Managing Pregnancy during the COVID-19 Pandemic

Living in the time of COVID-19 pandemic is stressful for all of us, but pregnant women and mothers of small babies are especially worried and anxious, Below are answers to some of the most common questions concerning pregnant women and mothers of small babies.

  • 1. ABOUT
  • WHAT’S DIFFERENT FOR PREGNANT AND POSTNATAL WOMEN IN THE TIME OF COVID_19?

The symptoms and signs of COVID-19 are the same in pregnant women as the general public. Everyone should take care to avoid infection or infecting others. You can help protect yourself by:

  • Wear a cloth mask in public.
  • Wash hands as often as possible with soap for 20 seconds (or use alcohol sanitiser)
  • Try to stay more than 2 meters away from others, if you can and avoid crowded spaces.
  • Avoid touching your face.
  • Practice respiratory hygiene: cough or sneeze into your bent elbow covering your mouth and nose, or into a tissue which you must then throw straight away into a closed container and wash hands with soap for 20 seconds).
  • Open windows when possible and keep household surfaces clean with 4 teaspoons bleach in 1 litre water. Keep bleach out of reach of children.
  • EFFECTCAN THE COVID-19 VIRUS AFFECT MY PREGNANCY?

Pregnant women are often worried about how a virus affects their health and that of their unborn baby. There is no proof at the moment that the virus causing COVID-19 can go via the womb to infect the unborn baby. There is also no proof of increased chance of miscarriage, early pregnancy loss or newborn abnormality. High fever from any cause can bring on labour early.

  • RISKARE PREGNANT WOMEN MORE AT RISK FOR COVID-19?

In general, pregnant women are more likely to catch seasonal “flu”, and to have more severe symptoms from flu-like illnesses. Medical professionals recommend flu injections for pregnant women. But, it is not yet known if COVID-19 is worse in pregnant women. At this time, there is no vaccination for it. If you have any other illnesses such as TB, heart disease, HIV or diabetes you may be more at risk.

  • ANTENATAL APPOINTMENTSSHOULD I STILL GO TO THE CLINIC DURING PREGNANCY?

Yes, pregnant women should continue attending their planned antenatal visits. Wear a cloth mask. When you arrive at the facility, you will be asked questions about COVID-19, have your temperature checked and asked to use hand sanitiser. Those women with symptoms (fever, dry cough, sore muscles, sore throat, difficulty breathing) will be cared for in a separate room and tested. If you have severe symptoms e.g. high fever or great difficulty breathing, you may be admitted or referred to a hospital or asked to isolate yourself at home while waiting for the COVID-19 test result.

  • SYMPTOMSWHAT MUST I DO IF I HAVE SYMPTOMS OF COVID-19?

Pregnant women with any COVID-19 symptoms (fever, dry cough, sore muscles, sore throat, difficulty breathing) need to be tested. Please phone the hotline (0800 029999) or your local antenatal clinic to find out where to go for testing or whether you need to call an ambulance to take you to hospital urgently. Wear a cloth mask. As soon as you arrive, tell a health worker that you have these symptoms.

  • TREATMENTHOW WILL I BE TREATED IF I GET SICK WITH COVID-19

If you test positive for COVID-19

  • In early pregnancy you will be managed at home (self-isolation) or in a place with other people with COVID-19.• In later pregnancy (after 5 months) you will be managed at home (mild symptoms and not in labour), in a safe place with other people who have the infection, or inyour maternity facility if in labour. • If you have severe symptoms like high fevers and shortness of breath you will be admitted to a specialised hospital with a maternity unit, where you might need tobe looked after in an intensive care unit.
  • If you have had the baby, you should stay together and breastfeed while wearing a mask. Health care workers that look after you will wear protective clothing and keep you in an area separate from other patients. Don’t worry about this; it is to protect them and other women from getting the coronavirus.
  • COMPLICATIONSWHAT SHOULD I DO IF I DON’T FEEL WELL IN PREGNANCY?

If you have COVID-19 symptoms and/or you have other pregnancy symptoms that worry you like bleeding, reduced movements of the baby, breaking of waters; you must attend your facility. Be sure to first tell the health care worker of your COVID-19 symptoms or other symptoms as soon as you arrive at the clinic.

