Good morning, my name is Melissa Goist, I am a associate clinical professor in obstetrics and
gynecology at the Ohio State Wexner Medical Center and today I'm going to be talking to
you about updates on COVID-19 and pregnancy. Although unfortunately the data is limited
thus far based on the last few months here in the United States and of course probably in the last
six months or so throughout the rest of the world, the research and information we have
so far with pregnancy is somewhat reassuring. Historically, many viruses such as H1N1 and
SARS have notably caused pregnant women more severe illness, but this virus, COVID-19,
does not seem to show an increased severity in the pregnancy population. About 80% of patients
who are COVID-19 positive are able to recover at home with rest, hydration, acetaminophen,
which is very reassuring news, and of course we don't even know how many patients have COVID-19
because of this testing as it is right now and as more people get tested we'll have better
information on overall outcomes and severity of this disease process, but all in all right now
it does not seem that the pregnant population is any more vulnerable to this virus than the
their counterpart female. So if you're a healthy 32 year old who's pregnant ,you are at no higher
risk of severe illness than your non pregnant counterpart. It is important to keep in mind,
though, that pregnancies that are complicated by other comorbidities such as high blood pressure,
significant asthma, other immunocompromised states, these patients are more susceptible
to severe illness and still need to be cautious. But don't get me wrong, the pregnant population
is still at high risk for getting COVID-19. We are all at high risk for getting COVID-19 because this
is a novel virus, which means that we all still need to be safe whether we're pregnant or not
and that safety means to follow the stay-at-home guidelines based on our Governor's recommendation,
as well as practicing safe social distancing, working remotely when feasible, using personal
protective equipment when appropriate, good hand hygiene, trying to reduce touching your
face. So all of the recommendations made to the non-pregnant population are similar
in the pregnancy population. Now what do you do if you are concerned that you are exposed
to the coronavirus or that you have COVID-19 specifically? Prior to showing up at any office
or showing up at the hospital, we are strongly encouraging our patients to call your primary care
provider first, whether that be your obstetrician or your internal medicine doctor or your family
medicine doctor. The reason for this is because there are different tiers to testing based on the
state of Ohio's recommendations. The other concern is that we don't want you coming to the office and
potentially exposing, inadvertently exposing, the rest of the patients that are there. So we do want
to know if you're concerned, we do want to know if you're concerned about exposure or illness based
on your symptoms. As the state of Ohio's tracking starts to ramp up with more testing and businesses
opening, I'm certain that we will have additional recommendations by Dr. Acton moving forward as to
how to test and who to test. When patients are concerned about exposure, if you've gotten a
call about specific exposure to someone who has tested positive, what many patients have probably
realized is that the office visits have changed a little bit. In terms of the obstetric population,
we have tried to take a very conservative approach to the obstetric visits, trying to
consolidate visits and stretching out visits to avoid inadvertent exposure from other patients
in the office, as well as to give our staff ample opportunity to make sure that the environment is
clean and safe. As you've also recognized, there have been no visitors at these appointments,
so no support people at this time. We do encourage you to put your support person on speakerphone or
FaceTime when appropriate to either listen to the heartbeat or ask questions. We by no means want to
make the support person feel unwelcome, we are just trying to keep our environment as safe as
possible and as soon as the governor and beyond Ohio State determines that we can go back to our
routine appointments, we will be doing so in the office and I think that's going to be here within
the next few months or so. Different things that you'll see at the hospital level as you enter the
hospital for delivery, you are continued to allow one support person at this time. Both of you will
be screened upon admission and given a mask prior to entering labor and delivery. I would strongly
encourage patients to discuss with their primary obstetric provider where to go if you are in labor
in the middle of the night. Many of the entrances at specifically OSU have been detoured to other
entrances in order to allow for the appropriate screening prior to entering the hospital and
this means that you may be parking in a different parking garage than what you were expecting based
on either the booklet we gave you at the beginning or if you were able to take a tour of the
hospital, so I'd strongly encourage you to talk to your provider about that to make sure you know
where you're going in the middle of the night on labor and delivery. Typically if you are a COVID
patient and you're COVID positive or a patient under investigation and you're having your baby,
you're in labor or having a c-section, you will be isolated from the other patients in your own
labor and delivery room that has the appropriate negative airflow in order to avoid exposure for
patients who are COVID-19 positive or patients under investigation and pregnant but not having
their baby. They are separated off unit on to the coded unit of the hospital in order to avoid
any inadvertent exposure to our other pregnant patients. You will notice that there will be
there potentially will be early discharge from the hospital, so if you've had a newborn in the
