Confronting the Coronavirus in the Third Trimester - Advice from a Philadelphia Doctor

Updated: Jul 20

As a mom-to-be (for the first time…or for the second, third, or 10th time), few things are scarier than the global outbreak of a mysterious new disease that has made its way to your community. In the age of the coronavirus, welcoming a healthy baby takes on a whole new meaning. Though there are still many unknowns about the coronavirus, there’s also a great deal of reassuring data and guidelines that medical professionals know but are unable to share with their patients outside of appointments.

Taking on the perspective of an expecting mom, we interviewed Dr. Radhi Kakarla, a member of EmmaWell's Advisory Board. Radhi, who is a respected physician at Main Line OB/GYN in the Philadelphia suburbs, is on the front line in the war against the coronavirus for moms and families and receives daily updates on all progress and protocols related to the coronavirus. She took time out between “homeschooling” her kids, seeing her patients, and advising on medical matters for EmmaWell to answer our burning questions about confronting this pandemic in the late stages of pregnancy.


What can I do to protect myself and my baby from contracting the coronavirus?


Aside from social distancing to reduce exposure, the number one thing is hand washing. I know we’ve all been hearing that repetitively, but hand washing is actually better than hand sanitizer. There was a great article in the New York Times about how soap works to kill viruses: [“A drop of ordinary soap diluted in water is sufficient to rupture and kill many types of bacteria and viruses, including the new coronavirus that is currently circling the globe.”] Washing your hands for at least 20 seconds — that’s the Happy Birthday song twice or the ABC song very slowly — should do the trick.


If you are leaving the house, you should wear a mask, and bring some disinfecting wipes to wipe down frequently touched surfaces. I’ve made my own bleach solution with water and wipes. [Here are some recipes for homemade bleach wipes and hand sanitizer if you are unable to buy them.] If you need to go to the grocery store, wipe down the handles before you grab the cart. The same rules apply for touching the credit card machine at checkout. If you have really young kids, you might want to keep a pack of gloves in the car as an extra precaution.


As a pregnant woman, am I at a higher risk of becoming infected?


As of now, the answer is no. We have limited data and are surprised that we’re not seeing more cases [since the immune system is typically suppressed during pregnancy]. But so far, pregnant women are not getting sicker, which is a very good thing.


Is there evidence that the coronavirus can pass from mother to baby during pregnancy or delivery?


No. It looks like there is not vertical transmission [the passage of a disease-causing agent from mother to baby in the period immediately before and after birth] of the coronavirus. The latest research is showing that contracting the coronavirus during pregnancy might slightly increase the risk of miscarriage, preterm delivery, preeclampsia, cesarean birth, NICU admission, or stillbirth. Again, this data is in its early stages and very limited.


What symptoms should I look out for that warrant medical attention?


Contact your healthcare provider if you start to develop any flu-like symptoms. Symptoms of acute respiratory infection, including a fever over 100.4, a new cough, shortness of breath, and muscle aches, should be reviewed by your doctor to determine whether you need to be tested for the coronavirus.


In the Main Line Health and Penn Medicine systems, there is access to drive-through testing with a referral from your primary care doctor. [edit: there are numerous drive-thru testing facilities in the area now.] If you are symptomatic and are at a higher risk (over the age of 65, pregnant, have a chronic condition, or are immuno-compromised), you should get tested. If your respiratory symptoms are severe, you should go to the emergency department right away. Right now we are focused on testing respiratory symptoms and tracking whom you’ve been in contact with. We are trying to keep people who don’t need to be hospitalized out of the hospital. [Check CDC guidelines for the latest recommendations on coronavirus testing.]


Are the symptoms of the coronavirus the same in children and adults?


Symptoms generally last 8–10 days in both children and adults and mimic the flu so closely that the coronavirus has been hard to detect. It looks like the symptoms are actually more muted in children. The people who are getting sicker are older. Kids will develop the symptoms (e.g. fever, cough, muscle aches) but get over it quickly, whereas some have no symptoms at all. We are most worried about kids being carriers for the virus.


