For parents expecting a baby, the months leading up to delivery can be a time of excitement and joy. The joy in bringing a new life into the world has hopefully not been diminished and we, as your obstetrics providers, remain excited to go on this journey with you.

Unfortunately, the COVID-19 pandemic has also brought an unknown into our community, and we want to address these concerns as well.

If you are pregnant right now, it’s important for you to take the same safety precautions that the Centers for Disease Control and Prevention (CDC) and our local governments have recommended to the general public. These recommendations may change, but will likely continue to include:

• Washing your hands with soap and water frequently for at least 20 seconds
• Avoiding touching your face, nose, eyes and mouth
• Disinfecting high-touch areas often
• Practicing social distancing, including avoiding large crowds and maintaining six feet between yourself and others, and wearing a face mask
• Using a face mask when leaving your home for an urgent need

Aside from following these recommendations, you may have many other questions about how the coronavirus pandemic will impact your pregnancy. Here are a few answers to some of the most common questions I’ve heard. Please remember that as more is learned, the answers to these questions may change.

How will COVID-19 affect my prenatal and postpartum care visits?

Prenatal and postpartum care visits are considered urgent needs and their continuation is recommended. We have made many changes at our offices to keep you and your families safe during these visits.

Here are some changes that we need your help to accomplish:

• Although we value the participation of your family and close friends, visitors are not currently advised to join you during your office visits. Having your support system participate over the phone or even through a videoconference such as FaceTime might be OK. Please contact your obstetrician’s office to confirm this.
• The use of a face mask throughout your appointment is recommended.
• The timing of your appointments may be recommended to change to provide you with the safest possible experience. We appreciate your flexibility.
• If you are having any symptoms of COVID-19 such as fever, cough, shortness of breath, body aches, sore throat or diarrhea — or if you believe you have been exposed to COVID-19 — please contact your obstetrician’s office before coming for your appointment.

Please call your obstetrics provider if you have questions regarding the recommendations for your specific care plan.

How can I stay physically healthy right now?

Pregnant women can stay physically healthy by following the usual recommendations during pregnancy. These include:

• Eating healthy meals (see ACOG for Nutrition During Pregnancy)
• Exercising regularly with the use of online classes or apps as desired, so you can continue to shelter in place (see ACOG for Exercise During Pregnancy)
• Getting plenty of sleep (six to nine hours each night for most adults)
• Avoiding alcohol, nicotine and illicit drug use (see ACOG for Tobacco, Alcohol, Drugs and Pregnancy)
• Regularly taking recommended medications, including a prenatal vitamin
• Receiving routine vaccinations, including those for influenza and whooping cough, as advised by your obstetrics provider(s)

How can I manage stress and anxiety?

We know that this is an anxious time for many people. Maintaining your mental well- being during pregnancy is important, but may be especially challenging right now. The above tips for staying physically healthy also can help your mental health.

A few other things that you can do to stay mentally well include:

• Staying connected with your friends and family over the phone or online
• Taking breaks from coronavirus news, especially from unreliable sources
• Practicing mindfulness
• Setting time aside every day to relax and unwind
• Pursuing spiritual connection
• Continuing to seek care from mental health providers such as therapists, psychologists and psychiatrics. Ask about the option of telemedicine visits with them

Please contact your healthcare provider if your anxiety lasts for more than several days in a row or feels overwhelming. To take a free assessment and schedule a telehealth appointment with a counselor at Willowbrooke at Tanner, please call the Help Line at 770-812-3266.

What should I do if I am pregnant and think I have COVID-19?

If you think you may have been exposed to the coronavirus and/or have a fever, cough, shortness of breath, body aches, sore throat or diarrhea, please call your obstetrics or other healthcare provider.

If you have emergency warning signs, call 911 or go to the hospital right away. Emergency warning signs include the following:

• Having a hard time breathing or shortness of breath (more than what has been normal for you during pregnancy so far)
• Ongoing pain or pressure in the chest
• Sudden confusion
• Being unable to respond to others
• Blue lips or face

If you go to the hospital, try to call ahead to let them know you are coming so they can prepare.

