FAQ’s

CORONAVIRUS (COVID-19) INFORMATION FOR PREGNANT PATIENTS

Uncertainty about the Coronavirus (CoVID-19) and it’s impact on our health, our pregnancies, our unborn and newborn babies is causing much distress in the community. It is important for us all to be aware, but not to panic. Remain informed with accurate and up to date information.

Updated General information regarding CoVID-19 can be found here:

RANZCOG statements Covid-19

DHHS Covid-19 information

This is a summary regarding the impact on pregnant women and their babies to the best of our current knowledge (with thanks to RCOG and RANZCOG information brochure):

What effect does coronavirus have on pregnant women?

As the pandemic has evolved, so has our understanding of the effect on pregnant women. Early on it seemed that pregnant women were not more at risk of becoming seriously unwell due to Covid-19.

However, with new evidence from overseas, it is now clear that pregnant women with COVID-19 have a higher risk of severe illness compared to non-pregnant women with COVID-19 of the same age. This includes an increased risk of:
–    hospitalisation
–    admission to an intensive care unit
–    invasive ventilation.

Women at greatest risk are those with coexisting medical conditions including diabetes, high blood pressure and obesity.

What effect will coronavirus have on my baby if I am diagnosed with the infection?

At present, there is no evidence to suggest an increased risk of miscarriage.

However, severe COVID-19 infection during pregnancy  increases the risk of complications for the baby including a higher risk of stillbirth and of being born prematurely.

Are the vaccinations for Covid-19 safe?

Thankfully, there are now very safe and very effective vaccines that prevent serious maternal illness in pregnancy and the subsequent risks to the baby. Both the Pfizer (Comirnaty) and Moderna (Spikevax) vaccines have now been extensively studied in pregnant women overseas, and are safe for use in pregnancy.

Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?

Yes. At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.

The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.

This guidance may change as knowledge evolves.

If you choose to breastfeed your baby, the following precautions are recommended:

• Wash your hands before touching your baby, breast pump or bottles
• Try and avoid coughing or sneezing on your baby while feeding at the breast;
• Consider wearing a face mask while breastfeeding, if available
• Follow recommendations for pump cleaning after each use
• Consider asking someone who is well to feed expressed breast milk to your baby.

Can I still attend my antenatal appointments if I am in self-isolation?

You should contact Neil to inform him that you are currently in self-isolation for possible/confirmed coronavirus.  It is likely that routine antenatal appointments will be delayed until isolation ends. If Neil advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen.

Will being in self-isolation for suspected coronavirus affect where I give birth?

Not at this stage.

Will being in self-isolation for suspected or confirmed coronavirus affect how I give birth?

There is currently no evidence to suggest you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus.

However, if your respiratory condition (breathing) suggested that urgent delivery would be needed, a caesarean birth may be recommended.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. However, the use of “laughing gas” may increase aerosolisation and spread of the virus, so Neil will discuss all the options with you in early labour to ensure you are aware of the pain relief options available to you.

What happens if I go into labour during my self-isolation period?

If you go into labour, you should call the birth suite of your chosen hospital. Inform them that you have suspected or confirmed coronavirus infection. Neil and the midwives have been advised on ways to ensure you and your baby receive safe, quality care, respecting your birth plan as closely as possible.

When you attend the maternity unit:

• You will be met at the maternity unit entrance and provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room
• Coronavirus testing will be arranged
• Your partner will be able to stay with you throughout, but no other visitors will be allowed to join you at this stage.

Could I pass coronavirus to my baby?

There are no reports of women diagnosed with coronavirus during the third trimester of pregnancy having passed the virus to their babies while in the womb.

As always, if you have any other questions or concerns, please call us on 9418 8127. 

Other resources:

• RANZCOG statement
• Department of Health – Self assessment tool. Who needs to be tested for Coronavirus?
• Coronavirus hotline – 1800 675 398

The new recommendation in Australia is that all pregnant women should be routinely offered the Pfizer  (Cominarty) or Moderna (Spikevax) vaccine.

