April 01, 2021
COVID-19: An Update for Childbirth Educators
By: Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE | 2 Comments
It has been a little over a year since COVID-19 was declared a pandemic by the World Health Organization. Overnight, daily life changed, in-person childbirth classes were canceled, and the birth experience changed for families around the world.
In recent months, there have been both bad news and good news. The bad news is that current research studies show that pregnant people ARE at increased risk both for getting the COVID-19 virus and for increased morbidity and mortality. In a study presented at the January 2021 meeting of the Society for Maternal-Fetal Medicine, researchers looked at a group of 1219 pregnant women in 14 states across the U.S. who had tested positive for COVID-19 at any time during their pregnancies. Almost half of the women were asymptomatic; 41% had mild or moderate symptoms; and 12% had severe or critical symptoms. As is true for the population in general, the women who developed severe or critical symptoms were more likely to be older, to have a higher body mass index (BMI), and to have an underlying condition such as asthma, pregestational diabetes, or chronic hypertension. They were at increased risk for cesarean birth, blood clots, hypertensive disorders, preterm birth, and death. Their babies were at increased risk for low birth weight and for admission to the NICU. There were 4 maternal deaths in the study of 1200 women, which is a far higher maternal mortality rate than the average maternal mortality rate in the U.S.
The good news is that both cases of COVID-19 and deaths from the virus are decreasing in some countries around the world and in many states in the U.S. Vaccines are available for many adults. Although pregnant women were excluded from the first vaccine trials, inevitably some women in the trials became pregnant. As far as we know, there have been no red flags for those women. Although safety of the vaccine during pregnancy has not yet been established by scientific trials, the World Health Organization, CDC, the American College of Obstetricians and Gynecologists (ACOG), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) all say that pregnancy should not be a barrier to getting the vaccine for those who choose to get it and vaccines are now available for pregnant people in many areas. In a new study just published online in the American Journal of Obstetrics and Gynecology, researchers enrolled 131 reproductive-age COVID-19 vaccine recipients (84 pregnant, 31 lactating, and 16 non-pregnant) in a prospective cohort study. They measured COVID-19 antibodies at baseline, second vaccine dose, 2-6 weeks post second vaccine dose, and for the pregnant women, at the time of birth. They found that the levels of vaccine-induced antibodies were equivalent in pregnant and lactating women compared to non-pregnant women. The levels of antibodies were higher than those induced by infection with COVID-19 during pregnancy. They found vaccine-generated antibodies in all umbilical cord blood and breastmilk samples. The researchers concluded that the COVID-19 mRNA vaccines generated immunity in pregnant and lactating women similar to that observed in non-pregnant women and that the newborn received antibodies via both the placenta and in breastmilk.
The birth experience has now improved for childbearing families in the pandemic. Early on, health care providers knew little about the transmission of the virus. They often separated parents and babies at birth and excluded labor partners from the birthing room for fear of the transmission of the virus. Currently, with support from the World Health Organization, CDC, and obstetric organizations such as ACOG and SOGC, almost all hospitals are allowing the birth partner back into the labor room. Many locations are also welcoming back doulas and other support persons. Most hospitals test the pregnant person for COVID-19 before admission or at the time of admission for childbirth, as special precautions are necessary for the COVID-19-positive patient. Usually both the laboring person and the labor support are asked to wear a face mask and to remain in the birthing room throughout labor and birth. ACOG states that the laboring person may push without a face mask as long as the health care providers are dressed in appropriate personal protective equipment (PPE). Labor and delivery nurses report seeing both increased and decreased instances of “laboring down.” Some health care providers encourage “laboring down” to decrease the amount of time spent in active pushing, in order to decrease maternal respiratory secretions. Yet other health care providers abide by the recommendation of ACOG. Whether or not in a pandemic, ACOG states that immediate pushing for nulliparous women with epidural analgesia is recommended.
Research is especially encouraging for keeping parents and babies together immediately after birth and in the early postpartum period, even for the new parent who is positive for COVID-19. Studies indicate that as long as the new parent is not critically ill and is able to care for their baby, skin-to-skin contact, rooming-in, and lactation are encouraged. The COVID-19-positive parent should wear a face mask when in contact with their baby, and should practice safe hand hygiene.
An unexpected outcome of the pandemic is that many new families report increased bonding and easier breastfeeding or chestfeeding because of pandemic-policies that limit visitors in the hospital and decisions to limit visitors in the early days at home.
In an encouraging study published by the American Society for Microbiology, researchers examined milk samples from 18 lactating women diagnosed with COVID-19. They found no virus in any of the milk samples. In 80% of the samples, they found antibodies specific to COVID-19; and in 62% of the samples, the antibodies were able to neutralize COVID-19 infectivity in the lab. This study suggests that human milk does not transmit the virus, but instead protects the newborn from the virus. The researchers are continuing the study with additional study subjects.
For more information about how COVID-19 has affected the Lamaze Healthy Birth Practices, listen to the Lamaze International webinar, The Effects of the COVID-19 Pandemic on the 6 Healthy Birth Practices. You can also download this chart with the bibliography at www.thefamilyway.com.
Gray, K.J., et al. (2021). COVID-19 vaccine response in pregnant and lactating women: a cohort study. American Journal of Obstetrics and Gynecology, doi: https://doi.org/10.1016/j.ajog.2021.03.023
About Debby Amis
Debby Amis, RN, BSN, CD(DONA), LCCE, FACCE, a perennial favorite at Lamaze Conferences every year will get us up to speed and facilitate a panel of experts in sharing information on this topic.
Debby Amis is a long-time childbirth educator who has served in many leadership roles in Lamaze, including President of the Lamaze Board and Education Council Chair. Debby is a registered nurse, DONA-Certified Doula, LCCE, and FACCE currently serving on the Lamaze Certification Council.
In recent years, Debby has presented several keynote addresses on current research for childbirth educators for Lamaze International, ICEA, and DONA. Debby is also the co-author of popular childbirth resources, Prepared Childbirth – The Family Way and The Educator’s Guide.
TagsChildbirth education Healthy Birth Practices Debby Amis Webinar COVID-19