Covid-19 infection is no reason to have a C-section

Covid-19 is a new disease and there are many things we are not certain about yet. Available information does not suggest that pregnant women are at greater risk of becoming infected compared to those who are not pregnant. Several pregnant women have been infected with Covid-19 and the course of the disease does not appear to be different than for non-pregnant women. This means that it is expected that the large majority will only have mild or moderate symptoms.

Are pregnant women at a higher risk of getting severely ill from Covid-19?

Due to changes in their bodies and immune systems, we know that pregnant women can be badly affected by some respiratory infections such as influenza and severe acute respiratory syndrome (SARS). It is therefore important that they take precautions to protect themselves against Covid-19, and report possible symptoms (including fever, cough or difficulty breathing) to their healthcare provider.

I am pregnant. What can I do to reduce the risk of infection?

Pregnant women should take the same precautions to avoid Covid-19 infection as other people meaning social distancing, frequent hand washing for at least 20 seconds with running soap and water, or sanitize with a gel that has 70 per cent alcohol.

Can Covid-19 be passed from a pregnant woman to her unborn or newborn baby?

Currently there is no evidence that the virus causes miscarriage or any abnormality in the baby. We still do not know if a pregnant woman with Covid-19 can pass the virus to her foetus or baby during pregnancy or delivery. A few newborn babies have tested positive for Covid-19 but it is not known if they were infected in the womb or after birth. To date, the virus has not been found in samples of amniotic fluid or breastmilk. Children generally seem to get mild infections.

Should I continue with my normal antenatal clinic (ANC) visits?

Your scheduled antenatal care should continue as planned. Hospitals are instituting various safety measures to ensure that those who need to seek care do it in a safe environment. At the Aga Khan University Hospital, we are also conducting tele-consultation via phone or zoom to cater for those who are unable to get to hospital due to restricted movements.

Can I still go to work as long as there is a Covid-19 outbreak?

We recommend you follow the directives from the Government of Kenya and your employer.

Our broad advice is that:

If you are in the 1st and 2nd trimester (less than 28 weeks pregnant), with no underlying health conditions, you can continue to work in a public-facing role provided that you practice social distancing and work environment is modified appropriately to minimize your exposure. This should be considered and discussed with your occupational health team or employer. If you are in the 3rd trimester (more than 28 weeks pregnant), or have an underlying health condition e.g. heart or lung disease you should work from home where possible, and significantly reduce unnecessary social contact. If you have any special concerns, you should discuss this with your employer and your doctor.

Can the Covid-19 outbreak affect the delivery of my child?

The delivery of your child will proceed as planned whether you are booked for a vaginal delivery or a caesarean section even if you are suspected or confirmed to have Covid-19 infection. Covid-19 infection is not considered a reason to perform a caesarean delivery.

What should I do if I think I could be infected with Covid-19 or if I have been exposed?

If you suspect could be infected with Covid-19 or have been exposed but you are in labour or have experienced any pregnancy danger signs (vaginal bleeding, reduced or loss of foetal movements, convulsions/fits, severe headaches with blurred vision, fever and too weak to get out of bed, severe abdominal pain, fast or difficult breathing) please come to hospital immediately taking the following precautions: Call the hospital; Put on a surgical mask en route; Alert the staff manning the entry points into the hospital and the maternity unit.

A surgical mask should be issued to you if you do not have one already on. Thereafter you will be assessed in an isolation room and further care discussed.

If you suspect that you could be infected with Covid-19 or have been exposed but your pregnancy is otherwise well please get in touch with you doctor. At Aga Khan University Hospital, we encourage you to immediately call the Covid-19 hotline 0709 931 700.

Can I touch or hold my baby if I have Covid-19?

Yes. Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be supported to:

Breastfeed safely, with good respiratory hygiene; Hold your newborn skin-to-skin, and Share a room with your baby Can women with Covid-19 breastfeed?

Yes. Women with Covid-19 can breastfeed if they wish to do so. They should:

Practice respiratory hygiene during feeding, wearing a mask where available; Wash hands before and after touching the baby; Routinely clean and disinfect surfaces they have touched. You should wash your hands before and after touching your baby, and keep all surfaces clean.

I have Covid-19 and I am too unwell to breastfeed my baby directly. What should I do?

You should be supported to safely provide your baby with breastmilk in a way possible, available, and acceptable to you. This could include:

Expressing milk Donor human milk Formula feeding should be reserved only as a last resort when it is impossible to get breastmilk for your baby. Re-lactation, the process of resuming breastfeeding after a period of little or no breastfeeding, should be started as soon as you are able to breastfeed again.

Which precautions should I take when I come home after the delivery of my child?

You can breastfeed and handle the baby as normal. You should still strictly adhere to the advice on reducing risk for infection. We all naturally want to welcome a newborn in to the extended family, group of friends and colleagues, but at this time visits should be discouraged.

Dr Mwaniki is the Vice Chair, Clinical Services, at the Department of Obstetrics and Gynaecology, Aga Khan University Hospital