While these vaccines were not initially tested for safety or efficacy in pregnant women, there is now global data regarding the use of these vaccines in thousands of pregnant women since December 2020. There is now very good evidence that shows these vaccines are both very effective at preventing severe Covid-19 infection in pregnancy and are not associated with poor pregnancy outcomes including miscarriage, stillbirth, preterm birth, growth restriction or pre-eclampsia.

In order to access the vaccine, I recommend you speak to you GP first.

Alternatively, you may access the vaccine through a Victorian government vaccination hub.

Use one of these sites to determine the first available booking:

• Covid Queue
• Vaccine Radar

Then complete the booking through:

• DHS  – 1800 675 398
• DHS Covid-19 vaccine booking site

Antenatal visits are scheduled at an increasing frequency as the pregnancy progresses:

• First visit: 8-12 weeks
• 12-28 weeks: Every 4 weeks
• 28-36 weeks: Every 2 weeks
• 36weeks – Delivery: Every week
• Post natal visit: 6 weeks after delivery

Extra visits may be necessary depending on your particular circumstances

A small amount of vaginal bleeding is not uncommon especially in early pregnancy. Even so, if you have any vaginal bleeding please call me.

Many medications are well studied and are safe to use in pregnancy. Common, safe medications include:

• Penicillin and “Penicillin like” antibiotics eg: Amoxycillin, Augmentin, Cephalexin
• Simple pain killers with/without codeine eg: Paracetamol (Panadol, Panemax) & Panadeine
• Anti-nausea medication eg: Metoclopramide (Pramin, Maxalon), Ondansetron (Zofran)
• Laxatives eg: Metamucil, Movicol, Fybogel

The Mother to baby website  has a fantastic list of fact sheets regarding medication use in pregnancy. Please check with me if you have any concerns about newly prescribed medications.

Many pregnant patients reasonably ask whether it is safe to continue their normal cosmetic routines or about other common everyday exposures. While a lot of these exposures haven’t necessarily been tested specifically on pregnant women, The Mother to baby website  (scroll down to “Other common exposures”) has very detailed and considered fact sheets on many of them. I encourage patients to read through these for more information in making their decision. As always, if you have further questions, please feel free to contact me for more information.

Nausea and vomiting in early pregnancy is common. It is related to a pregnancy hormone that peaks at approx 10-12 weeks and falls rapidly thereafter. Simple measures to control nausea are often successful:

• Eating small, frequent meals through the day. Avoiding foods that may precipitate nausea
• Drink plenty of fluids (small amounts throughout the day)
• Vitamin B6 (pyridoxine) 25mg three times per day (available over the counter), Ginger tablets

If these measures do not work, please call me through the rooms to discuss other options.

Heartburn or indigestion is common in pregnancy. It too is related to hormonal affects on the stomach and oesophagus (food pipe) and pressure from the growing uterus later in pregnancy. Again, simple measures are often effective in alleviating these symptoms

• Small, frequent meals
• Avoid eating meals too close to bedtime (within 30-60 minutes)
• Avoid foods that trigger symptoms eg: fatty, spicy, acidic foods

If these measures do not work, antacid medications are safe in pregnancy.

Ranitidine 150mg daily (available over the counter) should be tried first (Has been removed from circulation for the moment)

Alternatives- Famotidine 20mg daily or Omeparazole 20mg daily.

Hayfever and allergy symptoms can be troubling during pregnancy. Many of the nose sprays and antihistamines used to help with these symptoms are safe to use in pregnancy.

Antihistamines

Promethazine (Phenergan) and Polaramine. Safe to use in pregnancy however, they will cause drowsiness. As such you should take precautions, and avoid driving, if used during the day.

Newer, non-sedating antihistamines (eg: Claratyne, Telfast, Zyrtec) have not been studied as much in pregnancy. Studies to date, however, have shown no increase in pregnancy complications. I suggest they be used as a last resort if symptoms are very disabling.

Nasal decongestants 

Steroid based nose sprays are safe to use during pregnancy.  eg: Beconase allergy & hayfever. They also provide longer relief from symptoms than the nose sprays below.

Nasal sprays that cause constriction of the blood vessels should be avoided  eg: Otrivin, Vicks

Some infections can cause serious harm for both the pregnant woman and her unborn baby.

