Maternal and Child Health During COVID-19
COVID-19 poses risks to maternal and child health; nurses can use their knowledge and skills to help ensure a safe delivery and start to life.
By Debra Wood, RN, contributor
Nurses are trusted professionals, who can advise and guide women through pregnancy, delivery and newborn care in the age of COVID-19.
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Maternal health and COVID-19 concerns
COVID-19 can endanger pregnant women’s health and lives. If they become infected with SARS-CoV-2, they are often sicker than other women of the same age, more likely to need care in an intensive care unit and have a slightly higher mortality rate, reported Maria R. Fisher, CNM, MSN, MPH, IBCLC, clinical faculty instructor at Stony Brook Medicine in Stony Brook, New York. These increased risks are likely due to pregnancy suppressing a woman’s immune response.
“They have decreased capacity to fight the virus,” Fisher said.
Additionally, “Pregnant people with COVID have a higher risk of preterm labor,” Fisher said.
The best approach to managing COVID-19 in this population is to avoid an infection by following common public health practices—wearing a mask in public, frequent hand washing and physical distancing.
“Public health messaging needs to be reinforced,” Fisher said.
Family physician Erica Zelfand, ND, medical expert at Testing.com with a naturopathic and functional medicine practice in Portland, Oregon, recommends women be tested for vitamin D levels and supplement if low, since there is “good evidence that vitamin D3 can reduce the risk of getting sick with COVID-19, and reduce the severity and duration of the illness if we do contract it.”
“A bottle of vitamin D3 may be the cheapest and most important thing a mother picks up at the pharmacy this year,” Zelfand added. “A close runner up would be vitamin C, which, like D3, is absolutely safe for most pregnant women.”
Care for women with COVID-19
Nurses and other clinicians should remain mindful that pregnant women are not immune to COVID-19, which can present in a number of different ways.
COVID-19 symptoms may include a scratchy throat, cough or a stuffy nose but no fever. Or the woman may present with gastrointestinal symptoms, Fisher said. Clinicians must test for COVID-19 and determine if the cause of the presenting symptoms are complications of pregnancy or the coronavirus infection.
If the woman is positive for COVID-19, she should be educated to isolate from family members. The woman may be a candidate for an antiviral agent, Fisher said.
The woman’s antibodies in response to COVID-19 transfer to the fetus, offering some protection, Fisher explained.
Maternal health and COVID-19 best practices
During the early months of the pandemic, women often could not have a support person with them during labor, and babies were separated from COVID-19-positive mothers. Nurses, midwives and other clinicians now know these measures can be detrimental.
“There could be harm caused by separating mother from baby,” Fisher said. “Baby does best when with mom.”
Babies should be placed skin to skin on the woman’s chest in the first hour after birth. Premature babies in the neonatal intensive care unit also should have skin-to-skin time, as a treatment, since it helps stabilize the baby and has a calming effect on the newborn.
Breastfeeding should be encouraged and supported, but the mother should mask and wash her hands when in contact with the baby.
“Now is also the time for healthcare providers and society at large to encourage women to breastfeed,” Zelfand said. “A mother's milk contains important constituents that help her baby's immune system and gut microbiome develop properly. If a mother does contract COVID-19, she should continue nursing her baby, as her milk will contain antibodies that will reduce the child's risk of illness or serious harm.”
Maternal and child health relating to COVID-19 vaccines
The U.S. Food and Drug Administration has issued emergency use authorization for three COVID-19 vaccines. However, pregnant women were not included in the clinical trials.
“There are studies showing there is antibody transfer from the vaccine to the fetus and in breastmilk,” Fisher said. “Early data suggests a protective effect.”
Fisher cautioned to never vaccinate a woman in the first trimester of pregnancy.
“Many women have concerns about taking the COVID-19 vaccine, and they very well should: this is a new medical product that has been on the market for not even six months,” Zelfand said. “A mother who chooses to skip the shot deserves to be treated with respect and spared any judgement or sanctimony.”
Zelfand suggested partners and other relatives in contact with the mother and baby could “take the vaccine, until more is known about its safety in pregnancy and its long-term effects in babies.”
COVID-19 continues to infect people across the country, including pregnant women. Nurses play an important role in caring for the women and her offspring.
The Centers for Disease Control and Prevention (CDC) offers additional information about Maternal, Neonatal and Child Health Services During COVID-19.
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