COVID-19 & Pregnancy

In this episode we discuss the known and suspected effects on this novel Corona virus, COVID-19, on pregnancy, delivery and breastfeed. Remember that at this point in time things are changing by the hour in terms of what we learn about the virus and recommendations. So, as of right this moment theses are the current recommendations on this Corona virus in Pregnancy. 

If things change and new recommendations come about, please refer to 
my Instagram page @forvaginaonly for updates!

Transcript

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Hey guys, Dr Cellasene here in this episode of four vaginas only, we are going to talk about Cove in 19 also known as the novel Corona Virus, and its effects on pregnancy. So let's cue the music. I know right now we're not really a lot of people aren't in great times in great spirits. My music performed Jana's Only It's a little bit upbeat, which I usually love, but I'm hoping, you know, even in these dark times that a little bit of good music can cheer us up. So let's cue the music Hello and welcome to four vaginas only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it All right now that we got a little pep in our step, let's talk about something serious. So Cove in 19 or the novel Corona virus has been kind of sweeping the nation, not only the United States, but also across the globe. You know, our initially it had started in China when they report it to the World Health Organization back in December of 2019 and it's kind of just grown ever since. I am not an infectious disease doctor. I'm not even an internal medicine doctor. I can't even say I'm truly on the front lines of this by any means, because a lot of the treatment and monitoring of this really rests on those shoulders. Also infectious disease specialists in general, not only physicians, but when it comes to Cove in 19 and a pregnancy, I feel like at first I didn't really want to make a podcast episode about it, because literally, things are changing by the day and podcasts air so stagnant, right? So I make a podcast episode is posted on there on this date, and it's just out there forever. And the information I give today might not be the correct information an hour from now, a day from now a week from now, things are evolving very rapidly as we figure out this virus and what it can do. But I do have a lot of not only patients asking me questions but friends asking me questions and pregnant friends, especially about Cova 19 and how or what we know about it in terms of how it affects pregnancy. So I figure I would make this podcast episode about what we know as of right now and hopefully updates you on changes that are happening as this virus progresses as his pandemic progresses on my social media accounts. So you can go to at four vaginas on Lee on Instagram or Facebook. And if there's any updates to this or changes to this part gets episode, I will make reference to that. They're so with that being said, let's get into what we know about the novel Corona Virus, also known as Cove in 19 and Pregnancy. So first and foremost Cove in 19 or the novel Corona Virus or Just Corona virus. I'm probably gonna refer to it many different ways throughout this podcast, but just so you know, that is what I am referring Thio. Currently it is deemed a pandemic, and that was declared by the World Health Organization on March 11 2020. What a pandemic is is basically when a disease affects a wide geographic area as opposed to an epidemic. When it spreads in a more narrow a geographic area, a pandemic is when it starts to spread all over the world, basically, which is what we're dealing with right now. So currently it's a pandemic the way that it's spread so far. What we no is that it spreads by airborne droplets, which can happen when people cough or sneeze, or even sometimes with talking and also with contacts so touching hands touching surfaces than using those hands that are now contaminated and touching. Your nose, your mouth and your eyes. And it goes, it seeps into your body, and that's how you become infected with the virus. A lot of people have been asking if it could be transmitted sexually with semen or vaginal fluid, and at this time we don't think that it can. So that's a good thing in some respects, right? Because then we'd be dealing with an even bigger problem. So right now it's recommended in general is that we socially distance, so keep at least six feet of distance between you and any other person, so that decreases the droplets that are in the air with coughing, sneezing or sometimes talking from getting to you and getting into your system. Also, frequent hand washing with soap and water don't use things that are like natural cleansers because those aren't necessarily going to kill the virus. You can also use bleach, your bleach products as well in hand sanitizer, so those are just kind of general recommendations. But today we're here to talk mostly about Cova 19 and pregnancy. So, you know, the biggest thing is that we don't know ah lot yet about how it's going to affect pregnancy, if at all. We're kind of on Lee men or reaching for what has happened with other