Coronavirus (Covid-19) and pregnancy: Women navigating the two at once

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- photo by MaElena Barcenas

MaElena Barcenas, of Detroit, Mich., had what started out as a fairly normal pregnancy. Other than persistently high blood pressure, she said, the first seven months went smoothly for her.

In mid-March, around seven months into Barcenas’s pregnancy, she began experiencing symptoms of pre-eclampsia, including extremely high blood pressure and swelling in her feet and legs, Barcenas, now 36, said in a video interview. She was admitted to the hospital, where she was told she would stay until her delivery.

A few days later, Barcenas said, she developed a rattle in her lungs, which eventually turned into a cough. An X-ray of her lungs showed that she had pneumonia, and shortly afterwards, she tested positive for Covid.

“From there, it seemed like everything just went downhill super, super quick,” she said. She developed an extremely high temperature — 107 degrees is the highest she recalls it being — and her blood oxygen levels began dropping quickly.

Pregnancy in the time of Covid is a complicated and fraught issue. While women keep getting pregnant and having babies, the course is not always smooth. And yet, some women have gotten pregnant and had amazing birth experiences, and they especially treasure their pandemic babies since the odds and the atmosphere are so frightening.

Emergency C-Section, and then a medically induced coma

“Every time your oxygen drops, the baby’s drops,” the doctors told Barcenas. “So we have to take the baby out now.” Barcenas’s daughter was delivered via Cesarean section on March 23. Shortly afterwards, Barcenas was placed on a ventilator and put into a medically induced coma, where she remained for over a month.

“I never did get the chance to see her or anything like that because I was already under,” Barcenas said. “When I woke up, on April 27, she was already a month and a few days old, but she was still in the hospital. By this time they were letting my mom and her dad go see her, which was good, because for the first month she didn’t see anybody, just the doctors. No family, nobody to bond with.”

Although Barcenas’s baby did not contract Covid in utero, she became ill with the virus shortly after her birth — perhaps by catching it from her mother in the operating room, or from somewhere in the hospital, which was fraught with Covid cases. The child was transferred to a children’s hospital in Ann Arbor, where she remained for two months, receiving specialized care.

MaElena Barcenas

“She needed specialized care because they hadn’t seen [Covid] in anybody so young,” Barcenas said. The infant, Maria Elena, has since made a full recovery and, at seven months old, when the interview was conducted, Barcenas confirmed that her baby was “really, really healthy.” The baby did develop some kidney damage from her bout with Covid, but Barcenas said the doctors do not expect it to cause long-lasting problems forher, as her kidneys are still developing.

Barcenas said she is doing much better herself, although she is still experiencing some lingering symptoms from her illness, including shortness of breath. She also developed Guillain-Barre syndrome, which left her paralyzed from the waist down upon waking from her coma, but has since been localized to her right foot.

LIMITED INFORMATION FROM THE EXPERTS

Because the virus is so new, it is not yet quite clear how it affects pregnant women and their babies. But research and anecdotes can begin to paint a picture of what those experiencing Covid and pregnancy simultaneously might encounter.

According to the Centers for Disease Control and Prevention (CDC) website, studies have shown that pregnant women are at increased risk of becoming severely ill from Covid-19. Based on their research, the CDC says, “pregnant women are more likely to be admitted to the intensive care unit (ICU), receive invasive ventilation and extracorporeal membrane oxygenation, and are at increased risk of death compared to nonpregnant women. But much remains unknown.”

The Mayo Clinic website also notes that “some research suggests that pregnant women with Covid-19 are more likely to have a premature birth and their babies are more likely to be admitted to a neonatal unit.”

Nature reports that studies from around the world have shown an alarming rise in the proportion of pregnancies ending in stillbirths since the start of the pandemic. “Researchers say that in some countries, pregnant women have received less care than they need because of lockdown restrictions and disruptions to health care,” the journal reported. “As a result, complications that can lead to stillbirths were probably missed, they say.”

What to do after childbirth

After childbirth, the Mayo Clinic website recommends that women who are ill with Covid should wear a face mask and pay particular attention to hygiene when handling their newborn. The site also says that it should be all right for women to keep their newborn’s crib by their bed while in hospital, but that infected mothers should maintain a reasonable distance from their baby when possible. “When these steps are taken,” the site says, “the risk of a newborn becoming infected with the Covid-19 virus is low. Research suggests that only about 2% to 5% of infants born to women with Covid-19 near the time of delivery test positive for the virus in the days after birth. However, if you are severely ill with Covid-19, you might need to be temporarily separated from your newborn.”

It is not known whether Covid can be transferred through breast milk, although according to the CDC website, current limited research suggests that breast milk from infected mothers is not likely to spread the virus to babies. The greater concern, Mayo Clinic says, is whether an infected mother can spread the virus to her infant via respiratory droplets while breastfeeding. Thus, they recommend that nursing mothers wear a mask when breastfeeding.

The CDC says that young infants should not wear masks or face shields because of risk of suffocation.