Prior to pregnancy

Rubella and Varicella (Chicken pox virus)

• Booster immunisation is advised before becoming pregnant to those with no/low immunity

During pregnancy

Influenza (Flu, Swine Flu)

• Flu is particularly serious for pregnant women and their babies- both unborn and newborn. Flu vaccination is strongly advised if you are going to be pregnant during the flu season (March –October). The seasonal flu vaccine covers both seasonal flu and swine flu. It is SAFE and EFFECTIVE.

Pertussis (Whooping cough)

• This is a serious infection that mainly affects very young babies. Adult immunity from childhood generally wanes over time. If infected, these adults usually have a mild form of the disease but may pass on the infection to young babies. As such, booster immunisation to whooping cough is recommended for all adults who are going to be in close contact with young babies.
• Therefore, I highly recommend the following actions to reduce the possibility of infection in these most vulnerable young infants.
  • ALL adults who will be in close contact with the newborn baby should have a Whooping cough booster (Boostrix) if they have not had one in the last 5 yrs. This can occur at ANY TIME.
  • Pregnant patients should have a Whooping Cough booster between 24-28 weeks to maximise the transfer of protective antibodies to the fetus.
    • Recommended in ALL pregnancies, irrespective of when last Boostrix vaccine was administered.
  • Vaccinate young infants as per the National Immunisation Schedule at 2, 4 and 6 months.
• The vaccine is currently free for parents.

It is important to have a healthy and varied diet in pregnancy. Almost anything in moderation is a sensible approach however there are some things that should be avoided altogether.

• Listeria – Soft cheeses (brie, camembert, feta, ricotta -unless cooked), pate, pre-prepared salads/ unwashed vegetables, processed meats (unless cooked), soft serve ice-cream and raw seafood should be avoided.
• Toxoplasmosis – while this is generally associated with kittens and cat litter, it may also be acquired by eating undercooked meat or from unwashed vegetables/handling soil after gardening.

The NSW Food Authority provides an excellent, comprehensive summary of what to eat and what to avoid.
Please feel free to discuss any particular dietary concerns with me.

Travel during the second and third trimester (until 36 weeks) of pregnancy is generally safe. Your specific circumstances, gestation and destination will all impact on the advisability and particular advice for each individual. While I will discuss these issues with you, it is always advisable to inform the airline and insurance company of your plans before making any bookings.

Zika Virus

Zika is a mosquito borne virus. Zika virus infection in a pregnant woman may cause severe birth defects. The virus is mostly transmitted through bites from the infected Aedes mosquito. These mosquitoes are daytime biting mosquitoes, with increased activity around sunrise and sunset. There have been some cases of sexual transmission of the virus from an infected partner (male and female) to pregnant patients.

There is currently negligible risk of Zika virus transmission anywhere in Australia. As such, travel to any Australian destinations during and while planning a pregnancy is safe. Various destinations overseas however, have been associated with a HIGH risk of Zika virus transmission and my advice is to AVOID travel to these destinations during any part of the pregnancy.

A comprehensive list of these countries is available on the Australian Department of Health website – countries affected by outbreak of Zika.

Unfortunately, several of the South East Asian countries that many Australian tourists visit each year are included in this list.

Patients may CONSIDER deferring travel to countries at MODERATE risk of Zika virus transmission.

Women planning a pregnancy are directed to the Australian/New Zealand College of Obstetricians statement at RANZCOG Zika virus statement

A full explanation of the issues related to Zika can be found on the Australian Department of Health website

Regular exercise during pregnancy is an important part of maintaining your general health and is encouraged. A sensible exercise regimen, accepting of the changes to your body during pregnancy, is most appropriate. There may be circumstances that restrict the level/type of activity or require exercise to cease completely. Suitable exercise/strengthening regimens may be suggested by interested osteopaths or physiotherapists. Alternatively, pregnancy specific programs are available through well known commercial entities.

As a general rule, performing aerobic exercise so that you can have a “chat” while completing the exercise or keeping your heart rate mostly under 150bpm (beats per minute) is considered safe.