How does COVID-19 affect a fetus?

It’s too early for researchers to fully know how the virus will affect an unborn child, but currently there is no evidence of a fetus being infected by COVID-19 prior to birth even when the mother has been infected during her pregnancy.

While some pregnant women with COVID-19 have had preterm births, it’s not clear whether this was because of the virus. The good news is that current reports show pregnant women don’t have more severe symptoms than the general public. Some women may be at higher risk for complications if they have other medical problems such as high blood pressure, lung problems or heart problems that have been associated with more severe illness.

Even if you have no medical problems, it is crucial to take the necessary precautions to avoid the virus, because researchers are still learning how the illness affects pregnant women, fetuses and newborns.

Should I wear a face mask?

All people — including pregnant women — should wear a cloth face mask when in public to prevent the spread of COVID-19. Face masks should be worn during medical visits and anytime you are around other people. Here are instructions to make a face mask.

It is important to remember that use of a face mask does not replace the recommendations to to practice social distancing, wear a face mask, use good hand hygiene, avoid touching your face and disinfect high touch surface areas.

Should I change my labor and delivery plans?

In most cases, the timing and method of delivery (vaginal birth or cesarean birth) do not need to change. Please talk with your obstetrics provider about your specific labor and delivery plans.

Even with the concern for COVID-19, evidence still says hospitals are the safest places to give birth. In the hospital, our staff has been trained to do what is needed to keep mom and baby healthy as safe as possible. Visitors are limited within the hospital as well, and the use of a face mask is required when coming into the hospital.

If you are sick at the time of your delivery, extra precautions will be put into place. These precautions will be discussed with you during your hospitalization.

How can I avoid passing COVID-19 to my baby after birth?

After your baby is born, if you have symptoms of the virus or may have been exposed to COVID019, you should contact your obstetric and pediatric providers to receive specific recommendations.

To limit the risk of spreading the infection to your baby, the following may be advised:

• Utilize the support of a healthy caregiver to provide care to your newborn.
• Keep your baby at least six feet away from you when safely possible.
• Wash your hands for at least 20 seconds before touching your baby or breastfeeding.
• Wear a face mask while breastfeeding or when you are within six feet of your baby.
• Wash your hands before touching any breast pump or bottle parts and clean all pump and bottle parts after use.

The virus has not been detected in breast milk, but the evidence for this is still limited. What we do know is that breast milk provides protection to many illnesses your baby could encounter during early life. While it’s your decision to continue or discontinue breastfeeding, we recommend you discuss your decision with your obstetrics or pediatric provider.

Please know that we are working diligently to keep our community, our staff, you, your families and your unborn child as safe as possible.

If you have any additional questions about your pregnancy and COVID-19, obstetricians on Tanner’s medical staff are available to you by calling our offices.

Visit tanner.org/classes-and-events to register for our childbirth classes.

Additional helpful resources include:

Centers for Disease Control and Prevention (CDC)

• Coronavirus (COVID-19): A hub for the latest information on what everyone needs to know about the coronavirus and COVID-19.
• Pregnancy & Breastfeeding: More information about COVID-19, pregnancy, and breastfeeding.
• How to Prepare: Learn how the virus spreads, how to protect yourself and your family, and how to manage anxiety and stress.
• If You Are Sick: Guidance on what to do if you have COVID-19 or think you may have it.
• Travel: Frequently asked questions for travelers and travel notices for each country.

Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Distress Helpline

1-800-985-5990 (TTY 1-800-846-8517)
Text TalkWithUs to 66746
Call or text if you or a loved one is feeling overwhelmed with emotions like sadness, depression, or anxiety.

Postpartum Support International Helpline

1-800-944-4773
Text 503-894-9453 (English) or 971-420-0294 (Spanish)
Support, education, and local resources for postpartum women: https://www.postpartum.net/

National Domestic Violence Hotline

800–799–SAFE (7233) and 800–787–3224 (TDD)
Live chat and more information: https://www.thehotline.org/

Wishing you well,

Megan Grilliot, MD