If I know or suspect that I have the illness, should I quarantine myself completely from family members?


Yes. If you test positive for the coronavirus, the recommendation is to stay quarantined for two weeks from the time of exposure. If you are a mother confirmed to have the coronavirus and you are symptomatic, you should take all precautions including washing your hands before touching your baby, wearing a face mask (if possible) while feeding your baby, and thoroughly cleaning bottles or breast pump parts after each use. [See the CDC’s recommendations for detailed instructions on sanitizing your pump and baby feeding parts.] Some added measures you can take to protect the rest of your family are to follow the hand-washing guidelines mentioned previously, cough or sneeze into a disposable tissue, and disinfect objects after you’ve touched them.


Can I pass the coronavirus to my baby while breastfeeding?


It does not look like the coronavirus is passed through breastmilk. According to the latest data, studies on infected mothers showed no presence of the coronavirus in amniotic fluid, cord blood, or breastmilk. Outside of the immediate postpartum setting, the CDC recommends that an infected mother continue breastfeeding or feeding expressed milk to her infant while taking precautions to avoid spreading the virus through respiratory droplets. If you are symptomatic, you should wash your hands before touching your baby, as well as all feeding supplies, and wear a face mask while feeding your baby.


Is it safe for me to go to my regular OB check-ups and other doctor appointments?


Most doctors are cancelling all non-urgent appointments. For instance, all annual gynecological exams are cancelled in my OB practice, but we’re keeping most prenatal care appointments. Your OB-GYN’s office will be able to advise you on when to come in. For other types of appointments, call your provider to see if telemedicine is available. [update: Whenever possible, prenatal care appointments at most OB practices have been shifted to telemedicine].


After I deliver, will it be safe to bring my newborn to the grocery store or on other essential errands?


Only if you have to, but this is not recommended. If within your means, use food delivery services (e.g. Amazon Prime Now, Instacart) to avoid exposure.


Is there anything I can take or do to boost immunity?


Eat well, exercise, and maintain healthy living habits. Physical activity can help reduce the anxiety that is only natural under these circumstances. Of course, there are some homeopathic remedies, like upping your vitamin C intake or popping Emergen-C, but we don’t know if these treatments will really make a difference in protecting against the coronavirus.


Are there any additional precautions I should take before going in for my delivery at the hospital?


The latest recommendation is to adhere to a strict quarantine starting at 37 weeks of pregnancy. Please notify your healthcare provider and the Labor and Delivery floor at your hospital if you’ve been exposed to anyone who is getting tested or is a PUI (patient under investigation) or if you have any cold or flu symptoms (e.g. sore throat, cough). By calling prior to arrival, you’ll give the healthcare personnel involved in your care adequate time to make arrangements for infection control and prevention.


Hospitals in Philadelphia are allowing one support person per laboring patient.* Rapid screening for the disease is not yet readily available when patients arrive at Labor and Delivery, but this is in progress. Make sure your support person is not sick, and consider a back-up plan. For more on giving birth during the pandemic, read our post Preparing for Childbirth in the Pandemic.


You might want to check with your doctor to see if you can get discharged as soon as possible [day one after a vaginal delivery and day two for a C-section]. If you didn’t have any complications during delivery and you and your baby are both healthy, home is the best place to be.



With warmth and wellness,

Your EmmaWell Team


***


Disclaimer: The information provided here is for educational purposes only and is not intended as medical advice. Moreover, due to rapidly changing developments, we make no warranty or guarantee concerning the accuracy or reliability of this content. For the latest information regarding COVID-19, we refer you to the Centers for Disease Control and Prevention website (www.cdc.gov).


* Note: while our advice is known to be accurate at many local Philadelphia-area hospitals at the time of this publishing, this is a dynamic situation and you should take care to check the CDC's guidance and specific policies at your local hospital before you deliver.


Specific COVID-19 Policies at Philadelphia-area Hospitals:

Penn Medicine

Main Line Health Care System

Jefferson Hospital

Temple Health


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