The World Health Organization (WHO) website admits that “we still do not know if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery. To date, the active virus has not been found in samples of fluid around the baby in the womb or breastmilk.”

Interestingly, a Singaporean mother who was infected with Covid while pregnant in March has reportedly given birth to an infant with antibodies to the virus. A study in China recently noted that, out of 24 infants born to Covid-positive women, approximately 25% of the infants possessed antibodies to the virus upon birth. These antibody levels declined rapidly over time, “suggesting,” the researchers wrote, “a lack of protective passive immunity in infants,” although, the noted, “we do not know exactly what level of antibody titers are considered protective against infection.”

DECLINING BIRTH RATES AND A PREDICTED ‘BABY BUST’

Data suggests that the number of women choosing to have babies has declined dramatically in the U.S. because of the pandemic. When the pandemic lockdowns first started, some predicted that birthrates would spike as people found ways to occupy their time while stuck at home.

But as the pandemic drags on, the opposite seems to have occurred. Economists and fertility experts now warn of a coming Covid “baby bust.” Time Magazine notes, “a June report from the Brookings Institution estimated that the U.S. would see as many as 500,000 fewer births in 2021, a 13% drop from the 3.8 million babies born in 2019. Telehealth clinic Nurx tells TIME it has seen a 50% jump in requests for birth control since the beginning of the pandemic, and a 40% increase in requests for Plan B. A survey from the Guttmacher Institute found that 34% of sexually active women in the U.S. have decided to either delay getting pregnant or have fewer children because of concerns arising from Covid-19. Lower-income women were much more likely than other women to want to put off having a baby; that’s especially true among Black and Latinx women, who have suffered disproportionate income and job losses this year.”

This outcome is hardly surprising, as history has shown us that changes in a country’s economic condition correlates with changes in birth rates. Brookings reported that “an analysis of the Great Recession leads us to predict that women will have many fewer babies in the short term, and for some of them, a lower total number of children over their lifetimes.” They also noted that birth rates are directly linked to unemployment rates; one approximate analysis predicted that, in an individual state, “a one percentage point increase in unemployment reduces the birth rate by 1.4 percent.”

Trying for another baby? Maybe not right now

Pam Moscoso, a 39-year-old mother of two from Los Angeles, Calif., said in a Facebook Messenger interview that she and her husband had been planning to try for one more child, but are cautious now because of the pandemic. “We’re not trying,” she said. “We probably would have been trying now if it weren’t for COVID.”

Moscoso said she was sick with Covid for around six weeks, and has been experiencing lingering long-haul symptoms for approximately five months or more.

When asked what it would take for her to feel comfortable going ahead with a third child, Moscoso said, “I think public health experts will have to say, ‘It’s O.K. for you to gather with friends and with family outside of your household.’ We need social support for my appointments (so someone can watch the kids) and labor and delivery. But I’m also worried about what the virus has done to my body and if it would affect fertility and pregnancy. I’d ask my OB/NP before trying to conceive.”

UNEXPECTED PREGNANCY WITH COVID

T., a 38-year-old mother of a 3-year-old from Columbus, Ohio, who spoke on condition that she be identified by the initial of her first name, said in a phone interview that she began experiencing symptoms of Covid in November of 2019 after a vacation with her husband in Las Vegas, Nev. Her entire family became ill shortly afterwards.

“[I had] all the classic symptoms of COVID that we know about now,” T. said. “High fever, difficulty breathing… fever, sweating, chills, aches, the whole nine yards.” She tested negative for the flu and strep throat upon returning to Ohio.

T.’s symptoms lingered, with some variance in severity, for the next few months. Her doctors tried a variety of medications, although none seemed to help. T. was admitted to the hospital in February, with chest pains, an unusual EKG reading, tingling in her hands and arms, and tachycardia. Other than elevated D-dimer levels in her blood, T.’s doctors were not able to determine a cause for her symptoms. They could only assure her that she had not had a heart attack — which had been her concern — and attributed her symptoms to anxiety.

“This was mid-February, before doctors realized that Covid was already here and already pretty active,” T. said. “We’re learning that now. By the time I realized that I likely had Covid, it was way, way past anything a test would indicate.” At her sickest, T. said, she feared she would not survive.

A surprise pregnancy, then severe symptoms

T. and her husband were surprised when T. became pregnant with twin boys in May. The couple had initially been trying for a baby before T.’s illness, but had ceased their concerted efforts when T. became ill. T. said that most of her lingering Covid symptoms were gone by May but, between the sixth and seventh weeks of her pregnancy, she experienced a resurgence of symptoms so strong, she almost admitted herself to the hospital. These symptoms included painful swelling of lymph nodes all over her body, and a very specific type of headache that T. said she has only ever experienced with this illness.

The extremely severe symptoms abated several days later, and once again left T. with lingering mild symptoms, as she had experienced the first time around. She said she does not know if she was reinfected, or if this was a relapse of the same initial illness.

