Pregnancy can be a stressful time. It is common for a woman and her partner to have some degree of stress and anxiety during their pregnancy. The expectant couple can typically worry about the mother’s health and more often, the health of their baby. 

The Coronavirus pandemic has added further unknowns with respect to health implications for pregnant women and their babies. According to Dr Renée Miller (Perinatal Clinical Psychologist), “recent media attention on the possible increased incidence of stillbirth during Covid-19, has resulted in a further surge of fear in pregnant women and their partners. This is particularly confronting for parents who are pregnant after a previous loss.”

The present article aims to address the increased burden of worry faced by expectant parents. I address general concerns surrounding the impacts of Coronavirus during pregnancy. I also highlight limitations associated with the study referred to in the media regarding increased rates of stillbirth during the pandemic. Finally, together with Professor Mark Umstad and Dr Stephen Cole, we provide tips on how to keep you and your baby safe.

I’m pregnant. Should I be worried about catching Coronavirus?
From the limited evidence to date, pregnant women do not appear to be more severely affected by COVID-19 than the general population. The Royal Australian & New Zealand College of Obstetricians and Gynaecologists (RANZCOG) states that pregnant women do not appear to become more severely unwell if they develop COVID-19 infection than non-pregnant women of the same age. Most pregnant women will experience mild or moderate symptoms including fever, cough, loss of smell, headaches and fatigue. Most of these women will make a full recovery without need for hospital admission (RANZCOG, 2020).

I’m pregnant. Will my baby be harmed if I catch Coronavirus?
Women should remain reassured, that there is currently no evidence that COVID-19 will harm your baby or cause abnormalities during pregnancy. There is also no evidence to suggest that there is an increased risk of miscarriage with COVID-19 (RANZCOG, 2020). The risk of Coronavirus to a baby appears very small (Stillbirth CRE, 2020).

Should I be worried about the reports of increased rates of stillbirths during the pandemic?
A recent study in the UK found there was a 4-fold increase in stillbirths during the pandemic period (from February to June 2020). Understandably this finding is frightening for pregnant women. However, it should be noted that there were limitations to this study. 

These limitations include:

• none of the stillbirths occurred in women with COVID-19
• a small sample size
• a single-centre setting
• a short time frame
• a lack of information on the causes of the stillbirths 

Obstetrician, Dr Stephen Cole emphasizes that none of the fetal deaths in utero occurred in women with known COVID-19. He stated, “it is possible that increased stillbirths may be due to indirect effects such as a hesitation for women to attend the hospital for check-ups, to come in when they are concerned, or due to a reductions in antenatal visits”.  

While more stillbirth research clearly needs to be done, the UK study also points to possible indirect causes for the rise in stillbirth rates versus a direct link due to Coronavirus. 

Indirect effects include:

• a reluctance for women to present to hospital when necessary (with reduced fetal movements)
• fear of catching Covid-19 while in the hospital
• women not wanting to be a burden on the health system
• staff shortages
• reduced antenatal appointments 
• reduced screening (ultrasound)
• changes in referral patterns

According to Obstetrician, Professor Mark Umstad “It is important to understand that it is still safe to continue attending your care provider during the pandemic. They will have all of the appropriate precautions in place to protect you, including when you attend hospital. While it can be challenging to attend without your usual support team and may be confronting to see clinical staff in their personal protective equipment (PPE), these precautions will keep you and your baby safe during this pandemic."

In summary, studies conducted to date have limitations. Clearly more research is needed. 

What can I do to keep my baby safe?

The next section outlines what Midwives and Obstetricians are advising their patients who are concerned about the health of their babies during the pandemic. 

