Birth in the Time of COVID-19

Like many of you, I’m struggling to figure out the right way to respond to the pandemic. I’m alternating between frantic obsession with the mundane (moving my course online, making sure my undergrad advisees are getting home okay, planning an elaborate Homeschool curriculum for my kids), sadness over what I know are minor disappointments (summer vacation! my daughter’s first sleep-away camp!), concern for my parents’ health, and existential dread. I can only imagine this is much, much worse if you’re expecting a baby in the next few weeks. And, indeed, closely following on my last post on conception, I got a number of emails saying, more or less, the horse is out of the barn. What do I do now? So here are a few thoughts, both on the medical decision-making and on the more mundane task of what you really need to bring the baby home. First, a starting point. TALK TO YOUR DOCTOR. Yes, they’re probably almost as confused and nervous as you, but they’ll have a better sense of the right plan given where you are, and the particular hospital situation in your area. Second, a note on uncertainty. With respect to both the functioning of society and the virus itself, there are a lot of what we’d call “known unknowns”. Our understanding of the virus is rapidly evolving (which is good!), our ability to test is hopefully going to improve, and we’ll know more as time goes on. If we learn of something which changes this, I’ll update you. Childbirth Is my baby going to get COVID-19? What if I get it? I’ve written this before. We do not know that much - sample sizes are small - but the evidence we do have is largely reassuring. Small numbers of pregnant women in China were affected, and they seemed to have an illness course similar to others in their age group. Most of the data on this relies on a cohort of 9 pregnant women in China who presented with COVID-19 and had their babies either right before or right after infection. There wasn’t evidence of in-utero transmission, although a number of the babies did develop COVID-19. One of the infants did die but, and I will stress, this infant had other serious risk factors (namely, he was very preterm). Most of the evidence we have on the disease in kids and babies (here is one example with a 6 month old) is that they tend to be largely asymptomatic, but can still spread the virus. Should I avoid prenatal visits? No, probably not. It may be your doctor says some of the more marginal visits could be conducted by phone, if you are low risk. But not having prenatal checks also entails significant risk. For example, a missed case of pre-eclampsia can be extremely dangerous. Wash your hands, maybe do not take the bus to the office, but don’t avoid the doctor. I am worried about hospitals in my area being overwhelmed when I’m due; should I induce early now? This depends a little bit on what you mean by “early” and on your hospital situation. New guidance (from something called the ARRIVE trial) provides support for induction at 39 weeks (for all low risk women, not just related to COVID-19). I think there is some nuance in how we should interpret this data (perhaps this is for another newsletter) but it is reassuring if you want to induce at 39 weeks. So if you are 39 weeks and were on the fence about induction, I can see a case for going forward. But if you’re 37 or 38 weeks - or even less - I believe the answer is no. Inducing at this stage is likely to increase your risk for a C-section, and your infant’s risk for needing NICU care and respiratory support. Precisely what you do NOT want to be needing right now. Should I have a home birth if I wasn’t planning one already? Some people have home births; I talk about this choice in Expecting Better and if you’re thinking it through in general, there are lots of cites there that might help. I try to take a balanced view on the issue. The question I have been getting about COVID-19 is whether you should switch now to planning an homebirth. I cannot emphasize enough: No. The data suggest home birth does entail some risk at any time - this doesn’t mean you do not want to do it, just that you want to be aware of them - and it seems likely these risks are larger than any COVID-19 risks. In addition, if you’re currently 38 weeks pregnant you’re talking about trying to set up a home birth in a week or two. Home births are much, much safer with experienced providers and you may well not have time to find one. Beyond this, a reasonable share of home births - about half, especially with the first baby - end up requiring an emergency hospital transport. If the medical system is overwhelmed, this will be among the worst things to need. And if you are worried about viral exposure, emergency transport is likely to be a lot riskier than an orderly hospital admission through the delivery ward. After Birth A few more practical details… Everything is shut, I cannot shop. What is the minimum set of things I need when I bring my baby home? We could all minimize a bit more. Here is my must have list. Nursery A crib, with two sets of sheets Someplace to change the baby A place to sit for feeding Clothing Onesies (let’s say 10) Sleepers (4) Diapers Few side-snap shirts for before the belly button falls off Swaddle blanket (2) (yes, you can use a regular blanket for this but your life will be easier if you get something like the miracle blanket that doesn’t require you to be an expert to use) Two or three other blankets. Transport Car seat Some type of stroller (probably; could get a fold-up base that the car seat goes on) Some type of baby carrier (you may want to get out of house and may feel more comfortable with the baby strapped to you) Food If you are formula-feeding: formula, bottles If you are breast-feeding: boobs (check!), nipple cream and pads. If you are breast-feeding: some backup formula. I know I will get flack for this but: breastfeeding may not work. Sometimes it doesn’t. You may need to supplement. Please, please stock at least some formula and bottles, just in case. Can I let other people see the baby? Generally, most people recommend keeping the baby pretty isolated for the first few weeks. This recommendation is heightened during a viral pandemic. So, non-urgent visitors, no. Grandparents? At this point the medical risks are highest to them, so the decision is probably more about the risks on their end than to the baby. Should I take my baby for vaccines? YES. OMG, YES. If we have learned nothing else it should be in the value of vaccines against virus illnesses.

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