As of this November, a year since her initial infection, T. said that she is finally approaching feeling 100% well again. T. said she has been taking vitamin B-12 and vitamin D supplements, as well as zinc and prenatal vitamins. She has also been making sure to stay hydrated, and drinking electrolyte solutions, and is taking magnesium, melatonin, and “goodbye, stress” gummies to make sure that she gets lots and lots of sleep. She does not know if she can attribute these self-care practices to her improving health, but she is thankful to be feeling well again.

“I think the hardest thing is just…I’m having a hard time completing completely letting go of everything going on and trying to be really joyful about what blessing I actually do have, which is two amazing baby boys on the way,” T. said. “It’s a miracle, I think. And I do see the goodness that it’s brought to our life where I have something else to focus on. But I’m having a really hard time getting to that point of happiness and past a point of worry. I think that’s the hardest part for me.”

NAVIGATING NEW MOTHERHOOD WITH COVID

Chelsea Weaver, 29 who lives just outside of Asheville, N.C., and her husband, 31, both became ill in January. Weaver had their baby in February. Although the baby was born healthy, Weaver and her husband have continued to experience lingering Covid symptoms, including coughing, shortness of breath, body aches and extreme fatigue.

Their baby did develop some coughing and a few alarming drops in blood oxygen levels, but has otherwise remained healthy. Although Weaver and her husband were feeling somewhat better, they both began experiencing a resurgence of symptoms in September that they say has been worse than their first bout.

When Weaver and her husband tried to get tested after their second bout of symptoms, they were told by their doctor that a nasal swab test would cost $75 each, which the couple was not able to afford. Both Weaver and her husband are currently unemployed due to their illness.

Weaver, who worked as a surgical technologist before she became unable to work due to her illness, has some medical experience and keeps a heart rate monitor and pulse oximeter in the home. When she began experiencing alarming cardiac symptoms — her heart rate would drop to 40 bpm, then spike to the 120s — as well as chest pain, she sought medical help.

Weaver was dismissed by her doctor, and told that her heart rate, chest pain, and shortness of breath were all due to anxiety about having a baby. She was referred to a therapist.

“Recently,” Weaver said in a phone interview, “I just went ahead and told [the therapist], you know, I’m certain that my problems are more related to an issue that our medical community hasn’t caught up with quite yet, and that I wasn’t going to continue to spend the money to go talk to a therapist, to tell her how bad my chest is hurting that day.

“My whole life, I’ve had some level of anxiety, not even treated. I went through a lot of things in my life between my job working in cardiothoracic surgery to losing both of my parents. I’ve experienced anxiety, and this is not this pain that I get from anxiety. This is completely different. I went to the hospital thinking that I was having a heart attack, that I was going to be leaving my four-month-old at the time.”

Concern for their daughter; dismissive statements from doctor

Weaver and her husband fear for how Covid may have affected their daughter. Early on, Weaver said she brought her concerns to a gynecologist.

“I was worried with how it may have affected our daughter in ways we may not have been aware of at the time,” Weaver said. “The second that I started to breach the topic with her, she told me that this Covid stuff was all blown out of proportion, and that soon enough it was going to be going away and that people were getting more anxious about it than they needed to. And she was a young female! I was very surprised.”

Weaver said she told one physician that she and her husband — both formerly very active people — were experiencing blood oxygen levels that hovered in the low 90s, and dropped down into the 80s, especially at night. “He tried to say, ‘oh, well, you know, that’s kind of normal for some people; some people walk around 80% all the time and that’s their normal, so I wouldn’t be alarmed by that,’” Weaver said. “80s is not normal oxygen for us! …I have been so taken aback by the fact that we have so many people in our medical field who are just completely unwilling to acknowledge that this novel virus can be causing novel issues for the people that have been affected… I expected more from our medical community.”

Weaver is far from the first patient who has been struggling to feel heard during the pandemic. Numerous patients — women in particular — have reported being dismissed and not taken seriously by doctors, despite experiencing debilitating and potentially life-threatening illness. This was an issue long before the pandemic, but with many new patients contracting Covid, patient complaints about such episodes are increasing.

“It’s not comforting,” Weaver said, “but at the same time, it is comforting to know that there are a lot of people experiencing this, so that hopefully in the next few months to a year or so we can have a definitive answer to what’s happening here instead of ‘female anxiety’ because it didn’t work all these years….And it’s certainly not the approach that needs to be taken moving forward with people just coming out of this with chronic issues.”

Weaver said it is particularly frustrating to not be able to keep up with her daughter and be as present a mother as she would like, because of her illness.

“The hardest part, I think, is the fear,” Weaver said. “I’m worried about leaving a little baby girl. And then when you couple that with not being able to congregate and all those things, I feel like I’m keeping a whole normal life from our brand new little baby. She’s not been in a store. She hasn’t been in a restaurant since this all started. So just the unknown, and the fear that goes into navigating this by yourself…very much by yourself.”