It’s difficult to know what to write at times like these. My anxiety that something will go wrong with this pregnancy (our fifth) reached new heights this week. It’s been surreal feeling my nebulous, shapeless worries harden into concrete, very real fears in the face of the COVID-19 pandemic. Will I still be able to have my baby in hospital? What if the NHS is swamped? What if I get ill? What if Dan gets ill? Will I have to give birth on my own?
We’re a way off my due date yet, so for the most part these are still unknowable, unanswerable questions right now and, anyway, will be dictated by forces way beyond our control. Accordingly, a lot of my energy this week has been going into trying not to dwell too long on them; there is little point trying to control for or plan around these unknowns. Even so, there is no getting away from the baseline fear here: that my baby might die.
I’m sorry to put it so baldly, or if it seems histrionic, but there it is. Not exactly the kind of thing you feel you can drop into casual conversation on Zoom or Houseparty, hey?
This isn’t a new fear. It’s been there since I first took a pregnancy test back in November. It would still be thrumming in the background without the assistance of a novel coronavirus and life in lockdown. The difference is it now feels more difficult to dismiss this fear as simply hypothetical, based on our past experience not our current reality. It feels like our odds of bringing home a baby safely just took an almighty blow.
I know I’m not alone in feeling this way. There are a lot of us out there grappling with fertility and pregnancy questions and fears in the shadow of this pandemic (including last week’s guest post author, Rachel). So I’m incredibly grateful to this week’s guest author, Dr Ni Bhuachalla, a Specialist in Clinical Microbiology and Public Health doctor, who kindly offered to set out some of the facts on this front…
A guest post by Dr Cliodhna Ni Bhuachalla, Specialist in Clinical Microbiology and Public Health physician (@c_ni_bhuachall / @drcliodhna)
For those undergoing fertility treatments or for those who have suffered miscarriage(s) it can be a distressing and uncertain time. Unfortunately, developments around the COVID-19 pandemic can cause even further distress and uncertainty. Equally this distress and uncertainty can impact upon those who are pregnant also.
While there is a lot we still don’t know, we are learning more every day about the virus (SARS-CoV-2) and the infection that it causes (COVID-19). This increasing evidence base helps to inform and update guidance around fertility treatments and pregnancy.
The COVID-19 pandemic is a rapidly evolving situation. The key groups issuing guidance around fertility treatments and pregnancy in the UK have so far taken a precautionary approach as there is only limited evidence and information available at the moment. There are many different factors to consider when deciding on this guidance including the health of an individual undergoing fertility treatments, the health of any embryos, the health of a mother during pregnancy and after, the health of a baby during pregnancy and after, and the ability of the healthcare service to provide continuity of care for all of these groups throughout the pandemic.
While we don’t know currently how exactly COVID-19 may impact upon those different groups Public Health England (PHE) has advised that:
- those who are pregnant are considered a vulnerable group at increased risk of severe illness from COVID-19 and that they should practice stringent social distancing measures (you can read exactly what those measures are here)
- those who are pregnant and have ‘significant heart disease’ or those who are taking ‘immunosuppression therapies’ are considered an extremely vulnerable group at very high risk of severe illness from COVID-19 and that they should rigorously follow shielding measures (shielding is different from social distancing – how and when to do it is explained here)
This is an anxious time for many people. If you are feeling anxious, distressed or uncertain often accessing accurate and reliable information can help. It is also helpful and important to maintain close links with your GP/medical team for specific queries throughout the outbreak. Reputable sources for information include NHS, Public Health England, Royal College of Obstetricians and Gynaecologists (RCOG), British Fertility Society (BFS), European Society of Human Reproduction and Embyrology (ESHRE), Tommy’s and World Health Organisation (WHO). Some of these groups have very useful FAQs and ‘open letters’ which can help to provide information around how best to proceed if your fertility treatment has been deferred (see here) or how best to manage your pregnancy in conjunction with your medical team or what to do if you suspect you may have COVID-19 (including advice around self-isolation – here and here). It is worth noting that self-isolation is different to social distancing or shielding. It is also important to remember that advice and guidance may change as new evidence emerges so it is worth checking that you have the most up-to-date advice for that particular source.
The following Q&A addresses some additional common questions relating to miscarriage and pregnancy in the context of COVID-19…
Q: Does COVID-19 increase the risk of miscarriage?