viruses that are similar to covert 19. So just a general overview of viruses. There's two types of viruses. There's D N A viruses and are in a viruses DNA. People are used to kind of knowing what that is. Our Rene is a little bit different, but just so you know, there's two different types. Covert 19 is a R n, a virus similar to viruses that we've seen in the past that are other types of Corona viruses such as SARS and MERS. So we're kind of replicating our recommendations based on what we've seen in those outbreaks, even though this is technically a new or novel. Corona virus also were kind of looking at how pregnant women are affected by the flu. The influenza virus, as the influenza virus, is a virus we're more familiar with, Ah, as a country in the United States, Andi. It's also an orange virus as well. So a lot of our recommendations are drawn from what we've seen with other viruses when it comes to pregnancy recommendations, so are pregnant women at higher risk for severe disease. That's a question that a lot of my friends have been asking me a lot of patients. And the answer is likely yes, due to some of the normal physiologic changes in pregnancy and what we've observed with other types of Corona viruses such as saris, which is a severe acute respiratory syndrome virus, and murders, which is the Middle East respiratory syndrome virus as well. So not that you are at a higher likelihood of getting this novel Corona virus, but that if you do get it, there is a possibility of having a more severe illness Now that has not 100% been confirmed. Like many of the things that I'm going to discuss in this podcast episode. But it's, you know, be on high alert, wash your hands frequently and keep your distance from other people. Whether they're sick or not is basically the general recommendation right now for, ah, all pregnant women. Now, of course, when you become pregnant, you're not only thinking of yourself, you're thinking of your growing baby or the fetus, right? So a lot of people want to know about fetal risks, and unfortunately, the answer is, we don't know yet. And that's because the studies that have been done so far have a very small amount of people that are part of the study that have actually been infected with Corona virus. The novel coronavirus and are pregnant and usually wanna study That's done has a small amount of people enrolled in the study. It's hard to stay to tell the general public if what happened in that small, small study is what's gonna happen in the general public. Because there's just not enough people in the study to know if it's the recommendation for everyone, because everybody responds differently in any study that we do in the medical community. We want appropriate amount of end, which is the enough people in the study to let us know if these results translate to the global or a much wider population because everybody's different. Like we know everybody looks different. Everybody has different aspects of their D n A. You know. So it's just very hard with these very small studies that we have to tell everyone that this is a definite recommendation or a definite thing that's gonna happen. So for fetal risk overall, we don't know. But if we look at compared to SARS MERS or severe flu, possibly if you get very sick with the novel Corona virus, there could be a risk of fetal growth restriction, meaning a very smaller baby or preterm birth or preterm delivery. Now that's not like I said. It's not guaranteed, but possibly compared to what we've seen in those who have gotten very sick with the other similar viruses. So the other thing I'd like to say is that with the novel Corona virus, one of the symptoms is having a high fever. Now in general, even if you don't have the novel Corona virus in pregnant women that have very high fevers, especially if you have a high fever early in pregnancy, let me clarify earlier on in pregnancy to say that one more time. There's a risk of birth defects in general. Pregnant women, early pregnancy with very high fever. That's a known fact now. So that's, I guess, technically a risk. And somebody that has the novel Corona virus early on in pregnancy and does develop a very high fever and a fever isn't a general fever. As soon as we hit the number, we could tell you yes, it's a fever is when you hit 100.4 degrees Fahrenheit. That's usually what's classified as a fever. A very, very high fever is more like the 102103104 Fahrenheit range Just for clarification on that. And a lot of people are also wondering what can you pass this to your baby? So if you're pregnant and you are positive for covert 19 there is no evidence that as a mom, you can pass it on to the baby that's growing in your uterus to date. Right now, there's no evidence of that, so that's a good thing. But your doctor might have to monitor you more closely, such as more visits to the office, more testing and things such of that nature. So if you do test positive for covert 19 it's important that you let your doctor know and also stick to the plan that you create with your doctor on how to manage the pregnancy going forward. So testing this is a question for a lot of people, not even