• Get to know your baby’s movement patterns. If you notice a reduction or change in your baby’s movements, contact your care provider immediately. This may be your Midwife, Obstetrician or GP. Do this as soon as you notice the change in your baby’s movements. You will be asked to go in to your hospital/health facility for an assessment of you and your baby
• Settle to sleep on your side, especially from 28 weeks’ gestation. This is known to reduce the risk of a stillbirth (Still Aware, 2020)
• Be reassured that you are not a burden on the health system and that you and your baby’s health remain our priority 
• Recognise that hospitals and antenatal services are doing everything they can to keep you and your baby safe. Changes in hospital processes are in place to reflect this (e.g. Covid-19 screening, limiting visitors, limiting movement around hospital, frequent hand/equipment washing, staff wearing PPE)
• Keep your antenatal appointments. These are an important part of monitoring your and your baby’s health
• Voice your concerns and questions. Your health care provider knows what an anxious time this is for you and your partner
• Albeit a different experience to what you imagined, this is still an exciting time and soon you will be meeting your beautiful baby
• If you are struggling, contact a psychologist or service that can help you manage your fear and anxiety

Please note: this list is not exhaustive. Please always refer to your health care provider and the advice they give you during your pregnancy. 

The Coronavirus pandemic has understandably added an extra layer of uncertainty and stress for expectant parents. Try not to jump to conclusions in your own bubble of worry. Trust your healthcare provider. Ask your questions and voice your concerns. Focus on the facts, not on the media. You are not alone in this.

We left the paediatrician's office feeling shocked, gutted, and numb. We were told that our child's delayed development could be an indication of Autism Spectrum Disorder. We were barraged with names and details of specialists who could continue assessing Henry and provide therapeutic support. What? Autism?

In the days that followed we watched Henry's every move, his every expression, the way he played, ate, and interacted. The way we saw our beautiful boy had changed since the excruciating hour and a half we spent answering questions, completing questionnaires, and trawling through our memories of Henry's developmental milestones (or lack thereof). With each milestone he appeared to have 'failed', our hearts sank further and further.

We were reassured about the services that could help Henry to learn some of the skills he would need in life - a life we now imagined playing out in the bleakest of ways.

We began contacting the names of the practitioners we had been given. Dying inside that our boy was now going to be scrutinised, assessed, and labelled. Putting one foot in front of the other, we followed directions to implement assessment and support services for Henry.

But who is there to support us? Who can help us to cope with the grief, the trauma, the rising panic? How do we parent our boy now? Who are we now? What does this mean for our other children?

When a child is diagnosed with a developmental disorder such as Autism Spectrum Disorder, there are a multitude of services to support the child. But parents often feel out at sea themselves. Where do they turn to understand their role as parents? Who do they see to recalibrate their views and expectations of their child? How do they manage with the challenges their child brings to the family?
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Dr Alison Wilby is a Clinical Psychologist who supports parents facing developmental concerns in their young children (under 8 years old). Alison understands the trauma, the profound disappointment, and the fear that parents can feel when they are told there is 'something wrong' with their child.

Integrating over 20 years of working with new parents and young children (particularly where there are significant developmental challenges), and with a PhD on the role of parenting in early social emotional development, Alison is well placed to support parents traversing the multidisciplinary landscape of the Autism Spectrum.

Alison is a warm and caring practitioner who helps parents understand how their child thinks and behaves within the challenges and strengths each child displays. Alison provides assessment and support for parents who are concerned about the development of their infant or child, and she provides tools to manage difficult behaviour while helping parents to gain clarity on the underlying causes.  

Alison has a particular interest in Autism Spectrum Disorder and anxiety disorders in early childhood, including young children with selective mutism.  

With her background in parent-infant settings, Alison works with children who have been affected by a parent’s mood disorder.  In situations where mothers have been hospitalized, Alison supports children who are struggling with the distress of separation.

Irrespective of the diagnosis a child might receive, Alison assists parents to build confidence in their parenting, working with couples to help them to determine optimal strategies for parenting their particular child. Alison's ultimate aim is to help parents to parent with love and acceptance of their child, and to see the unique capabilities that every individual child possesses.

Alison is located in Melbourne’s south east (Caulfield North, Hampton and Glen Iris).
Read more about Dr Alison Wilby here: https://www.antenatalandpostnatalpsychology.com.au/dr-alison-wilby
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​Article written by Dr Renée Miller
Principal Clinical Psychologist
Antenatal & Postnatal Psychology Network