Birth In The Time of COVID-19
What to know for your prenatal, delivery and post natal care
By Violeta Patinioti
If you are pregnant or a new mother during this period, it can be stressful and understandably so. If you live in Turkey, this article will share ways to keep you and your loved ones as safe as possible as the COVID-19 pandemic unfolds and we learn more about its effect on the population.
There is no evidence of an increase in the risk of miscarriage or birth defects if the mother has the virus. According to the World Health Organisation (WHO), pregnant women with no underlying health problems do not appear to be any more likely to catch COVID-19 than the general population. We don't know if the disease is transmitted to the baby in the womb. There have been three documented cases in China where babies were infected in utero but they were all cured by the time they were six days old, and have survived. There was also a case in China, where antibodies were found in a healthy new-born whose mother was COVID-19 infected. Many questions regarding COVID-19 symptoms remain unanswered, and the risk of the unknown is always high. Therefore, the Turkish Society of Obstetrics Gynaecology recommends erring on the side of caution and self-isolating. According to United Nations Population Fund (UNPF) pregnant women with symptoms or who have been affected by COVID-19 have priority for testing and treatment.
The safety measures taken by pregnant women should be the same as any healthy person. Along with social distancing, maintaining proper hygiene—especially hand washing—is the most important thing one can do.
In Turkey, 184 is the national COVID-19 help line that offers assistance in multiple languages. In the meantime, the healthcare system provides pregnant mothers a midwife, who is linked with the family’s general practitioner. Please get in touch with the family health centre in your neighbourhood to find your midwife, in order to receive the best medical advice possible.
Doulas and midwives around the world are receiving requests and questions from women about a variety of concerns. We will try to answer some of them with the special help of doctors, midwives and associations. Please keep in mind that in Turkey each private hospital has its own policy which can change at any time. We recommend you double-check the latest policies with your midwife and hospital beforehand.
WILL MY BIRTH PARTNER BE ABLE TO JOIN ME WHEN I DELIVER?
The majority of hospitals are restricting the number of people who can accompany you in labour for health and safety reasons. In public hospitals, a male partner is not allowed to be with the mother during labour at any point. As a result of COVID-19, private hospitals allow only one family member in the labour and delivery room. In some very rare cases, when for example there is a language barrier, a doula may be allowed.
Unless the manager approves it beforehand, public hospitals do not allow partners or other third parties in the labour and delivery room at any point.
My advice is to check with the hospital where you will deliver, and ask if you can have your mobile device with you and FaceTime with your loved ones during labour. If you are comfortable with that, keep spare batteries on hand because you never know how long it will take.
Birth partners may wish to discuss whether they should be wearing personal protective equipment (PPE) such as gloves and masks, in order to help to reduce potential transmission of COVID-19 between them and the medical staff.
WILL I BE ABLE TO HAVE MY BABY AT HOME?
Even though you can deliver at home with a private midwife, the papers still need to be signed by a doctor. If you have already organised a home birth with a private midwife and she hasn't cancelled due to the social distancing policy, then everything should go as planned. At the end of the day it is your choice where to have your baby. However, you will need to take into account any specific issues that might affect your delivery, as well as the chance of contracting COVID-19. Keep in mind, many home births are being cancelled and transferred to hospitals or birth centres in order to provide necessary medical attention.
CAN I USE GAS & AIR (ENTONOX) DURING DELIVERY?
Gas and Air is a mixture of oxygen and nitrous oxide used for pain relief during delivery. However, it is not an option for labour in Turkey.
WHAT ARE MY OPTIONS IF I HAVE A SUSPECTED OR CONFIRMED COVID-19 INFECTION?
The latest guidance from the Turkish Perinatal Society is to encourage, rather than require, women with suspected/confirmed COVID-19 to birth in the pandemic hospital. Although she is not in danger, she is still contagious so the standard procedure has to be held for the health and safety of the doctors and medical staff.
During labour, the mother will be isolated in a private labour room and will be asked to wear a mask. Vaginal birth is always encouraged if there is no emergency reason for a caesarean section. In preterm cases where the baby’s lungs are in need of antenatal steroids to function, the mother’s health must also be continuously monitored so as to not put her at risk.
Although there is no evidence yet providing risk of contamination from the umbilical cord, the society recommends immediate clamping as the new-born needs to be examined. However, it is at the doctor’s discretion to decide when the cord will be clamped.
There are also reports underlining that the virus is not transmitted from breastmilk or nursing. However, if you are pumping, make sure you keep all the equipment and the bottles clean and disinfected.
If mother and child share the same room, the society recommends a social distance of two metres between their beds.
WHO CAN I SPEAK TO IF I AM CONCERNED ABOUT MY HEALTH?
You should memorise the COVID-19 Helpline for Turkey (184) and have your midwife's doctor’s numbers on speed-dial.
WHAT ABOUT SUPPORT WITH FEEDING MY BABY?
The latest guidance from Temas Association confirms that even women with confirmed COVID-19 infection should be encouraged to have skin-to-skin contact and breastfeed their baby if that is their choice. If the mother doesn’t feel secure enough to breastfeed she can always pump. The standard health and safety precautions will apply.
Whether in hospital or at home you must:
Wash your hands before touching the baby, the pump or bottles
Avoid coughing or sneezing on baby while feeding at the breast or wearing it
Consider wearing a face mask while breastfeeding and baby-wearing.
Follow recommendations for pump cleaning after each use
Consider asking someone who is well to feed your expressed breast milk to your baby.
Breastfeeding Counsellors, Lactation Consultants and doulas together with your local midwife are available for information and support so do reach out if needed. For breast-feeding support organisations in Turkey, you can contact: La Leche League or Temas
WHAT ABOUT FORMULA FEEDING?
If you choose to formula feed your baby, sterilising the equipment must be your number one priority. Also, please do consider the number of people who get involved with the baby.
Due to the stock shortage during this crisis, please inform your pharmacy for the quantity you need so they can place an order for you.
You will get support at any maternity service you choose, as long as you inform your midwife or doula and cooperate with her.
None of this information could be possible without the help, advice and contribution of Dr Gulnihal Bulbul, Obstetrician and Gynaecologist, who specialises in natural birth, and doula and baby first aid specialist Refika Onat. My greatest respects to the Association for Improvements in the Maternity Services UK for the inspiration of providing in public an article like this referring on COVID-19 and pregnancy. My deepest gratitude to all these wise women of Red Tent Doulas who since Day One of this pandemic crisis discuss, connect and asks for answers to advocate and support pregnant women when is needed.
This article is not intended to replace the advice of a medical doctor. Its purpose is to inform, raise awareness, and start a conversation about the necessary protection and support during pregnancy, labour and postnatal care.