those that are pregnant. But who are we testing at this point? I have not found any specific recommendations saying that were either testing all pregnant women or testing pregnant women that have, um, you know, some mild symptoms. I haven't really seen that to be the case. I feel like that might be the case moving forward as this changes from day today. So in general, if you have a fever, which, as we just went over, is usually classified as 100.4 degrees Fahrenheit and or you have a cough with shortness of breath and you've had close contact with someone that has a confirmed case of the novel Corona virus, which a close contact means you've been within six feet of them for long periods of time or actually contacted their secretions from a sneeze or cough or something like that in your face um, or secretions that you've touched and then touch your face if that's a concern. So if you've done any of that and you have symptoms that I mentioned within 14 days of symptom onset, so if you've contacted or been in contact, close contact with a person within 14 days of your symptoms happening or if you've traveled to an infected area and now you have symptoms within 14 days of that travel, then you will meet the requirements for being tested. Also in general, call your doctor. If you have been exposed in any way or your concern that you've been exposed to Cove in 19 they can help talk you through your symptoms how many days it's been and determine whether or not you should be tested. So it's very important. Any concern. Make a phone call not any concern. Go to the hospital unless you are unable to breathe. You have severe chest pain. I would recommend calling your doctor first in order to determine where you need to go from there, and that's not because I don't want you to get treated. I don't want you get seen. It's just because our hospitals are overrun right now, and that's probably only gonna get worse. And if you don't really have severe since symptoms and say you are not positive for covert 19 you're kind of going into the epicenter of where a lot of people might be. If you do, just show up at the hospital, so you're also increasing your risk on in that respect. So that is my recommendation. For now. Talk to your doctor. If you are having fever with cough, shortness of breath, you've been in close contact with somebody or traveled to an affected area within 14 days of your symptoms Starting. Also, additional guidelines from the CDC on who should be tested is anybody with symptoms, and they're also older, adult with some or someone with a chronic illness or who's immuno compromised, such as people that have diabetes, heart disease. If they're on immuno suppressant medications, have you recently received a transplant and you're taking medications for immuno suppression that falls under that category or immuno suppressants for other conditions? Some people take immunosuppressants for things like Lupus or rheumatoid arthritis, so that's something to keep in mind. Also, if you have chronic lung disease such as C o p, d. Or even asthma is, ah, criteria. Or if you have chronic kidney disease, this puts you at a higher risk of contracting the disease and having a more severe illness due to the disease. So you should also be tested as well. And if you're part of my group of people, any healthcare personnel. If you have symptoms within 14 days of being in close contact with somebody or suspected contact, then you should be tested as well. So you nurses, doctors, anybody that works at a doctor's office or a hospital yaar clinic. If you've come in contact with somebody and you're starring developed symptoms, you should be tested. Now. Just a little quick could know on how we do the testing. The preferred method is by PCR or preliminary race chain reaction, and that could be done off. What we're doing now is a swab, so a nasal, fragile swab. I know people are doing throat swabs and nose swabs, and then that gets sent off for testing. Right now, it's taking a few days to get testing. Recently, I heard that a a shorter time frame test within like 48 hours or so has been recently approved, so hopefully the testing results start to come back sooner so we can isolate people sooner. And that's the preferred testing method for pregnant women. However, if that test is not available, we can still do a C T scan or a CAT scan. Now, I know that a lot of pregnant women out there are very concerned about radiation to their baby, which is understandable when your people are talking about getting CT scans It it is radiation. Okay, But just so you are aware, if you're unable to be tested in the preferred method of just having a swab done and we're really concerned for your symptoms were gonna recommend doing a CT scan of your chest. And that could be done with shielding your abdomen in order to protect the baby as much as possible from the radiation. And just know that with that abdominal shielding that the level of radiation that your baby gets is below that of which is associated with any tour allergenic effects, meaning that it should not harm your baby. The most important thing is that we get a proper diagnosis and that