past you may have stayed in the hospital for two days after a vaginal birth or three days after a
c-section. If our moms and newborns are healthy, early discharge is possible as long as we feel
that that is safe and the patient feels that it was safe to be discharged home. For patients
who are COVID-19 positive or patients under investigation at the time of delivery there will
be a conference between you your obstetrician and the pediatrician about recommendations
for your newborn. We are still encouraging breastfeeding for our COVID-19 patients if
possible based on the health of the mom, but there are some different recommendations in regards to
wearing a mask at the time of breastfeeding as well as social distancing with the newborn in
the labor and delivery and postpartum room so these recommendations will be reviewed with you
at the time of your admission to the hospital to make sure we're doing what is best for the
patient as well as the newborn. These guidelines are evolving and they're very fluid, so over the
next several weeks you may hear new guidelines in regards to labor and delivery and breastfeeding
and appointment as more and more knowledge is obtained about COVID-19 and pregnancy. The final,
final thing I want to discuss is the mental health of the new mom. I do think that it's a
very unnerving time and pregnancy in and of itself can be highly have a lot of anxiety associated
with it and in these situations sometimes moms struggle to be able to feel that they cannot
procreate with these worries and concerns, so please know that we are here for you as your
obstetric providers to either guide you to help counsel you or to point you in the right direction
to make sure you're thinking that you are able to take care of yourself as well as your newborn
in the best manner. Thanks so much for listening today and joining me on this Facebook Live event,
I'm new to Facebook and new to this so I apologize for any jitters or mistakes that I made. I'm happy
to take any questions I have about five minutes left to go through questions if you have anything.
Hi, Josh thanks for question Josh asked, his wife is delivering at OSU in the next few weeks,
will she be wearing a mask during labor and delivery?There's a great question. At this point,
the recommendation is that you and your wife will both be wearing masks while labor and delivery
room when there is either a provider or a nurse in the room with you and will be wearing masks
as well, but currently we are not requiring our moms to wear a mask during the specific,
especially with the pushing process, so you can alleviate some of her fears that she
won't need to be wearing that mask during that pushing process, at least right now.
Hi Katie, thanks for your question of keeping newborns safe. You know,
honestly I do think at this point with this Ohio and the recommendation continuing with
social distancing that you show off your baby on social media for the next couple of weeks
and then as things continue to evolve in the state and we start we open up,
hopefully you'll have friends and family come and visit as soon as we feel that it's appropriate,
but yes I agree reading at this point it was really difficult especially from a support person
if that that people can't have them family around, but I do think from a newborn baby
perspective at this point you should you should try to keep those new grandmas and grandpas away.
Hi Ashley, good question about baby showers and seeing friends and family. I still think at this
point pregnant women should try to wait as much as possible again, although the pregnancy population
does not seem to be more vulnerable when it comes to this illness, I think it would be miserable if
you did get sick period so for as much as we can socially isolate, clearly if you have a small baby
shower with appropriate social distancing, no hugging no kissing of your friends and family,
then you may be able to do that but I think within the next month to two months we will
definitely be seeing the recommendation increase in terms of number of people that
can be together right now. I think governor DeWine has recommended no more than ten people together.
Hi, Melissa thanks for the shoutout.
Kristen, good question. Our second time pregnant mom with preeclampsia with the
first visit at higher risk? No, currently the research does not suggest that you are unless
you otherwise have chronic attention prior to the preeclampsia or with this pregnancy,
so it is okay and we still recommend the use of the baby aspirin to reduce your risk of
preeclampsia being that that's safe even if you do get COVID-19 because we know the
benefits are so significant so I would say, you know, stay safe, stay healthy,
but I do not believe that you are at any higher risk for having more severe illness.
Hi, good question, do we have to or recommend quarantine two weeks prior to term date? I think
this is gonna be my last question because I've gone over the 15 minutes which I knew I would,
I should have warned Kelly that I talked a lot and we'll get to the rest of the questions and will
certainly get your answers via Facebook, I will finish answering them but my thing's
only supposed to be 15 minutes. So ACOG, which is the American College of Obstetrics and Gynecology
states that prior to delivery, two weeks prior to delivery, you could consider quarantine in
patients specifically who are not able to work remotely during this time to avoid inadvertent
exposure prior to delivery, so this I think is something that the patients have to have
with their provider. It is not an absolute recommendation, definitely something to be
taken into consideration, especially with our patients who are, who have or who aren't able to
work remotely and have others and have access to others in the direct contact with other patients.
I hope this answers all your questions, thanks so much much guys for being here and happy Mother's
Day to all of you moms out there and hopefully the weekend will look all right. Take care.