Ob-Gyn talks about creating a birth plan and breastfeeding during Covid-19

Covid is causing a significant amount of stress to pregnant women. They have various concerns around creating a birth plan, the safety of C-section, the availability of doctors, and whether they can breastfeed.

Doctors say that being prepared, staying calm, avoiding social gatherings, and choosing the right doctor that women are comfortable with, are key to a safe pregnancy and giving birth in these uncertain times. As far as breastfeeding is concerned, all major organisations like the World Health Organisation (WHO) have endorsed it. The WHO says the data on vertical transmission of covid-19 through breastfeeding is still not sufficient. “In infants, the risk of covid-19 infection is low, the infection is typically mild or asymptomatic, while the consequences of not breastfeeding and separation between mother and child can be significant,” the organisations says.

In the second part of our interview with obstetrician and gynaecologist Dr. Vanita Vaishnav (consultant with Practo), we address these concerns that pregnant women have during the time of Covid. Edited excerpts:

• How should women create their birth plan as things are not the same because of Covid-19?
• Is an elective C-section safe in the time of a panemic?
• Is breastfeeding safe? Can Covid-positive mothers breastfeed?
• How much time should you spend at the hospital post giving birth?
• What are the special precautions you should take at the hospital?
• How can pregnant women cope with increased stress caused by covid?

Due to the disruptions caused by Covid-19, pregnant women are worried that their doctors may not be available. In that context, what should their birth plan look like?

Women should discuss their birth plan in detail with their primary health consultant. Every patient is different, and every case is different, so the doctor will have a plan which suits the patient.

In cases where elective C-section needs to be done, women can be mentally prepared since they know the date and time of the caesarean. The healthcare facilities are taking care of sanitisation and hygiene. As far as that is concerned the patient need not worry. Inside the hospital, the number of visitors is limited. Hospitals usually allow only one family member to accompany women in labour. As far as labour is concerned, it is slightly unpredictable, but the ob-gyn are trained to handle these cases. Even if your primary doctor is in self-quarantine, there will be other doctors who will be available as they work in shifts.

It is best to leave the birth plan to the doctor. If pregnant women have any doubts about the birth plan that the doctor has recommended, they should get a second opinion. But if they trust the doctor, then they shouldn’t interfere with it. Pregnant women should follow up on their prenatal checkups, and decide the place and date of delivery in advance. Do not keep on changing the doctor, unless it is absolutely necessary. Get familiar with the place of delivery. Most hospitals are doing covid testing two weeks before delivery, so pregnant women will be tested. If they have chosen the hospital, the staff will be keeping a track. They will start following up and call them for covid testing. 

What about women who plan to have an elective C-section? Is it safe in the time of a pandemic?

It is safe. Covid doesn’t change anything as long as the hospital is following protocol, and taking measures to maintain hygiene, testing the staff as well as the patients. If everything is taken care of, it is like any other delivery. Doctors do deliver babies for HIV-positive patients; even that can be transmitted. The doctors can be exposed to HIV; even in those cases, doctors follow protocol and deliver babies. Similarly in Covid  as well, as long as the precautions are taken, elective c-sections can be done safely.

If a woman who has just given birth has covid, can she breastfeed? What are the chances of the baby having covid? Can covid-positive mothers breastfeed?

If they are in the hospital or even back at home, it is better for the new mother to wear a mask and keep their mouth away from the baby. It is not just about covid, even if it is a cold, you don’t want it to be transmitted to the baby during this time. Hand hygiene, wearing a mask, all these precautions must be taken, even if they have covid or not.

All the national as well as international obstetrician and gynaecological bodies and other organisations including the WHO have strongly advised that breastfeeding should be continued, even if the mother is positive, provided she is stable. If the mother is not stable it is a different thing. But if the mother is fine or even has mild symptoms, breastfeeding should be encouraged because the advantages of breastfeeding go a long way. There have been studies on covid-positive mothers who breastfed their infants. Even babies who got it, the studies cannot conclude for sure, whether they got it from the breastmilk or not. 

There is no conclusive study which says that breastfeeding is harmful. Research and available data suggest that infants and very young children have mild infection or symptoms of covid. They are not developing severe infections. The severity is high mostly in the aged population, and now it is also seen in people in their 30s or 40s. We don’t usually come across cases where say a 4-year old or a 2-month old baby has a severe infection. Breast milk contains antibodies and immunity is passed on to the baby, so it is strongly encouraged.

The other precaution for covid-positive mothers is that the baby should be taken to them only for breastfeeding. The rest of the time someone else can take care of it.

There is no conclusive study which says that breastfeeding is harmful. Research and available data suggest that infants and very young children have mild infection or symptoms of covid. They are not developing severe infections. Breast milk contains antibodies and immunity is passed on to the baby, so it is strongly encouraged.

Women are also worried about spending time in the hospital after birth, does this increase their risk of Covid exposure?

The packages for delivery, whether it is elective c-section or vaginal birth, don’t normally extend beyond 72 hours. That is what is needed for the mother and the baby. In the first 24-48 hours, babies may develop some conditions, so they have to stay at the hospital. Hospitals are following protocol strictly, they are not allowing relatives, they are testing patients and their staff. Some hospitals are also allowing patients to have home-cooked meals if they have apprehensions about eating the food cooked by the staff. Hospitals are taking precautions, doctors are taking precautions, so are the patients who are worried for themselves. If the doctor says, you should stay a bit longer, you can.

Some private hospitals offer single rooms, but not everyone can afford it. So, if you are in a shared room or a general ward, it does increase the exposure, but there is no way out, you can’t deliver and go home immediately. There is some protocol which has to be followed post giving birth. There are also vaccinations which are must for the baby, and all of them have to be administered while the baby is in the hospital.

If you are in a general ward, what are the special precautions you should be taking?

The precautions are the same, wear a mask, wear a face shield, use gloves whenever you are using the washroom. Take your own bed sheets and bed covers, pillows, do not use the hospital sheets if you are not sure that they are washed properly. You can also wear your own clothes if the hospital allows that. Do not talk to people if it is not necessary. Keep the interactions to the minimum, and limit the number of relatives that visit you. 

How can women cope with the increased stress of being pregnant during the time of a pandemic?

They should try to stay as calm as possible. Since the unlock has started, try to get some support from a relative, who could perhaps stay with you. Especially close to the delivery date, get someone who can help you out. If you are a first time mother, or if you already have children, you will need some help. Follow all the precautions. Maintain physical distancing and avoid social gatherings. Keep your supplements up to date, stay in touch with your doctor, you can do it over the phone, or using telemedicine. Whatever your concerts, doubts are, they can be solved over video or audio consultation.

Stay in touch with friends and family. Even if you are not physically connected with people, stay in touch with them otherwise you will feel aloof. If you are alone, you will keep thinking about covid, if you have people around, you will have other things to talk about and share. It helps divert your mind. You can also take this time to indulge in hobbies, which won’t harm your pregnancy. Always choose a doctor, who you can trust completely. If you don’t like a doctor in the first consultation, you can always find another one that you are more comfortable with.

Stay in touch with friends in family. Even if you are  not physically connected with people, stay in touch with them otherwise you will feel aloof. If you are alone, you will keep thinking about covid, if you have people around, you will have other things to talk about and share.

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