Ask Maven Anything: Experts answer questions on COVID-19, fertility, and pregnancy

Q: Should pregnant women consider a home birth?

Dr. Jane van Dis: COVID-19 should not be the reason that you choose a home birth. Women choose many different types of births, and we respect that maternal choice. I do emphasize that if you are considering a home birth, you should speak with a provider in order to fully evaluate what the risks might be for you, and what the risks might be for your newborn. A study that came out recently revealed that newborns who were born at home had a rate of death four times higher than those born in a hospital. You should also think about the fact that half of all home births require transfer to a hospital. And this is the most striking thing for women to consider right now, because in the coming weeks and days, we expect that our healthcare system is going to be very stressed and what would be devastating is if you called for an ambulance during a home birth and there wasn’t one available, due to the massive influx in need. While I understand the thought of staying away from the hospital may feel like the best approach, if you’re going to make that decision, just do so with all of the information that you can so you make a choice that is comfortable and right for you.

Q: For women and their families preparing to go into the hospital for delivery, how can they stay safe at the hospital from COVID-19 and how are hospitals preparing for safe deliveries?

Dr. Jane van Dis: Most hospitals are limiting visitors, some to only one or two people. There can’t be any alternating between people, like we would commonly see in a Labor & Delivery room. A lot of hospitals are currently putting in a separate entrance.

The most important recommendation is to call before you go to your hospital, especially if you are having any signs or symptoms of COVID-19. So if you have a fever and a cough, call ahead so that you don’t go straight to Labor & Delivery unannounced, as you might have otherwise, so that everyone can effectively keep other patients and healthcare workers safe when they present to the hospital.

One thing that will be different in the hospitals, in Labor & Delivery in particular, is that we’re going to see more virtual care. On Maven, we have virtual doulas, lactation consultants, certified nurse midwives; so even if your doula who you worked with throughout your pregnancy is restricted because your hospital is only allowing one person with you and you’re going to bring your partner, you can still connect virtually with birth personnel. I want to remind women that even though some of the systems are changing, you shouldn’t feel alone.

Q: For women in their first or second trimesters, we’re starting to hear from our members about appointments getting pushed or early appointments getting canceled. This is causing some anxiety, particularly for women in high-risk pregnancies or who have had miscarriages prior to their current pregnancies. How should pregnant women in their first or second trimesters be thinking about these changes?

Dr. Jane van Dis: I connect with a lot of OB-GYNs across the country every day, and what I’m seeing is that a lot of OBs are imagining how they can move some of their visits to a telehealth solution. So your OB-GYN might recommend that some of your visits be via telehealth, and that shouldn’t alarm you or scare you—that’s just to limit your exposure to others and allow you to go through some of the normal prenatal care from your home. We as a workforce, as OB-GYNs, are working with the American College of OB-GYNs (ACOG) and the Society for Maternal Fetal Medicine (SMFM) trying to understand what has to happen in-person, and what can be accomplished via telehealth, and we think that there may be some new guidelines coming.

We do know there are a couple of milestones in a pregnancy that require you to either get a lab or an ultrasound:

• A first trimester ultrasound to date the pregnancy and determine a due date, and make sure it’s in the uterus, as well as obtain some first trimester baseline labs
• There’s another lab draw at 18 weeks
• An anatomy scan is very important at 20–22 weeks
• There are labs again at 28 weeks, including rhogam if you are Rh-negative
• Lastly, there’s an important lab at 35 weeks to determine your GBS (Group B Strep) status

Again, I will emphasize that there are a lot of things that can be accomplished via telemedicine—at Maven, we obviously have maternal fetal medicine doctors on our platform, we have genetic counselors, we have mental health practitioners, doulas, CNMs, lactation consultants, dietitians, diabetic coaches—so I would expect that, if your in-person OB-GYN is recommending telehealth, that you avail yourself to that because it does allow you to keep that social distance.

Q: If a mother and her infant test positive for COVID-19, will they be separated in the hospital, and for how long?

Dr. Jane van Dis: That is a good question, and the current recommendation is that they should be separated. Now, what that separation looks like depends on a specific hospital’s protocol; sometimes, I’m reading that the baby and mom are in separate rooms, but in other instances I’ve seen a six-foot distance with some type of barrier, maybe a cloth curtain, in between mom and baby. So we are working through these protocols, and recommendations obviously need to be specific to the hospital you are delivering at, but given that we are seeing that newborns and infants are affected by this virus, and that they can require critical care, taking the appropriate precautions for COVID-positive pregnant women after birth in terms of separation are very much warranted.

Q: When do you think elective procedures will resume?

Dr. Brian Levine: Unfortunately, we don’t have any insight into the actual timeline of when we will be allowed to start elective procedures, and this is happening on a state-by-state basis. We do know that the American Society for Anesthesiologists came forward with a petition statement recommending that procedures be done outside of the hospital setting, so I think what we’re going to see over the next couple of weeks is that it will be permissible to do elective procedures, provided that they’re not using hospital-based resources. I think that’s going to be partially due to the fact that a lot of people cannot wait for these procedures, which would be likely orthopedic or other procedures, but also because there’s going to be a backlog, and many people won’t get treated at all.

In the fertility world, I think it might be eased up even sooner, given the fact that people are going to continue to age and there is going to be a backlog of cases, but we just don’t know right now, and it’s really on a state-by-state basis.

