the beginnings of that. Those March conceptions are starting to come in.”