Issue link: https://maltatoday.uberflip.com/i/1237083
6 CORONAVIRUS CRISIS maltatoday | SUNDAY • 19 APRIL 2020 LAURA CALLEJA PREGNANCY is a special time full of excitement and an- ticipation. But for expectant mothers facing the outbreak of COVID-19, fear, anxiety and uncertainty are clouding what should otherwise be a joyously life-changing event. This anxiety and fear is often amplified by social media, where misinformation can run rapid and unchecked – especially at a time of social distancing when many individuals are scarce- ly leaving their houses and are more reliant than ever on the internet to stay updated on the latest developments, particular- ly on the health and safety front. But gynaecologist Mark Sant is urging expectant mothers to not skip their antenatal ap- pointments, especially given that Malta has yet to experience a worrying surge of COVID-19 patients in its midst. "The only time we postpone appointments is if the patients themselves show symptoms. In that case they are swabbed and if found positive, the idea is to follow them remotely until they are fit to come in – unless, of course, they need to be seen anyway, in which case the long- term plan would be to set up a COVID-clinic. However, that hasn't proven to be necessary as of yet," Sant said. He also debunks the myth that caesarean births are automati- cally the safer option for women in light of the pandemic. "Cae- sareans may be safe for the peo- ple attending to these women, but not for the women them- selves. So while we did have a discussion on whether or not we should encourage more caesar- eans for the sake of health care workers, this has not yet become an official recommendation and we're not applying as a policy… and neither are the UK, for that matter," Sant added. Contracting COVID-19 during pregnancy Sant also regales us with a small bit of good news: so far, there has been no evidence of verti- cal transmission of COVID-19. Which means that the babies in the uterus do not appear suscep- tible to the virus. "There haven't been signs of any anomalies developed from the virus. And even though we still classify pregnant women as a vulnerable group, as a whole they have not reacted to the virus in any worse a way than non-pregnant people so far." Sant says all women in the labour wards are being tested for COVID-19 on arrival, with women divided into those pend- ing swab results and those with known status. "A ward we're calling the 'COVID ward' has also been set up. In here you'll find those who have tested positive for the virus, those who have been quarantined and those awaiting a swab test. So it's pretty safe, and it's also worth mentioning that the number of people on the wards has declined by quite a bit." Meanwhile, midwife Pauline Borg says that midwives and doctors alike are following in- fection control guidelines as issued by the infection control team at Mater Dei Hospital. "This includes, among others, hand washing, social distancing when possible and wearing per- sonal protective equipment. So it might be that midwives look a bit different since we are wear- ing masks and visors but rest assured we are smiling with our eyes and the care is there none- theless." Paediatricians are advocating for the separation of mother and child if the mother tests positive for COVID-19. "Currently the policy adopted locally is that the mother and child are separated," Sant says. He also cautions against com- paring local practices to inter- national ones. "In the UK, if you go into the hospital and say you have a fever and a cough, and it doesn't seem like you need ad- mission, they don't even swab you – they just send you home. So if you look at the UK and the situation they are in, and the da- ta has shown that babies aren't badly affected, they may choose not to separate the mother and child." Sant however argues that if Malta had the necessary facil- ities that would allow for sep- aration to be made possible, it would be the recommended course of action to take as it may decrease the risk of infection in the labour ward. Partners in the delivery room To date, partners were only al- lowed into the birth room dur- ing the second stage of labour, and for a short time afterwards. "Once the midwife sees that the second stage is approaching, the partner is called to be with their wife/partner during the birth," Pauline Borg says. "The couple may decide whether the partner is to then wait outside in the car, say, or at home. But it's worth noting that should this not be the patient's first birth, the second stage may occur rather quickly. For this reason, some partners may opt to simply wait in the car should the woman still be in active la- bour." While Sant acknowledges that this may not be an ideal situa- tion, he stresses that the pro- tocol was being adopted in the best interest of the population. "Midwives and doctors are not happy that the partners are not there with the mother… it's not nice, and quite often a partner can be very helpful during de- livery. But this is a situation that has come upon us, and we need to get on with it." Sant also highlighted that when it came to COVID-19, contact hours did make a difference, so the idea of allowing partners to stay – even for a short while – cannot be medically justified. "The idea that if someone is allowed in for half an hour then they may as well be allowed in for eight hours simply does not hold. Because the risk of expo- sure depends on a number of factors: the space you're in, how close together you are and yes, how long you're in there for." Managing anxiety Borg says that a big part of the anxiety and fear expectant mothers were experiencing was due to social isolation, and as such, it was important for moth- ers-to-be to keep in touch with their social network, family and other mothers. "We all need to keep ourselves socially connected despite phys- ical isolation. However, it's also the case that new and expect- ant mothers should limit their exposure to social media and television. Should they wish to remain updated on the latest news on the virus, they should rely on established sources like the World Health Organisation, and the mainstream local me- dia," she says. Borg advises that exercise is essential by increasing endor- phins, decreasing anxiety, pre- venting and treating aches and pains common in pregnancy and helped mums-to-be sleep better. "Sticking to a healthy food regimen and drinking plenty of water is a must to avoid com- plications in pregnancy and to support mental wellbeing. It's also helpful to keep a daily rou- tine and to plan the day, keeping the mind active and even doing some work at home or any pro- jects which are of interest, but which can be done without leav- ing the house." In particular, Borg recom- mends indoor hobbies that are creative and therapeutic. "Speaking to a midwife and taking an online childbirth education class will provide much-needed empowerment and the necessary tools for birth. Babies will continue to be born irrespective of COVID-19, meaning that women need the same level of preparation, sup- port and positive determination to get them through this chal- lenging miracle of bringing life into the world." She adds that a balance had to be reached between being well-informed and sometimes letting "babies make their own story," as some choose to come into the world in ways that many mothers may not expect. "It is always good to be open and maintain a positive out- look." Midwife knows best: mums-to- be can relax "Babies will continue to be born irrespective of COVID-19... women need the same level of support to get them through the challenging miracle of bringing life into the world" Mark Sant