…and is it Right for Me?
The coronavirus pandemic has caused significant disruption to most plans, large and small, over the past few months. For many women, confusion and anxiety regarding the safety of being pregnant, laboring and giving birth amidst coronavirus has put their plans to start trying for a baby this year on hold. As we settle into a new normal, you might be asking yourself whether this is the right time to try and conceive.
The RCOG has published comprehensive guidelines on pregnancy and occupational health for those pregnant during the coronavirus pandemic. These guidelines have been discussed in depth in our blog posts on pregnancy and breastfeeding and maternity leave and employment rights throughout the Covid-19 pandemic. These guidelines do not suggest that pregnancy is contraindicated at this time.
Ultimately, the right time to try and conceive is different for every woman and the decision as to when to start trying is yours.
The main factors that influence why this decision is even up for debate are around firstly, if you try to conceive and are successful then have risks of contracting coronavirus during fertility treatment and prengnacy. The second is the wider context of how coronavirus affects the experience you will have in pregnancy and having a newborn, and whether this is something you want to persue at this time.
To help you make this decision, I have summarised the pros and cons of pregnancy and giving birth during coronavirus below.
Factors in favour of trying to conceive at this time
Risks in pregnancy and birth
🌟 There is no evidence to suggest that pregnant women are more likely to catch coronavirus than non-pregnant women, or more likely to become seriously unwell should they contract coronavirus. Most pregnant women with Covid-19 will develop only mild, cold/flu-like symptoms.
🌟 Current evidence suggests that coronavirus is unlikely to have a negative impact on your baby’s development in the womb (and no problems with fetal development linked to Covid-19 have been observed to date).
🌟 Your risk of miscarriage does not appear to be increased if you develop coronavirus during your pregnancy (even in the early weeks).
🌟 The newest evidence shows that the risk of a pregnant woman with coronavirus passing the infection to her baby is very small. However, the risk of Covid-19 transmission from mother to baby remains possible. In all cases to date of newborn babies developing coronavirus soon after birth, the babies were well.
The effect on your maternity care
🌟 Maternity care is an essential service and women will continue to be supported and cared for safely throughout pregnancy, labour, birth and the postnatal period. You will be able to discuss any concerns or worrying symptoms that you have throughout pregnancy with an appropriate healthcare professional (e.g. midwife or obstetrician), although this might be on the telephone in the first instance.
If it is determined, at any point during your pregnancy, that you require urgent assessment or treatment, you will still be able to be seen promptly, in-person and by the appropriate maternity care professional.
🌟 Women will continue to have significant choice in how and where they give birth during coronavirus. Elective C-sections are still taking place, although the service at your local hospital may not run as normal.
Women who are confirmed or presumed to be negative for Covid-19, and those who are asymptomatic with the virus, should still have the option of giving birth at home, in the birth centre or on the labour ward. However, birthing options can differ across hospitals and some Trusts have had to temporarily close home birthing services and birth centres (although most of these have been, or are in the process of being, reinstated).
It is important to remember that there are individual factors separate from coronavirus which might make certain birthing options more or less suitable for you (e.g. high vs. low risk pregnancy).
🌟 Water births remain an option for women who have no symptoms of coronavirus and are suspected or confirmed to not have Covid-19 (provided the maternity care team can wear appropriate PPE).
🌟 You should be supported and encouraged to have one, asymptomatic birth partner with you throughout labour and delivery (including C-section deliveries). Partners cannot be present for births that occur under general anaesthetic (where the mother is put to sleep), although this has been the case since before the pandemic.
After birth
🌟 Skin-to-skin contact following birth should be supported and encouraged for all mothers and babies, even if the mother has suspected or confirmed coronavirus (unless the baby requires care in the neonatal unit).
🌟 There is no evidence at present that coronavirus can be passed to babies through breastmilk. However, due to the close contact between mother and baby during breastfeeding, transmission of coronavirus might occur via airborne droplets. You should be actively supported to breastfeed if it is your desire to do so, with additional hygiene precautions (e.g. regular hand washing, wearing a face mask).