we treat you for isolate you as soon as possible. So that can't be done with just AA swab or a sample. We might have to do a CT scan, but just be rest assured that your baby will be okay with after just having one CT scan of your chest. We're not scanning your abdomen and we're gonna cover your abdomen to protect the baby as much as possible from the radiation that will come from doing the chest CT. I've also heard of hospitals around here doing chest X rays as well, Which is a little bit lower oven exposure. But right now, the testing methods that are preferred are the PCR swab or the CT of the chest. Okay, so now the delivery. A lot of you pregnant women just like everybody in the country. It was not expecting this, right? We had a plan. We knew what was gonna happen in our life next we knew was gonna have with our job. We knew it was gonna happen next in life as much as we can. We know we can't control everything. But you got pregnant and you planned this delivery in your mind. You planned this. What was gonna happen at the hospital or at the midwifery center who was gonna be with you, um, at the time of delivery to experience this miracle of birth. And now that's all changing, which is really unfortunate. And I know that it's trashing a lot of your dreams. I understand. Trust me, you know, just to know that it's for the best tits tryto work with your health care providers as much as you can. We're trying to keep everybody safe, not just u um, the elderly and other populations that are at risk at this time. So anyway, would that set? Let's talk about the delivery and what's gonna be different and what you can expect first and foremost. No matter what I say here about your delivery, you need to call your hospital or your physician's office to find out their policies and just know that that can change day by day, hour by hour. So if you're about 34 weeks or more, you need to be in a constant contact with your either provider or your hospital about what to expect and what to plan for your delivery. Because, like I said, things are fluctuating. So cove it itself. Cove in 19 is not an indication for delivery. So if you're just afraid of getting cove it 19 or even if you're positive for covert 19 that's not a cause for your doctor to deliver you right then and there. And even more so your delivery might be postponed if you are positive for Cove in 19 especially if you're in the third trimester and you'll be delivering soon. Some women might have had scheduled inductions or scheduled C sections, and obviously we can't predict when the baby's gonna come. But we try to schedule some of these things for different reasons ahead of time. But if you were positive for Covert 19 you need to talk to a doctor right away because we might postpone your delivery because we want thio. Try to make sure you are recovered as much as possible before going through that, and also to diminish you, passing it on to your newborn baby by just being close contact with them after the delivery. And currently, right now, the CDC is recommending temporary separation from the infant or newborn baby. If the mom is positive for Covert 19 until the mom is deemed low risk or no risk of transmission exactly what that means. I can't tell you. Every hospital system is kind of doing that differently. Whether that's retesting or just monitoring for symptoms or just a predetermined amount of time, you'll have to talk to your hospital system about what that means if you are positive for Cove in 19. But overall, it should be safe to deliver in hospitals, even if your hospital has had cases of Positive Cove in 19 or taking care of people that are positive for the novel Corona virus. And that's because those people are put in isolation. They're doing their best to keep it away from people that are not sick with Cove in 19 Some people are in negative pressure rooms, which means basically the there's a vacuum system sucking up all the air in their room and so that it doesn't go out into the hallways or out into the hospital. And also another reason why, if you're not having severe symptoms, you should stay home or take care of yourself at home. And that's just a limit. The exposure of everybody else that might be in the hospital for other reasons as well. But overall, it should be safe to deliver in a hospital, even if that hospital has cases that they're caring for for covert 19. All right, so your baby's delivered. Or maybe you had a delivery just before all this outbreak, and you're trying to manage what to do when it comes to breast feeding. Luckily, so far, Cove in 19 has not been seen or identified in breast milk, so you don't have to worry at this time about transferring the infection to your baby via your breast milk. So that means breast feeding is encouraged in all pregnant women infected with Cove in 19 or not. Now let's get into that so non infected women or women that are known or not known to be infected with covert 19 it's still important that you'd have proper hand hygiene. Wash your hands for 20 seconds with soap and water prior to touching your baby, and also after touching her baby, some women may choose to even wear a face mask