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As if family planning, conception, pregnancy, birth, and bringing baby home weren’t complicated enough, COVID-19 has brought an additional set of concerns.
Many potential parents have similar questions about how to best move forward with their lives and plans for their families. Here, experts—a family medicine physician, OB/GYNs, and pediatricians—from Virginia Hospital Center reveal the latest thinking on the four stages of starting (or expanding) a family.
Many questions about COVID-19 vaccinations relate to conception, pregnancy, and breastfeeding. The vaccines seemingly have no adverse effects on fertility. The American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, and the American Society for Reproductive Medicine concur that whether women are trying to conceive, become pregnant, or are breastfeeding, they should not be excluded from getting the vaccine. Further, ACOG recommends that pregnant women be free to make their own decision regarding vaccination.
“Whatever the patient decides, my role is to help them work through it and support them,” says Dr. Lynsey Owen, of the VHC Physician Group-OB/GYN.
“Neither COVID-19 itself, nor the vaccines are thought to affect fertility and it’s not necessary to delay pregnancy after getting vaccinated,” says Dr. Kendall Adams. “Also, you do not need to take a pregnancy test before getting the vaccine.”
Deciding to start a family should also include deciding to be as healthy as possible—no different than pre-pandemic. “I help women with pre-planning to make sure any chronic illnesses they have are well controlled six months prior to conception,” says family medicine doctor Nardin Khalil of VHC Physician Group Primary Care, National Landing. “I try to help my patients attain their best health possible before they try to conceive.”
Once pregnant, how will COVID-19 impact your health and the health of your baby?
Pregnant women are considered high risk because COVID-19 is a lung-based illness. This risk increases at around 24 weeks when the mother’s lungs are compressed due to the baby’s gestational development, which can lead to more respiratory complications. “Pregnant women who are at an increased age or who have coexisting medical conditions are at an even higher risk for severe COVID-19 illness,” says Dr. Adams.
“Pregnant women with severe COVID-19 are hospitalized more often than their peers,” says Dr. Amy Porter, OB/GYN. “That’s why we definitely recommend that pregnant women be vaccinated.”
“I am a person of science,” says Dr. Khalil. “Seeing how safe the vaccine is so far, I would tell most women that it’s not an active (live) vaccine and you should highly consider getting it.”
Pregnancy during the pandemic also poses new concerns around mental health. Because of COVID-19, pregnant women are experiencing increased social isolation at a time when more support is really needed. “I’m seeing a lot of mental health fallout in women who are pushed to the limit before and after their baby is born,” says Dr. Pritha Workman, OB/GYN at the Mid-Atlantic Permanente Medical Group. “Postpartum depression and anxiety are on the rise. I caution my patients to be on the lookout for these changes. If they need support brought into the home, we need to have that conversation. Together, we work out what can be done to make them feel mentally and physically well.”
How has the birth experience changed during the pandemic? Actually, not that much. At VHC, labor and delivery care are essentially the same, except staff is masked and wearing more protective gear. All moms, meanwhile, are tested for COVID-19 upon admission. If the test is positive, but mom is asymptomatic, we do normal obstetric care, with mom and her partner, and the baby staying in their room while avoiding contact with others.
“People worry we’re going to take the baby away if mom is diagnosed with COVID-19,” says Dr. Ingrid Winterling, OB/GYN. “That doesn’t happen unless we need to intervene for the health of the mom or baby—which would be true whether or not there was a pandemic. Most patients say they were nervous about delivering a baby during the pandemic before coming in, but afterward, they felt good about their birth experience. Once they’re here they see it’s really not that different. It’s normal obstetric care, just with more protective gear for staff.”
Patients also wonder if there is an increased likelihood of having Cesarean delivery if they have COVID-19 close to their delivery time. “Even with moms who have a severe case of COVID-19 requiring hospitalization and oxygen supplementation, their risk of Cesarean delivery is only 2 percent to 3 percent higher than the national average,” says Dr. Khalil. “That gives reassurance to moms.”
We know that even young children and infants can catch COVID-19, though they’re less likely to see severe symptoms. And, the risk of a child transmitting to an adult is lower than from adult to child.
“On the whole, we’ve seen that babies and toddlers are not at high risk for severe disease if they get COVID-19, but we don’t have long-term data,” says Dr. Sarah Hesselmann, a pediatrician, who gave birth shortly before the pandemic started. “It often will present like a cold, with headache, sore throat, and runny nose. But the presentation is not limited to these symptoms. If your child is ill, we often advise to keep him or her out of daycare or school until assessed by a doctor.”
“Even before the pandemic, we advised new parents to limit exposure to non-family or non-essential caretakers the first couple months of life,” says Dr. Hesselmann. “The baby has very little immunity, especially in the first few months. For older siblings who attend daycare, we understand it is often a necessity. We recommend parents do their research about what the daycare is doing in terms of safety protocols. If your center is complying with CDC and local health guidelines, it’s safe for siblings to attend.”
“My parents just held my seven-month-old for the first time,” says Dr. Owen, who was 20 weeks pregnant when the pandemic began and has lived through it along with her patients. “To keep everyone safe, we wanted to wait until they were vaccinated.”
“We are frequently asked, ‘Should my children wear masks when taking care of the baby?’” says Dr. Andrew Wu, MD, a pediatrician. “I believe we need to weigh the risks and benefits of preventing spread vs. creating a normal healthy environment in which the child can develop. During the first couple of months of life, it is so important for the child to bond with immediate family members to form strong connections at an early age. Not seeing facial expressions and smiles makes it hard for a child to develop in a healthy way. I recommend you maintain normalcy at home, and that means not wearing masks around family.”
Family planning in the time of COVID-19 is still a moving target, with constantly changing recommendations. By taking precautions and adjusting to your environment, having a baby can still be the joyous event it’s always been. The key is to have good relationships with your primary care physician, OB/GYN, and pediatrician. Ask lots of questions until you understand and are comfortable with the answers.
“Life goes on, and we have to keep moving forward with precautions,” says Dr. Winterling. “My best advice is to think about the total picture,” says Dr. Wu. “Your health and the health of your family are more than just physical. They include your emotional health, social health, and psychological health too.”
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