  • LABOURWHAT HAPPENS WHEN I GO INTO LABOUR?
  • Women who may have or have COVID-19 can have normal labour and there is no need for a special type of delivery such as caesarean section. Skin-to-skin care and breastfeeding should start at birth. All women arriving at a facility in labour will be screened for COVID-19 symptoms.
  • If you maybe have, or definitely have COVID-19, you will be looked after in a separated area and the health workers will wear protective clothing. You will be asked to wear a mask to prevent infection from spreading to other patients or health workers.• If you do not have COVID-19, you will be looked after in the normal delivery area with other patients. Although birth companions are very supportive to women in labour, some facilities may not allow them to be with you during this time of the COVID19 pandemic. This is to prevent the virus spreading from people without symptoms to other patients, newborn babies or health care workers. You will need to ask your facility what their policy is. If you can, try to connect with your support person over the phone as much as possible, while you’re in labour.
  • CLINIC VISITSWHAT IS NORMAL DURING PREGNANCY _ AND WHEN SHOULD I TO GO TO THE CLINIC?

Many mothers are worried about their pregnancies and COVID-19. Here is some information about what is normal for pregnancy, what could be due to anxiety or a cold, what could be a pregnancy complication and what could be symptoms of COVID-19.

  • Heart palpitations: these are usually from a lot of stress and worry or could be due to a fever causing your heart to beat faster. If you do not have a fever, this is probably not COVID-19.
  • Shortness of breath: in pregnancy, your womb grows bigger and can make you feel a little short of breath. Sometimes if your red blood cell levels are low, this can also make you breathless. But, if your breathing is very fast and you are struggling to breathe, this could be caused by an infection – and you need to get medical attention urgently.
  • Blocked nose, stuffy, heavy feeling in the head: these are signs of a ‘cold’ or hayfever and are not common with COVID-19. You can take paracetamol to relieve symptoms
  • Headaches: in pregnancy, many women have headaches. They do not need to go to a clinic if the headache gets better if they drink fluids and take simple painkillers (paracetamol). But, headaches that don’t go away or are severe, can mean there is a serious problem like high blood pressure or COVID 19 (if also have fever and cough).
  • You should go to the clinic immediately, and inform the nurse when you arrive, if the headache does not go away, is severe or comes with swelling of the feet, lights flashing in front of the eyes, painful belly, or you know you have a high blood pressure condition, or fever

Contact your maternity unit if:

  • you have any bleeding from your vagina
  • you have pain in your belly
  • the baby is not moving as much as usual

None of these is likely to be caused by COVID-19. When you go to the clinic, wear a cloth mask, go straight away to the person who is organising the screening when you arrive. Difficulty breathing is an emergency, and you or your relative should phone the clinic or hotline to see if you need to call an ambulance to take you to hospital. If you are not sure what a symptom means, or are unsure how urgent it is, phone your clinic or the hotline for advice. 0800 029 999.

  • BREASTFEEDINGCAN I BREASTFEED IF I HAVE, OR MAY HAVE COVID-19?

Breastfeeding is recommended for all mothers, including mothers who have, or may have COVID-19. So far, the COVID-19 virus has not been found in breastmilk.

  • Always wash your hands with soap for 20 seconds before and after you breastfeed.
  • Make sure you follow good respiratory hygiene: cough or sneeze into your bent elbow covering your mouth and nose, or into a tissue which you must then throw straight away into a closed container and wash hands with soap for 20 seconds.
  • Everyone in the house should wash hands often with soap for 20 seconds (or use alcohol-based hand sanitiser).
  • If you have COVID-19, you should wear a mask that covers your mouth and nose when breastfeeding. A homemade mask can be a cloth or scarf that is washed after each use. Do not touch the mask while the baby is feeding or when spending time with the baby.
  • NEWBORN CAREHOW CAN I PROTECT MY NEWBORN BABY FROM COVID_19?
  • Breastfeed: with proper handwashing before. If you have COVID-19, breastfeed with a mask.
  • Hold your newborn baby skin-to-skin on your chest (but keep them warm).
  • Everyone in the house should wash hands often with soap for 20 seconds (or use alcohol-based hand sanitiser).
  • Choose only two or three other people to help with the baby. Everyone who spends time with the baby should always wash hands for 20 seconds before and after touching the baby. They should also use a clean, homemade mask each time they are with the baby.
  • They must not touch their face or the baby’s face.
  • No-one should kiss the baby’s face.
  • If possible, other people should be at least 1-2 meters away from the baby and the person caring for the baby.
  • Keep household surfaces clean. Use 4 teaspoons of bleach in 1 litre of water. Keep bleach out of reach from children.
  • WORKING PARENTSHOW CAN I PROTECT MY CHILDREN IF I AM GOING OUT TO WORK?

