What We Can Control……

To say that we are living in unusual, confusing, and stressful times is an understatement.  There have been many attempts to define or even characterize the impact that the Covid-19 pandemic has had on us as a society.  In my opinion, they fall short because every situation is so different and words can’t describe the true range of emotions and experiences that are happening throughout the entire world right now. 

It makes me feel even more for people who are considering a pregnancy or who are in a pregnancy after a previous loss.  I often think of those situations in terms of the roller coaster of emotions and constant stress as well.  Having that experience at the same time as the pandemic is more than anyone could prepare for.   

Adding to the stress are the confusing, conflicting, and often scary reports coming from medical and non-medical sources.  Who should we believe?  How scared should we be?  What should we be doing differently? 

A recent news report shared a case study of a woman with Covid-19 who had a 2^nd trimester loss and evidence of Covid-19 was found in the placenta after delivery.  This is obviously very scary and heartbreaking for this woman and her family.  But trying to identify how this situation should affect what other pregnant people are doing is rather complicated.  I’ve had some fascinating conversations with members of our medical advisory team about this and many other reports lately.  (Side note – a special THANK YOU to everyone who has taken the time to respond to my questions and offer your perspective and expertise in the middle of taking care of your patients!!).  Health professionals prefer to base every decision on hard evidence.  Unfortunately, right now, the evidence is still being developed.  The questions and studies that usually take years or decades are being considered in a matter of hours or days.  Inevitably, it leads to more questions. 

In the situation of the study mentioned above, many of our advisors acknowledged that the potential for this to be something of concern is real.  Infection is hard on a mother’s body and a developing baby, there are reports of Covid-19 affecting blood flow/clotting, and true vertical transmission (the baby being infected through the placenta before birth) would be a new report that we haven’t yet seen with this particular virus.   But there are also many questions that may lessen our concern.  How was the testing done?  What other tests were done or not done?  Can we confirm that the baby’s death was due to the infection (rather than the baby dying of another cause that happened at the same time the virus was present)?  What other factors were present in this pregnancy that could have affected the outcome?  Will this situation be repeated in other people or is this a very unique case?

And this is just one article!  There are dozens published every week. 

Anecdotally, many providers tell us they are seeing an increase in the number of miscarriages and stillbirths.  What we don’t know is how many of them are in people with Covid-19?  How many are due to Covid-19 or not?  How many are more related to a change in care protocols (especially fewer in-person prenatal visits and less monitoring)?  How many are related to the stress or fear experienced by families at this time?  How many are related to the health disparities that are always present but exacerbated during the pandemic?

I don’t have the answers either.  Nobody does.  And that, unfortunately, is the hardest part.  The good news is that we learn more every day.  The bad news is that it isn’t yet enough.  Some day it will be – but that won’t be for a while.  

But that doesn’t mean we’re helpless either.   I encourage everyone who is pregnant now to think about the aspects of this situation that you have control over.  Do those things and know that parenting is hard! 

• Attend all of your prenatal visits.
• Don’t be afraid to tell your provider if you have questions, concerns, or are uncomfortable with the current plan/answers.  Work through the situation together!
• Advocate for yourself and your baby!  You know this baby and your body better than anyone.  Be sure and tell your supporters and your health providers what is happening and if you have any concerns.
• Don’t avoid seeking health care for fear of Covid-19.  Health care facilities are doing more all the time to ensure the staff and patients are protected. 
• Be your own pregnancy monitor!  Get familiar with your baby’s movements – the strength, pattern, frequency, triggers, and other characteristics.  If you notice ANY change in these behaviors, call your provider or go into the hospital/clinic immediately! 
• Practice social distancing and good hygiene.  Encourage those in your household to do the same as much as possible.
• Tell your provider if you have been exposed to Covid-19
• Be part of the solution!  There are many studies you can join to help researchers learn more about pregnancy during the pandemic and in general!  Consider participating in the Pregnancy Research Project, the Covid-19 and Maternal Health study, and more!
• Take care of yourself emotionally as well as physically!  Join our free, virtual support groups or call our Support Line (952-715-7731, ext 1). 
• Attend one of our virtual Childbirth Classes designed for families who have had a previous pregnancy loss or other poor outcome.  In addition to the usual childbirth issues, we’ll discuss plans and contingencies related to the pandemic. 
• Call your health provider or go to the hospital immediately if you have any of the following:
  • Fever
  • Difficulty breathing
  • Severe cough
  • Severe headache
  • Sudden or increased swelling
  • Severe itching
  • Any change in baby’s behavior
  • Bleeding
  • Sudden or worsening abdominal pain
  • Other concerns or ‘gut feeling’ that something isn’t normal or okay

Until we have more answers – we’ll be walking beside you!  It is true that we all have a different experience and perspective on this pandemic, but it is also true that we can work together and let this newest challenge bring out the best in all of us.