while breastfeeding because you're in very close proximity to your baby. I have not necessarily seen that recommendation for those that are not known to have Cove in 19. But you know it's not hurting you, so if you want to try it, go ahead. Ah, those who are infected with covert 19. Like I said, you're still encouraged to breast feed your baby. You need to wear a face mask while doing it. You need to make sure you're washing your hands with soap and water for those 20 seconds before and after doing breast feeding. It's actually even recommended that instead of having such close contact with your baby that you express the milk so you use a breast, a dedicated breast pump, one that your own, the one they're only gonna use this whole time while you're infected with the novel Corona virus in order to feed your baby and express your milk from your breast so that your baby is not right up on your chest to decrease transmission from droplets and breathing on your child, coughing or sneezing around your child. Also, if you're using a dedicated breast pump, you need to make sure that you're cleaning it before and after. Okay, and then you can have a healthy caregiver feed the baby with your pumped breast milk. Now, when it comes to cleaning your breast pump. What you need to do before is make sure that you wash your hands with soap and water for 20 seconds, like I talked about, and they say friction is the bus, so aggressively rubbing your hands. Make sure you're getting under your nails and make sure you're adequately putting friction on your hands with the sylvan water. Okay, and then you assemble the breast pump after you're done expressing the breast milk and maybe while you're handing off the breast milk to a healthy person that's feeding the baby, you don't need to take apart and rinse the dedicated breast pump. What that means. You have to clean it in a designated basin or bucket. Don't wash in a sink because a sink have other germs and residual virus in there. Also use warm water with soap and a designated scrubbing brush to scrub all the individual parts of the breast pump and then let it air dry, either on a clean towel or a clean paper towel. If you want to use a dishwasher, you can do that as well. It is recommended that you run a hot water cycle and that you do the heat dry cycle afterwards or the heat dry? Yeah, drying it on heat afterwards. Why don't I don't even know how. Uh, dishwasher works right now, so he wash and heat dry is recommended. There you go. Okay. So what everybody wants to know, right? Treatments? How do we treat this thing? We don't know. And I know you know, we don't know, because if we knew, everybody would know by now, because this is just taking over the world. But luckily, everyone all over the globe is pretty much working on a treatment and or a vaccine. So hopefully something like that will come down the pipeline shortly. But currently there is no approved treatment for Cove in 19. Now, those of you that are trying to have a baby now or trying to conceive now or have been thinking about and kind of planning to attempt to get pregnant now, you know we're all anxious. What the hell do we D'oh. What's the recommendation? Well, there's no reason that we can say right now that you should hold off on creating your family. But at the same time, we're also saying there were not 100% sure of the transmission at this time. So even though we don't think that this virus causes birth defects or causes an increased risk of miscarriage, the fact is we don't know 100% no. But the recommendation is still not to hold off because right now it looks like it doesn't lead to an increased risk of miscarriage higher than the general population and no birth defects. It also looks like we can't transmit it from mom to baby while the baby's in the uterus. So things are looking positive. So there's no reason right now that you need to hold off on creating a family. Unless I would say, you know, there's obviously a financial burden to this pandemic. A lot of people are losing their jobs or getting cut with their pay and pregnancy and having a baby and things like that. A lot of women I know are kind of deciding not to do that right now because it's just an extra concern or stress on their life. But if that's not you, and if you really want to try to have a baby right now, I can't say that there's recommendations for me to tell you not to. I would just look at your situation. I know how you feel. Talk to your partner about it and make a decision between yourself and also watch the news and what's going on with the CDC and the World Health Organization on a daily or every other day basis so that you are most up to date on what we know. So you're upset Rick appointments? Yup. Those getting canceled. Ah, lot of people are getting cancelled appointments or moved Thio telling medicine appointments were talking to your doctor on a Web camera over the phone. Then that's only because we're trying to limit contact with people in general, not only you with us, you have people in the waiting room. Um, we just want to decrease the amount that we're transmitting this virus. So you know your payments aren't