Pregnancy and the Covid-19 pandemic

I’m concerned about Coronavirus and Stillbirth rates, but maybe not for the reasons that you might think.
It has long been known that, whilst pregnant women are not necessarily more susceptible to viral illness, changes to their immune system in pregnancy can be associated with more severe symptoms should they happen to contract a viral illness when pregnant. That said the absolute risks of Covid-19 causing maternal or fetal morbidity or mortality are currently thought to be very small, in fact so small that at the moment that general consensus from professional bodies and Governments alike (see below) is that pregnant women are at no greater risk of contracting this virus than the rest of the general population.
So while, of course, pregnant women need to take the same kinds of precautions as everyone else, they really don’t need to be treated any differently than anyone else. Which brings me to my next point.
I say this to my midwifery students all the time “the ultimate pregnancy complication is death of either the baby or the mother and so the whole point of routine maternity care is to reduce the possibility of that complication. Reducing harm or injury to mother or baby is a neat side benefit, but we need to keep in mind that the whole aim of pregnancy care is to prevent death.”
This is not just what I think. I quote from the RCOG website:
Maternity care is essential, and has been developed over many years to reduce complications in women and babies. The risks of not attending antenatal care include harm to you, your baby or both of you, even in the context of coronavirus.

Now I come to my first cause for concern because changes are in fact being made to maternity care and this is occurring Globally. Let’s look at the kind of changes I am talking about. The RANZCOG website provides the following list for suggested changes to routine pregnancy care in Australia, including:

• Reducing, postponing and/or increasing the interval between antenatal visits
• Limiting time of all antenatal visits to less than 15 minutes
• Using telehealth consultations in Australia or New Zealand as a replacement, or in addition to, routine visits
• Cancelling face to face antenatal classes
• Limiting visitors (partner only) while in hospital
• Considering early discharge from hospital
• Minimise risk of neonatal complications by avoiding early planned birth unless clearly clinically indicated

These changes mean that women are not currently being given care based on the Australian Governments recommendations. To point to but a few inconsitencies: 

Now, of course we are in unprecedented times but these kinds of measures were developed and enacted broadly and quickly, without supporting evidence. They also supersede current pregnancy care guidelines which are all based on a WEIGHT of evidence, developed and refined over many years.
So here are my concerns, or at least a few of them:

• I’m worried that there will be a Global uptick in numbers of stillbirths in 2020 and that (God forbid) IF that were to occur that by the time we see it in statistics two or three years from now that it may be put down to the wrong cause i.e. directly linked to Covid-19 when it will be more likely to be indirectly linked to care provided during the Covid-19 outbreak.
• I’m concerned that care providers are limiting contact with women during pregnancy based on their own fear and perhaps misguided concern to overprotect women such that essential maternity care developed over many years to reduce complications for woman and their babies is being substituted by our best guess care , without any apparent regard for the actual physical assessment and emotional support women and babies require during pregnancy.
• I’m worried that pregnant women who have concerns about a change in their unborn baby’s movements may be even more reluctant than usual to access timely assessment of their baby's wellbeing from their care provider

Finally, as recently as today, Women and Birth (the journal of the Australian college of midwives” published an editorial titled “Midwives in a pandemic: A call for solidarity and compassion which had this to say :“Recent experience in Italy has shown that many pregnant women (especially women with previous loss) are really afraid of being COVID19 positive and feel insecure and anxious. This means that many women have an increased need for support and reassurance by all health care professionals, both during pregnancy and also during childbirth and puerperium”
So, I ask my obstetric and midwifery colleagues: Do we really want to increase risk of known pregnancy complications such as hypertension, diabetes, preterm birth and stillbirth because we cant think of creative and safe ways to still properly care for our women?
1:  QLD Health (COVID-19 Guidance for Maternity Services).RANZCOG (Coronavirus (COVID-19)). The Lancet (What are the risks of COVID-19 infection in pregnant women?). The Royal Women’s Hospital (COVID-19: Advice for visitors and pregnant women) RCOG Covid 19 infection in pregnancy
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