Q: Here’s a question from a member: “I’m self-pay and live in New York City, but I’m currently in Los Angeles. If I can’t make it back to my city for the procedure if my city isn’t starting egg freezing cycles, can I just do a cycle here? What are the considerations involved?”

Dr. Brian Levine: I always urge patients who get “stuck” somewhere else that it is up to the clinic that they’re looking to go to, and their comfort level with proceeding with a cycle. There are some really basic things that need to be known before stimulating any patient: what is their risk of ovarian hyperstimulation or getting sick as a result of the stimulation itself, and also what are the other health complications or considerations had before stimulating them.

In this very charged time, some places are having a “lockdown”, so it’s not possible right now in Los Angeles or San Francisco to proceed with treatment. In the next couple days to weeks to months, it’s quite possible that you’ll be able to do their cycle, but it will be up to that actual clinic if they’re still running and if they do want to accept patients that were initially not their own. So it’s a clinic-to-clinic basis.

Q: What are the risks/benefits of using anti-anxiety medications while pregnant? From a member: “I’ve treated my anxiety with Zoloft in the past, but I’m currently unmedicated. My anxiety has been under control my entire pregnancy (I’m 25 weeks) until this past week when it started interfering with my sleep.”

Dr. Jane van Dis: You’re not alone. A lot of us are feeling heightened anxiety. I think that any medical decisions about what medications to take must be made in consult with your doctor because your doctor knows your medical history and all the other medications you might be taking as well.

Having said that, anxiety is a normal and appropriate response to a crisis like this, and I would say for those who are experiencing anxiety, having the access to mental health professionals is also something that should be availed. I can’t really offer advice about a specific medical recommendation, but I can tell you that working with your doctor along with mental health professionals can really help in the next few weeks and months.

Q: What are the specific ramifications to the fetus if the mother gets coronavirus? Is it more dangerous for a pregnant woman to get coronavirus earlier or later in their pregnancy?

Dr. Jane van Dis: What we know is that there currently is no evidence of vertical transmission—that is to say, if a mother is pregnant with COVID-19, she does not give COVID-19 to the baby while in utero. That is our knowledge to date. In terms of when the infection might be the most risk to a developing embryo or fetus, we know that a fever in the first trimester can increase the risk for miscarriage, becasuse we saw that in some of the SARS data that has come out, which is another coronavirus. So we need more information, more data, to be able to give a very concise opinion about which trimester might be the most dangerous, but what I would say is that if you have a fever, you need to reach out to your doctor and find a way to address that.

We get fevers for all sorts of things in pregnancy—we sometimes see fevers due to a kidney infection in the first trimester—anytime there’s a fever in pregnancy, it’s something that we as OB-GYNs and medical professionals all want to treat. So I recommend taking precaution whenever you have a fever in pregnancy, and we’ll know more about which trimester later on.

Q: “I’m pregnant and I like to run outside. I’ve heard contradicting statements about whether the virus is airborne. If I’m practicing social distancing, should I feel safe running in my neighborhood as an at-risk category person?”

Dr. Jane van Dis: I think running outside is probably good for mental and physical health, and the discussion about airborne vs. droplet is one that has gotten a lot of conversation. According to the CDC, we still understand this to be a droplet precaution, so I think that getting outside and getting fresh air, so long as you’re keeping your social distance (at least six feet), will be good for mental and physical health.

Q: Can a baby contract COVID-19 when born naturally vs. a C-section, and is there a greater risk for C-section?

Dr. Jane van Dis: We have not seen that there’s a greater risk for C-section. Some of the case studies that we saw coming out of China had increased rates of C-section for women who had COVID-19. You can imagine if you’re having respiratory issues, or if your lungs aren’t at full capacity, pushing for three hours would be too taxing on the maternal physiology—so Cesarean sections might have been performed for maternal indications, maybe for fetal indications. But to my knowledge, there’s no difference between vaginal birth vs. C-section, in terms of passing COVID-19 to the fetus. What we are thinking is that passage of COVID-19 to the fetus occurs via respiratory droplet after birth.

Q: “If we’re following lockdown and we’re trying to be safe at home, do we also need to physically distance ourselves from family members in our homes if we’re pregnant? If we’re going to the grocery store to get food and supplies, should I be distancing?”

Dr. Jane van Dis: That is a hard question because we all have different living arrangements and we don’t all have the ability to social distance in a way that really matters. Therefore, I would say that in the same household, we need to make sure everyone is practicing good hand washing. Unless someone in your home is showing signs of illness, pregnant women shouldn’t social distance within their own home.

Maven is here for you

In a time of heightened anxiety, misinformation, and a lack of access to medical providers, we at Maven are committed to ensuring women and families have access to the most up-to-date information and fact-based resources, as well as on-demand care and support when they need it without having to leave home.  

• Stay well and stay informed by visiting our coronavirus resource center - we’re updating this regularly, and will share information here on next week’s Ask Maven Anything webinar (updated March 20)
• Read more FAQs on pregnancy and coronavirus answered by Dr. Jane van Dis (updated March 20)

What is Maven?

Maven is a virtual clinic for women and families. If you have a specific question, or cannot get through to your doctor, you can schedule a virtual appointment to speak with one of Maven’s providers. There are more than 20 types of care providers available on Maven, including OB-GYNs, pediatricians, nurse practitioners, midwives, doulas, and more. To get started, download the Maven app by searching “Maven Clinic” in your iTunes or Google Play app store.