actually canceled. Their just probably either delayed or they're being done in a different way, which is good. You know, we're adjusting with the times, and we're adjusting with the knowledge, so that's a good thing. But high risk patients it's still recommended that you have care and that you have your proper surveillance. So that's not going to be dropped. Even though, um, we're kind of in a worldwide panic right now. We're still gonna make sure that we take care of not only all pregnant women, but especially those that have higher risk. Now, if you're pregnant and you're a health care worker, you can still work. Just make sure that you are decreasing your exposure to positive patients. Make sure that your job knows that you are pregnant and a lot of people are early in pregnancy there. You know, it's not. People usually reveal at 12 weeks or 14 weeks or 21 weeks, whatever you've decided. But at this point in time, you need to make sure that you have not only the proper protective equipment to protect you from getting exposed to the virus, which is hard to come by in the United States at this time. But also your employer needs to know, you know, so that they know what situations to put you in and to not put you in. And last but not least, let's talk about pets in the home. So if you're pregnant and you're worried about transmission from your pet to you, or if you're bringing a brand new baby home and you're worried about turns of Shin from the pets to the baby, even though there was one incident of an infected dog in Hong Kong, there is no evidence of transmission from pets to humans, But with that being said, I would take the general precautions, wash your hands frequently, try to minimize how much you're kind of rubbing up on your dog and minimize how much they're licking your face. Um, just because, like I said, we give these recommendations. But mostly everything I said here is something we're kind of figuring out as we go. We're making recommendations from what we've seen so far, so I can't 100% say that is how it's gonna stick around forever. But this is what we know right now. So I have two dogs myself. I have two little labradoodle Tze and I know how hard it is to not rub on them and love them and all of that. But just try to decrease that as much as you can, even though right now we don't think that there's any transmission from pets to humans, which is good. So thank you guys. So much for listening to another episode of four vaginas on Lee. I hope to keep you more updated on covert 19 the novel Corona virus not only through podcast format but on my instagram page at four vaginas on Lee. Also, there's four vaginas only dot com if you want to take a look at some other pockets episodes either past ones or future ones that are coming out. Maybe if things changed drastically, I might do another podcast episode on some updates. Also, not only do you follow me at four John's only dot com to keep abreast of the situation, but I have some pretty great friends that I think you guys should follow as well to make sure that we all know what's going on. One is Dr Shetty at high risk underscore pregnancy on instagram. The other is Dr Phillips at D. R. Camila says K M e E L A H s A Y s and the other is Dr Perez at D r dot m a r T a p E R E z. So follow us. Follow along with this. Follow with the World Health Organization, w h o dot or GE, the CDC, CDC dot or GE the Society for Maternal and Fetal Medicine, which is a great resource for pregnant women, S M F m dot or GE, and also with the American College of Obstetricians and Gynecologists at a cod or a C, o. G dot or GE. That's where you can get really great information about how this is unfolding for pregnant women, pregnancies and deliveries and also for breast feeding. In addition, I found today actually on the CDC that for on the Corona virus page they have a Corona virus self checker. So you answer a few questions and it gives you recommendations based on your symptoms and your exposure, what you should do next. So I just thought I found that today. I thought I would share that with you guys as well. It gives you an idea what to dio keeps people out of the emergency room that don't need to be there, and I think it's a great resource as well. Thank you guys so much. I'm Dr Celestine. Let's hang in there together. Let's get through this united hopefully as a country, hopefully as many of us as possible can survive this novel Corona virus. And we don't take to heart of a hit on our families on our lives, on our financial situations, you know, whatever is your biggest burden right now, I'm sure there's a 1,000,000 other people going through it as well, Which, How often can you say that? Right. So hang in there. If you have any questions, please feel free to reach out to me at four vaginas on Lee. You can also email me at Dr C D o C T O R C at f ve Onley dot com and let's chat. I think one way to decrease our anxiety is to talk about it. I'm a big talker, so I love to discuss things I love to learn new information you have new fax did not only give you guys, but learn for myself and let's come out this even stronger than we went in. All right, bye.