Pregnancy is usually accompanied by feelings of enthusiasm and eagerness but unforeseen situations such as the outbreak of a pandemic disease can cause considerable uncertainty. COVID 19 outbreak has raised concerns among Pregnant mothers who are likely to deliver a baby during the pandemic. The significance of coronavirus on pregnancy and child birth are not yet identified, as the virus and its effects are novel and health care challenges are still evolving. Queries on whether Pregnant Women are more at risk of getting COVID-19 or can experience more severe symptoms and whether they might pass the virus to the baby remain unresolved and unanswered. The World Health Organisation (WHO) has stated that there is no current evidence to suggest that pregnant women are at higher risk of experiencing severe COVID-19 symptoms than the general population. Being pregnant can raise worries over extra possible measures to protect herself and her baby from the fast spreading coronavirus infection.

It is made mandatory in all health care centres to obtain the following information from all pregnant women:
• A detailed travel history
• History of exposure to people with symptoms of COVID-19
• Symptoms of COVID-19
• Coming from hot spot area
• Immunocompromised conditions

Pregnancy suppresses the immune system and thereby pregnant women are at higher risk for respiratory infections in general. Weakened immune defences during pregnancy are a normal physiologic response to facilitate the mother’s body not to reject the pregnancy itself. The physical changes during pregnancy, owing to the increasing size of the foetus, also compress the diaphragm and reduce overall lung volumes. An increased stress on the respiratory system through an infection can impose greater effort to breathe.

It is important that pregnant women take precautions to protect themselves against COVID-19, and report possible symptoms (including fever, cough or difficulty breathing) to their healthcare provider. Hence, It is necessary that they practise hand and face hygiene in more stringent ways now than ever to combat the risks of infection. The same is to be insisted with other inmates of the house. It is advisable to stay more than 1.5 metres away from people when out in public, even during hospital visit. Wearing a face mask or personal protective equipment (PPE) during antenatal procedures, if and as suggested by the gynaecologists may also lower exposure to coronavirus infection.

Maintaining social distancing and following regional lockdown protocols as stipulated by the local government not only ensures safety from COVID but also avoids undesirable circumstances of social insecurity. Emphasis on physical distancing measures can keep the pregnant woman safer from acquiring the infection.

• Abiding by stay-at-home policies that discourage people from going outside except for essential travel is great

• Avoiding gatherings or functions like baby shower ceremonies even at home would be essential. No contact with others can certainly reduce the chances of becoming a coronavirus victim

• Prenatal appointments that may be more frequent during the later stages of pregnancy are essential but the gynaecologist can suggest if some of these appointments can occur over the phone. Technology enables doctors to interact with pregnant women over video calls to offer telemedicine and thereby minimise the frequency of in-person visits

• Doctors may recommend spacing out ultrasound appointments and other elective procedures to reduce woman’s risk for transmission.

• Women who are self-quarantined because someone in their household has possible symptoms of COVID-19 are advised to disclose it to the health care provider in order to keep check. The gynaecologist will defer appointments for 14 days.
  Pregnant women are advised to increase their social distancing to reduce the risk of infection. Having said this, such situations can be highly stressful and make it hard for women expecting first-time or already a parent managing a kid, for not having the usual support network around the house. It is understood that the COVID-19 pandemic can possibly add further stress and may cause anxiety in some pregnant women. It is important to identify signs and symptoms of stress among pregnant women under lockdown.
• Signs that indicate stress during pregnancy are:
  • abnormal appetite and irregular eating habits
  • expressing feelings of fear and worry about the pregnancy and delivery more often
  • sleep disturbances or inadequate sleep
  • inability to concentrate
  Practise tips that may help relieve situational stress during pregnancy include:
  • Limiting the news related to COVID only to specific times of the day and not round the clock can enable leaving rest of the time free for relaxing and promoting sleep.
  • Online antenatal classes, referred by the doctor can act as a medium to meet and talk to other pregnant women.
  • Meditation, deep breathing or gentle stretching exercises can help ease tension.
  • Connecting with friends and family over the phone or through video calls can help overcome feeling of loneliness.
  • Maintain consistency in sleep time and limit screen time.
  • Eating a balanced diet and staying active can help the body stay healthy in times of mental stress.
  • Learning or renewing art forms such as playing an instrument, learning a language, reading, hand crafting clothes, blankets, toys etc for the coming baby can divert worries.
  • Taking help from the partner or other house members if present at home for managing daily chores and seeking a reliable neighbour for grocery shopping can bring down the workload.
  Another reason that pregnant women are stressed is that this pandemic has resulted in many pregnant women experiencing changes to their birth plan. Under the given crisis situation, hospital would still be a safer and better protected place for child birth with all accessible post-partum care. Access to relevant information may help gain control and reduce anxiety among women who are soon to deliver. A pregnant woman may have the following questions to the doctor:
  • How the hospital/clinic working hours or accessibility change?
  • Whether telehealth or antenatal interactive programmes are available?
  • What are the Safety measures when visiting the doctor’s clinic or going to the hospital?
  • How can COVID-19 concerns at the hospital affect during delivery?
  • Will there be changes in terms of the medications during delivery or the possibility of the partner being present in the delivery room?
  • Any area-specific or condition-specific changes that one may need to be aware of ?
  It is a good to get pregnancy care while preventing the spread of disease. As the virus is fast spreading, it is wise that pregnant women keep in touch with the gynaecologist for updates, necessary precautions and practical advice. It is also significant to note that the maternity team is allowed to care for pregnant women as per guidelines issued to them. Overall, it is important that pregnant women still eat well, stay active, get some exercise and practise necessary precautions to ensure continued healthy pregnancy and safe delivery.

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