If you are working out of the home, try to protect your children and other family members from COVID-19.

• Stay home as much as possible

• At work

  • Wear a clean cloth mask
  • Try to stay more than 2 meters away from others
  • Don’t hug or kiss or have ANY physical contact with anyone
  • Avoid touching your face
  • Avoid groups where you see them gathered
  • Try to avoid surfaces like doorknobs and switches that are touched by many people
  • Wash hands as often as possible with soap for 20 seconds (or use alcohol sanitiser)
  • Leave all items such as pens, at work, if possible.

• At Home

  • If possible, wash your hands and body and change into clean clothes before you enter the home
  • Hand washing as above
  • Wipe down any items your brought home, straight away with sanitiser or use 4 teaspoons of bleach in 1 litre of water. Keep bleach out of reach from children.
  • CHILD FLUMY CHILD HAS FLU SYMPTOMS WHICH STARTED YESTERDAY. WHAT SHOULD I DO?

Children tend to have a mild type of COVID-19 illness if they get the infection. But they can spread it easily to others. As we go into flu season, children can pick up viruses other than Corona at this time. The symptoms caused by these viruses may be very similar to COVID-19. You should take the usual precautions to avoid COVID-19:

  • Wash hands as often as possible with soap for 20 seconds (or use alcohol sanitiser)
  • Stay at home
  • If breastfeeding, continue with breastfeeding.
  • Teach your child to avoid touching his face.
  • Teach your child respiratory hygiene. This means cough or sneeze into his bent elbow covering mouth and nose, or into a tissue which he must then throw straight away into a closed container and wash hands with soap for 20 seconds.

If your child has fever, cough or difficulty breathing, seek medical care early. For advice on what to do and where to go, contact the free COVID-19 hotline (0800 029999/0800 111 132).

  • TRANSMISSION OF COVID_19 BY A CHILDCAN CHILDREN WITH COVID-19 SPREAD THE VIRUS TO OTHER PEOPLE?

Yes. Children can seem well or have mild COVID-19, but still spread the virus to other people. So, as far as possible, children should be kept apart from adults who have illnesses like asthma, TB and diabetes and other serious health problems. Also, children should be kept apart from adults over 60 years of age as much as possible because older adults with COVID-19 may get sicker than younger people.

  • EXTENDED FAMILYHOW CAN I PROTECT MY BABY FROM COVID_19 WHEN I LIVE WITH AN EXTENDED FAMILY AND SOME WORK OUT OF THE HOUSE?

If you are living with an extended family, you should take the same precautions to avoid COVID-19 infection as other people. You and your child can help protect yourselves by:

  • Wash hands as often as possible with soap for 20 seconds (or use alcohol sanitiser)
  • Try to stay more than 2 meters away from others, if you can and avoid crowded spaces.
  • Avoid touching your face.
  • Practice respiratory hygiene. This means cough or sneeze into your bent elbow covering your mouth and nose, or into a tissue which you must then throw straight away into a closed container and wash hands with soap for 20 seconds).
  • Do not allow family members to hold your baby unless they have washed hands properly before and after and use a clean homemade mask, each time
  • Avoid kissing the baby on the mouth or face.
  • Open windows when possible and keep household surfaces clean with 4 teaspoons bleach in 1 litre of water. Keep bleach out of reach of children.

If you have fever, cough or difficulty breathing, seek medical care early. For advice on what to do and where to go, contact the free COVID-19 hotline (0800 029 999/ 0800 111 132).

  • IMMUNISATIONSHOULD I STILL TAKE MY BABY FOR IMMUNISATIONS?

Yes. Your baby should still be taken for immunisations as usual. You should take the same precautions for you and your baby to avoid COVID-19 infection as other people. Wear a cloth mask. You can help protect yourself and your baby by:

  • Wash hands as often as possible with soap for 20 seconds (or use alcohol sanitiser)
  • Try to stay more than 2 meters away from others and avoid crowded spaces.
  • Avoid touching your face.
  • Practice respiratory hygiene. This means cough or sneeze into your bent elbow covering your mouth and nose, or into a tissue which you must then throw straight away into a closed container and wash hands with soap for 20 seconds).

If you have fever, cough or difficulty breathing, seek medical care early. For advice on what to do and where to go, contact the free COVID-19 hotline (0800 029 999/ 0800 111 132). If you can, phone before going to your clinic, to find out if special arrangements have been made for immunisations.

