A COVID positive mother should continue to breastfeed the baby but is advised to keep the baby at a distance of 6 feet from her when she is not breastfeeding – Dr Manju Puri, Head, Department, Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi

Dr Manju Puri, Head, Department, Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi talks about the recent decision to administer Covid-19 vaccination during pregnancy, and what precautions women should take to protect herself and her child from catching COVID-19.

It has now been approved that woman can take COVID-19 vaccines even during pregnancy. How will it help?

During the second wave, many women contracted COVID-19 during pregnancy compared to the first wave. COVID if severe can lead to serious complications during pregnancy, especially during the last trimester as the uterus is enlarged and presses on the diaphragm, compromising a woman’s ability to cope with a fall in oxygen saturation. This may lead to a sudden fall in blood oxygen saturation and risk the lives of both the mother and the child. Vaccines will help prevent severe disease in pregnant women.

Also, vaccinating a mother is likely to give some degree of protection to the new-born as the antibodies developed in the mother’s body post-vaccination will pass on to the developing foetus through her blood. In the case of lactating mothers, an infant gets these antibodies through the mother’s breast milk.

Some people believe that vaccines can cause infertility among women. Is it true?

These are rumours that get circulated on ubiquitous social media. Misinformation is far more dangerous than virus itself.

Though the Covid-19 vaccines are relatively new, these have been developed using time tested techniques. Vaccines help the body develop immunity against a specific pathogen, it does not affect any other body tissue. In fact, we give some vaccines such as hepatitis B, Influenza, pertussis vaccine to women even during pregnancy to protect them and their unborn child from various diseases.

Besides, our regulators have approved the administration of the vaccines during pregnancy only after they were confident of their safety. There is no scientific data or studies that show that vaccines can cause infertility. These vaccines do not affect the reproductive organs in any way.

What precautions should a pregnant woman take to protect herself from catching COVID?

Pregnancy and childbirth are social events in our society. But during the pandemic, it may mean exposing the mother and child to infection. We recommend that an expectant mother should wear a mask and maintain physical distance even when at home, amongst her family members. It is because she may not be going out, but her family members could be going out for work and she can contract the infection from them.

So, women should use all Covid-Appropriate precautions during pregnancy, and after childbirth as it can prevent them from catching the infection and related complications.

What should a pregnant woman do if she shows symptoms of Covid-19?

First, if they have any symptoms of COVID, they should get themselves tested at the earliest, as the sooner we diagnose, the better we can manage the disease. The management of COVID is almost the same during the pregnancy as it is for others, but it should be done only under the strict supervision of a doctor.

A woman should isolate herself, drink plenty of fluids, check her temperature and oxygen saturation every 4-6 hrs. If the temperature does not come down even after taking paracetamol, she needs to contact the doctor; if there is a fall in oxygen concentration or if there is a decreasing trend for example if it is, say, 98 in the morning, 97 in the evening, and then drops further the next day, she needs to get in touch with her doctor.

Besides, women who have associated illnesses such as diabetes, high blood pressure, cardiovascular disease, obesity, etc, need to be more careful, as they may need hospitalisation. So, consult your doctor and keep in touch with your doctor throughout the recovery period.

We strongly recommend an overall health check-up post-Covid recovery to ensure that the mother and the foetus are doing fine.

Can a foetus contract Covid-19 from the mother?

There is no evidence to support this concern. We have done a couple of studies and found that the placenta, an organ that is formed in the uterus in which a foetus grows, acts as a protective barrier. There are a few cases where the new-born were found infected but we are not sure whether those babies got the infection inside the mother’s womb or soon after the birth.

Having said that, as I have explained earlier also, pregnant women must take all the possible precautions to prevent the infection as Covid-19 can affect her and her child in many other ways.

What precautions should a COVID positive mother take to protect her newborn?

A mother should continue to breastfeed the baby but is advised to keep the baby at a distance of 6 feet from her when she is not breastfeeding. A caregiver who is tested negative can also help in taking care of the newborn. Before breastfeeding the newborn, she should wash her hands, wear protective gear such as a mask, face shield. She should also sanitize her surroundings frequently.
If there is no one else to take care of the child, a mother should wear a mask all the time, and maintain physical distance from the child as much as possible. The mother and the child should stay in a well-ventilated room. And she should regularly wash her hands and sanitise the surroundings.

Postpartum depression and anxiety are common among women. Do you see an increase in mental health issues among women during the pandemic?

Certainly, there is an increase in mental health problems among women during pregnancy and post-childbirth. These are times when a woman undergoes a lot of hormonal and physiological changes. She has poor coping skills and needs social support. In the absence of this social support, she can feel lonely, helpless, and depressed.

Isolation for 15-days is difficult for everyone, but more so for pregnant women and postnatal mothers. During this time, the additional anxiety about her child’s health can severely affect her mental status.

So, it is important to provide constant support and assurance to women during this time. The family should stay in touch through video calls, and observe any change in her mood and seek medical help if she looks and feels depressed.

We always ask our pregnant women and mothers two simple screening questions: One, does she have little or no interest in doing her routine chores? And second, does she feel sad or feel like crying without any specific reason anytime in the past 2 weeks? If the answer is yes to any of these questions it means she needs further evaluation by a psychologist. Doctors, as well as family members, need to watch a woman’s behaviour carefully during this time.

What advice would you like to give to your women patients?

We ask them to stay safe, take adequate precautions and follow Covid-Appropriate Behaviour. Take vaccine as and when it is available to them. Avoid meeting many people.

If they have symptoms suggestive of COVID such as fever, sore throat, loss of taste or smell or exposure to a COVID positive person they need to seek medical help immediately, should not delay the diagnosis and should not self-treat. And lastly, we also counsel all our pregnant women about various contraceptive methods during pregnancy and offer them postpartum Intra-Uterine Device (Cu T), which can be inserted immediately after childbirth or caesarean delivery. It saves them of an unnecessary visit to the hospital after childbirth and reduces the risk of an unplanned pregnancy.