🌟 Women who have recently given birth, and are otherwise fit and well, are not at an increased risk of contracting coronavirus compared to the general population.
Factors against trying to conceive at this time
Additional restrictions
🌟 Pregnant women are included in the moderate-risk group (clinically vulnerable) as a precaution. Under current guidance, this means that you will still be able to go outside as often as you like and visit businesses (such as shops and restaurants) as long as you practice effective social distancing.
However, the government still advises that you keep social interactions to a minimum. This will likely mean that you are unable to see friends and family as you’d like throughout your pregnancy, and might be particularly challenging for women who wish to have a baby shower or baby moon, etc.
Mental health
🌟 It is important to consider the impact that reduced social interaction, changes to your prenatal plans (e.g. cancelled trips or special events) and the additional anxiety associated with the pandemic will have on your mental health.
Being pregnant can be an emotional experience at the best of times, and the current events might make you feel more worried or upset than you otherwise would.
If you are concerned about your mental health during pregnancy, your maternity care team will be able to provide ongoing support, advice and a referral if needed.
Risks of catching coronavirus
🌟 The Faculty of Sexual and Reproductive Healthcare has advised women who are trying to conceive to consider the risks of contracting coronavirus associated with trips to hospital and contact with healthcare professionals and other patients. This is a particularly important consideration for women who might require more frequent hospital attendances or an admission during pregnancy (e.g. previous pregnancy complications, long-term conditions such as heart disease, diabetes or epilepsy).
🌟 There have been reports globally that show some babies were born prematurely to women who were seriously unwell with coronavirus. However, it is unclear if coronavirus caused the babies to be born prematurely, or whether the maternity team decided to deliver the babies early to support the mother’s recovery.
Changes to maternity care
🌟 Disruption to maternity services is an ongoing difficulty throughout the pandemic. You should expect some changes to the way in which you receive antenatal care. These changes might include a reduced number of antenatal appointments; changes to the dates and times of your appointments; remote consultations (e.g. over telephone or video); and re-structuring to include multiple investigations in the same appointment. You might also find that you have to wait longer to speak to a healthcare professional on the phone or be seen in person for non-urgent concerns.
🌟 Although the suspension on visiting hospital inpatients and accompanying patients to outpatient appointments has been lifted in England, local hospitals and Trusts have different policies on visiting restrictions (and the suspension might remain active at your local hospital).
Contact your maternity unit to find out if they are allowing companions at antenatal appointments or visitors to their antenatal and postnatal wards. If such measures are allowed, it will almost certainly be limited to one person per appointment or visit.
🌟 If your planned birth partner has symptoms of coronavirus, or has recently tested positive for Covid-19, he/she will not be able to enter the maternity suite. This might put you in the position of having to choose a different birth partner at short notice (although this can be from a different household).
🌟 At present, women are only allowed one birth partner during labour and delivery. This restriction might be particularly challenging for women who had hoped to have multiple loved ones at their birth, or to employ the services of a Doula or birthing photographer.
🌟 As with antenatal care, you should expect some changes to the structure and number of your postnatal appointments. Your postnatal care is likely to include a mix of face-to-face and virtual appointments.
Unknown effects and impacts of coronavirus
🌟 It is important to remember that healthcare professionals are constantly learning, reviewing and adapting their practice in line with the most up-to-date evidence on coronavirus (which is changing frequently). It is possible that, throughout your pregnancy, coronavirus guidelines will change and that this might affect your birthing options or antenatal and postnatal experience.
Although not expected, it is also possible that, as new evidence emerges, some of what we think we know about coronavirus at present, including its impact on pregnant women and babies, will turn out to be incorrect. As Covid-19 is a new virus, there is still a lot we do not know about its impact on pregnancy. In particular, we do not have information on the long-term effects on either mothers or babies from contracting coronavirus during pregnancy or shortly after birth.
What does this information mean for me?
The decision on when to start trying for a baby is a very personal one and the unprecedented current events do not change that. Current guidelines on coronavirus during pregnancy are based on the limited evidence available about the virus and its impact on mothers and babies. It is likely that, as further research is conducted, these guidelines will continue to change. However, the evidence we do have does not suggest there is a direct increased risk to pregnant women or babies from coronavirus.
