What to expect when you’re expecting: The pandemic version

Prenatal care in the time of COVID-19

*** Last updated: July 22, 2020 ***

Here you will find information on prenatal appointments, what to do if you get sick and information about breastfeeding during the pandemic.

Prenatal Appointments in the time of COVID-19

Different doctors are doing different things, and quite honestly, we’re still figuring out what to do on our end. That gives you options. Feel free to talk to your provider about what you think might work best for you. Here are some things you may want to consider doing.

Can you do some appointments by phone?
For all phone appointments, it’s helpful if you can weigh yourself and take your blood pressure.

Here is how many care providers are organizing visits:

  • In person appointment at 11-13 weeks, 20 weeks, 26-28 weeks, 32 weeks, 36 weeks, 39, 40 and 41 weeks
  • Phone or video appointment at 16, 30, 34, 37 and 38 weeks

Can you just have fewer appointments?

  • The WHO suggests that prenatal appointments be scheduled at 12, 20, 26, 30, 34, 36, 38 and 40 weeks. A lot less busy than our Canadian schedule, eh?

Can you do shared care?

  • This might be a good option if your OB is in the hospital and you really want to avoid a visit.
  • Shared care means that your family doctor and your prenatal care provider (another family doctor, midwife or obstetrician) both see you for your prenatal appointments. For most women in pregnancy, your family doctor will be able to do your usual measurements, have a listen to baby and guide your care. They can always send a note to your prenatal care provider if for some reason, you aren’t able or comfortable with in-person visits.

Ultrasounds

A quick note on ultrasounds. We are trying to limit people’s contact in health care settings as much as possible. This means that we are trying to consolidate ultrasounds. For example, if you are sure of your last menstrual period date, your provider will likely suggest skipping an early dating ultrasound and just doing an ultrasound as part of the Down Syndrome screening (eFTS). If you aren’t able to get an eFTS ultrasound because you are on quarantine or for some other reason there are other options for screening. See this helpful link.

Bloodwork

Early pregnancy: Unless otherwise suggested by your doctor, I would suggest doing your basic pregnancy labs at the same time as your bloodwork for Down Syndrome screening (depending on the test, around the 9-13 week mark). There is no need for two lab appointments.

Mid-pregnancy bloodwork: I have been advising patients to combine the diabetes bloodwork with the repeat anemia/blood type test at 28 weeks. You can consider doing a new test (haemoglobin A1c and random glucose) for the diabetes screening that does not involve you hanging out at the lab for an hour. If your doctor wants you to do a test that involves having to hang around for more bloodwork, ask them to write on the requisition ‘Okay to wait for blood draw in car’ so that you don’t have to sit in a room with other people.

Should I still be working?

The Society of Obstetricians and Gynaecologists of Canada believes that it is safe for even pregnant health care workers to continue their duties, wearing whatever personal protective equipment (mask, gloves, faceshield) that their non-pregnant colleagues use. Most doctors are not putting pregnant patients off work during this pandemic to just avoid the virus. I understand that many people are not comfortable going into work right now. Talk with your employer about minimizing your exposure to others and maximising remote work if possible. Follow public health guidance on hand washing and social distancing.

Now... what if you get a cough? A fever?

Anyone in Ottawa can now go to an assessment center and get a COVID test. If you have symptoms, such as a cough or a fever, I would go. With two small kids and a husband who works in the ER, my family has already been five times for sniffles and fevers (and this was before daycare opened)! It’s not scary and if my one year old can do it (twice), so can you! Mask up and bring something disposable to read!

If you have a fever, it would be wise to check in with your doctor by phone but with any typical cold, and COVID-19 too, it will likely be gone after a few days. It is safe to take acetaminophen (Tylenol) for fever in pregnancy. It is not safe to take ibuprofen (Advil/Motrin) during much of pregnancy, so just forget about that one. Many over the counter cough medications are not safe for pregnant and breastfeeding women so if you feel like you need something for cough, talk to your pharmacist and let them know you are pregnant. Also look out for alcohol in cough syrups! That would be a no. A product with just dextromethorphan at the usual over the counter dose in most pregnant women would be okay.

Now... what if I actually get COVID-19? Will my prenatal care be different?

Pregnant women who get COVID-19 will likely be managed in a similar way to pregnant patients who get the flu. Please stay hydrated and taken acetaminophen (Tylenol) for your fever. If you can feel your baby already, you should be mindful of doing your kick counts. Your provider may want to do a few extra ultrasounds when your self-isolation is over to see how your baby is doing. With most providers, your prenatal appointments will be done by phone until your quarantine is over. Please see my other blog post about what to expect if you have to go the hospital for a problem in pregnancy or labour.

Breastfeeding

If you have COVID-19, please strongly consider breastfeeding your baby.
Your immune system will give your baby extra protection via your breast milk. COVID-19 is not likely to be transmitted via breast milk.

It is advised that you wear a mask until your symptoms have completely resolved and please be extra careful with washing your hands when handling your newborn.

Breastfeeding is a skill. Prepare as best you can by reading, watching videos and talking to a lactation consultant prior to giving birth. If you are having trouble once baby arrives, please ask your doctor, nurse and lactation consultant for help.

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