  • FAMILY PLANNINGMAY I STILL GO TO THE CLINIC FOR MY FAMILY PLANNING DURING THE TIME OF COVID_19 AND DURING LOCKDOWN?

Yes. You will still be able to get family planning services from your local clinic. But try to find out if there are changes to the service. Be sure to continue with your family planning during this time to prevent unwanted pregnancies. Remember that condoms give you protection against pregnancy, HIV and other sexually transmitted infections. If you are planning a pregnancy, it is better to wait until the COVID-19 problem is over.

  • PUBLIC TRANSPORTI AM PREGNANT AND USE PUBLIC TRANSPORT TO GET TO THE CLINIC. SHOULD I STILL GO TO THE CLINIC?

If possible, walk to the clinic to avoid being close to other people. If you need to take a taxi, try to sit with space between you and others. You should take the same precautions to avoid COVID-19 infection as other people. You can help protect yourself by:

  • Wear a cloth mask when in public places.
  • Wash hands as often as possible with soap for 20 seconds (or use alcohol sanitiser)
  • Try to stay more than 2 meters away from others, if you can and avoid crowded spaces.
  • Avoid touching your face.
  • Practice respiratory hygiene. This means cough or sneeze into your bent elbow covering your mouth and nose, or into a tissue which you must then throw straight away into a closed container and wash hands with soap for 20 seconds).

If you have fever, cough or difficulty breathing, seek medical care early. For advice on what to do and where to go, contact the free COVID-19 hotline (0800 029 999/ 0800 111 132).

Pregnant women and women who have recently delivered – including those affected byCOVID-19 – should attend their routine care appointments. If you can, phone before going to your clinic, to find out if special plans have been made for antenatal and postnatal visits.

AUTHORS AND REVIEWERS

1. Dr Fathima Naby Paediatric Infectious Disease Specialist; Pietermaritzburg Metroplitan Hospitals; Affiliated to KZN Provincial Outbreak Response Team

2. Dr James Nuttall; Paediatrician and Paediatric Infectious Diseases Specialist; Senior Specialist and Senior Lecturer at Red Cross Children’s Hospital and the School of Child and Adolescent Health, University of Cape Town; President of Southern African Society for Paediatric Infectious Diseases (SASPID)

3. Dr Kopano Matlwa Mabaso; Executive Director, GrowGreat, MBChB (UCT) Masters inGlobal Health Science (Oxford University); DPhil (PhD) in Population Health (Oxford University)

4. Dr ME Patrick (FCPaed); Research Centre for Maternal, Fetal, Newborn & ChildHealth Care Strategies, University of Pretoria, South Africa; Department of Paediatrics, Grey’s Hospital, Pietermaritzburg, South Africa; School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa; Executive member: Child Healthcare Problem Identification Program (Child PIP)

5. Dr Natasha R Rhoda; National Perinatal Mortality and Morbidity Committee vice-chair (NDOH); HCU Neonatal Medicine, Mowbray Maternity Hospital; MBChB (UCT), FCPaed(SA), Certificate in neonatology(SA)

6. Professor Priya Soma-Pillay; Professor and Head – Obstetrics, Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital; Hon. Secretary: College of Obstetricians & Gynaecologists (SA) and South African Society of Obstetricians & Gynaecologists (SASOG)

7. Sally Field; Project Co-ordinator, Perinatal Mental Health Project; B.Soc Sci Psychology and Sociology, UCT, BA hons Psychology, Rhodes University, MA Video for Development, University of Southampton

8. Associate Professor Simone Honikman; Director, Perinatal Mental Health Project; Alan Flisher Centre for Public Mental Health; Department of Psychiatry and Mental Health, University of Cape Town (MBChB; MPhil in MCH); Expert Committee member Standard Treatment Guidelines and Essential Medicines List (Hospital Level); Contributor to development National Framework and Guidelines for Maternal and Neonatal Care during a crisis, COVID-19 response, for Director of Maternal and Neonatal Health, NDoH

9. Professor Susan Fawcus; Emeritus Professor and Senior Scholar, Dept Obstetrics and Gynaecology, University of Cape Town; Public sector obstetric specialist (MA, MBBCh. FRCOG)

10. Professor Welma Lubbe; PhD; M.Tech; RN; Adv M, NE, Associate Professor, School of Nursing Science, North West University)

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