If you are trying to conceive, you should take all precautions advised for pregnant women (e.g. regular hand washing, avoiding social gatherings). Our blog post on pregnancy and coronavirus details steps you can take to limit your risk of contracting coronavirus.
Everyone will have different feelings on trying for a baby at present. It is important to remember that, whatever you decide, healthcare professionals (including your GP, midwife and obstetrician) are here to support you and will work tirelessly to provide you with the safest possible care at the right time for you.
What if I am using/considering assisted reproductive techniques?
If you are using, or considering using, assisted reproductive techniques (such as in-vitro fertilisation (IVF) or artificial insemination), the information above will still apply to you.
Following a motion from the Human Fertilisation and Embryology Authority in May, most fertility clinics have now re-opened. Clinics will be required to adhere to strict professional guidelines to keep patients, staff, gametes and embryos safe. A complete list of open clinics who have been authorised to resume fertility treatments can be found here. If you have questions about pursuing or continuing fertility treatment, you should contact your local clinic directly.
The storage limit for frozen eggs, sperm and embryos has been extended by two years during the pandemic. This means that couples undergoing fertility treatments throughout coronavirus will have more time to complete their treatment.
What do I do if I am offered immunosuppressive treatments by my fertility clinic?
Sometimes clinics offer additional treatments to women on top of their main fertility treatment. One such additional treatment is the use of immunosuppressives. Immunosuppressive treatments are known to carry significant risks and these are increased during the pandemic, as they can make women more prone to catching infections. There is also concern that women on immunosuppressives are at high-risk of developing serious complications should they contract Covid-19.
The current advice from multiple professional agencies, including RCOG, the British Fertility Society and the Association of Reproductive and Clinical Scientists is that additional immunosuppressive treatments should be avoided. This is because there is no proven evidence that they will help you get pregnant and they might put you at increased risk of becoming very sick should you catch coronavirus.
Useful Resources
- A collection of frequently asked questions on coronavirus and fertility treatments answered by the Human Fertilisation and Embryology Authority: https://www.hfea.gov.uk/treatments/covid-19-and-fertility-treatment/coronavirus-covid-19-guidance-for-patients/frequently-asked-questions-for-patients-on-coronavirus-covid-19/
- Governmental guidance on staying safe for people in the clinically vulnerable group (e.g. pregnant women): https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing/staying-alert-and-safe-social-distancing-after-4-july#clinically-vulnerable-people
- Guidance from the Faculty of Sexual and Reproductive Healthcare to support healthcare workers in managing women who ask to discontinue contraception and plan a pregnancy during coronavirus (easily readable for all): https://www.fsrh.org/documents/fsrh-ceu-information-to-support-management-of-individuals/
- A collection of excellent advice from the Maternal Mental Health Alliance on promoting well-being, managing anxiety and accessing support services while pregnant during coronavirus: https://maternalmentalhealthalliance.org/news/mmha-members-offer-reassurance-amid-coronavirus-outbreak/
References
(1) Coronavirus (COVID-19) Infection in Pregnancy: Information for Healthcare Professionals. Royal College of Obstetricians & Gynaecologists and Royal College of Midwives. Published: 24/07/2020. https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-24-coronavirus-covid-19-infection-in-pregnancy.pdf
(2) COVID-19 Resources and Information for SRH Professionals. Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists. https://www.fsrh.org/fsrh-and-covid-19-resources-and-information-for-srh/
(3) Coronavirus (COVID-19) guidance for patients. Published: 28/07/2020. Human Fertilisation and Embryology Authority. https://www.hfea.gov.uk/treatments/covid-19-and-fertility-treatment/coronavirus-covid-19-guidance-for-patients/
(4) Treatment add-ons. Human Fertilisation and Embryology Authority. https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/
(5) Coronavirus infection in pregnancy: information for pregnant women and their families. Royal College of Obstetricians & Gynaecologists. Published: 10/08/2020. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/