The RCOG guidance issued on Saturday 28th March tells us: “As this is a very new virus we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage…We will update our information if and as soon as there is any change in the evidence”. While this is reassuring, as more information emerges about the impact of this virus in pregnancy an increased risk may become evident so it is a good idea to keep up to date with what the RCOG is saying.
(Source: RCOG FAQ)
Q: What do I do if I think I am having a miscarriage during the outbreak?
Sadly, as we know, some pregnancies will end in miscarriage. The RCOG advises: “if you have an urgent problem related to your pregnancy but not related to coronavirus, get in touch using the same emergency contact details you already have.” It is essential to contact your healthcare team immediately if you have any concerns about miscarriage. The Miscarriage Association UK issued updated guidance (here) last Friday 27th March and it gives clear advice on what to do, who to contact and what to expect if you are concerned about miscarriage. It gives information about missed or incomplete miscarriage (including management options and what happens after), and also gives advice on ectopic pregnancy and molar pregnancy to help you during this difficult time.
Q: Is there any reason we should stop trying to conceive during the pandemic?
This is a complex issue and it is a very difficult decision for people to make as many factors need to be considered. It is worth discussing this in detail with your fertility team, medical team or GP. Of note, the Miscarriage Association UK advises that it may be prudent “to wait until the pandemic is over before trying to conceive. This is to minimise the burden on the health service, to ensure you have full access to early pregnancy and maternity care and because it is too soon to fully understand the effect of the virus in pregnancy.”
Q: Can healthcare workers carry on working if they are pregnant?
The RCOG has issued the following advice to pregnant healthcare workers to help them stay safe while working during the pandemic: “If you are in your first or second trimester (less than 28 weeks pregnant), with no underlying health conditions, you should practise social distancing but can choose to continue to work in a patient-facing role. If you choose to continue working, it is strongly recommended the necessary precautions are taken. You should avoid, where possible, caring for patients with suspected or confirmed coronavirus infection. If this is not possible, you should use personal protective equipment (PPE) and ensure a thorough risk assessment is undertaken. If you are in your third trimester (more than 28 weeks pregnant), or have an underlying health condition – such as heart or lung disease – we strongly recommend you avoid direct patient contact. It is better to work from home where possible, avoid contact with anyone with symptoms of coronavirus, and significantly reduce unnecessary social contact. Whatever gestation of your pregnancy, you should discuss your individual circumstances with your local Occupational Health department”.
(Source: RCOG FAQ)
While we are learning more about this new virus every day, we do know that the main sources of transmission that have been seen so far include direct spread from person to person via droplets from someone with an infection, or indirect spread from a surface that has been contaminated with droplets from someone with an infection. So practising social (physical) distancing, shielding if you are in specific groups, and keeping your hands clean and away from your face will really help you avoid infection. If you do develop COVID-19 infection then it is very important to follow the medical advice you are given. As there is no effective vaccine or specific antiviral treatment yet we must rely on these enhanced measures to help limit the spread of infection. Some sources refer to this as trying to ‘flatten the (epidemic) curve’. It can be hard to implement these measures, but it is critical that we all play our part to try and limit the spread of infection, break the chain of transmission and protect our family, friends and vulnerable populations in these challenging times.
Stay safe everyone.
Both the Royal College of Obstetricians and Gynaecologists and Tommy’s have pregnancy FAQs here and here
The Miscarriage Association have published advice about miscarriage care during the pandemic here
The Tommy’s midwife advice service is still running via email (email@example.com ) for any concerns you have – not limited to coronavirus enquiries.
There is a message on COVID-19 and how it might affect early pregnancy units, from the chair of the Association of Early Pregnancy Units, here. (The Association of Early Pregnancy Units also has a ‘find my nearest unit’ tool here – it includes contact numbers and opening hours.)
For questions and support relating to TFMR (termination for medical reasons) the charity ARC’s helpline is still open on Tuesdays and Thursdays. (Find them here).
If you are having fertility treatment or have had treatment cancelled due to the pandemic, the Fertility Network’s support lines are still open – 0121 323 5025 – or you can email: firstname.lastname@example.org.
And if you feel you need ongoing support, the HFEA recommends the Professional Infertility Counselling Association (BICA) (which has a ‘find a counsellor’ tool).
Likewise, Petals, the baby loss counselling charity, is still offering sessions over Zoom. (You can find them here).
PLEASE NOTE: All information accurate at time of publication (April 2nd, 2020) but given the evolving nature of the pandemic, please do check directly with the sources above for updates.