Front Burner - Pregnancy in a pandemic

Episode Date: April 6, 2020

Questions about the impact of coronavirus on pregnancy are running through the mind of many expectant parents. But there is scant research into how COVID-19 affects pregnancy: the disease is just so n...ew. Today on Front Burner, we talk to the head of labour and delivery at Mount Sinai Hospital in Toronto, Dr. Wendy Whittle, about what we know so far about pregnancy and coronavirus, and what hospitals are doing to operate safely.

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Starting point is 00:00:00 In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. So a few weeks back, I got a little bit sick. I couldn't get out of bed. I had this wicked headache and a pretty nasty cough. I'm also pregnant, 34 weeks now, with my first child. So even though I felt like I was kind of on the mend, yesterday I was like, oh my God, there we go.
Starting point is 00:00:39 I feel better, but yeah. My amazing midwife, Tracy, she talked it through with me and she advised me to get a test for COVID-19. The hospital of Mount Sinai here in Toronto agreed and this was all set up in advance. I met Tracy at the hospital on a Saturday. So you can stand here and they're gonna take care of you. Thank you. She was actually the one who performed the tests. We were in a separate part of the hospital. She had personal protective equipment on and I was given a mask and gloves and she walked me through the whole plan. Okay so Tammy what we're going to do is we're going to do all the things we normally do
Starting point is 00:01:15 when we assess someone here. So you know we're going to take your vital signs. We're going to we're going to check the baby. We're going to do a test on the baby. Okay. She checked my baby's heart rate. That's what you're hearing there. Tracy also checked my blood pressure. She checked my temperature. Is this the COVID one? This is a thermometer. Oh, thermometer, okay. It's a fancy thermometer. Oh, fancy.
Starting point is 00:01:38 So that's my husband, Dan, if you're wondering who that voice belongs to. At the time, he was allowed to come with me. And then I got the COVID-19 nasal swab. They'd warned me it would be a bit uncomfortable. And if you just kind of do like a little bit of a, not fully back, but just a bit of a, yeah. Is that good? Okay. oh man really stick that up i really stick that up there yeah i know i'm sorry no no it's okay it's okay and then you can put your mask back on and that was it i'm very relieved to say that i tested negative for covid19 it's been a huge relief to just have that peace of mind these last few weeks. But there's still not a lot of research on how the coronavirus can impact pregnancy.
Starting point is 00:02:33 The disease is just so new. And now as hospitals across the country and around the world change their protocols around prenatal care and labor and delivery to adapt to the pandemic. I wanted to talk to an expert about what we do know about pregnancy and COVID-19. So today I've got Dr. Wendy Whittle with me. She's the Medical Director of Labor and Delivery at Mount Sinai Hospital in Toronto. I'm Jamie Poisson and this is Front Brown. Dr. Whittle, I want to thank you so much for making the time to talk to me. I know these are very busy and very intense times for you and we are very appreciative. Oh, it's my pleasure to be able to chat with you and share some information with your listeners.
Starting point is 00:03:23 Wonderful. So before we get into all the questions I have about this, I think one big thing to note off the top is that this virus is so new, right? And so is it fair to say that you and other experts in the field are still learning about this disease and how it affects pregnancy? Absolutely. Unfortunately, we don't have research and literature to guide us in understanding how this particular virus is going to affect moms and babies in the course of the pregnancy. We certainly can look back at other viruses that have similar characteristics, the SARS virus and the MERS virus, but at the end of the day, this is a novel and unique virus,
Starting point is 00:04:00 and we have to learn through the experience and reach out to others who perhaps are a bit more advanced in the experience, you know, our colleagues in Paris, our colleagues in Italy and Switzerland and China to say what happened, you know, what was your experience with the pregnant woman that can help us guide and care for moms on this side of the world. And so what you're learning from colleagues around the world right now, what do we know today about pregnant women's susceptibility to this virus? You know, is it easier for them to catch it, for example? It doesn't appear that women, pregnant women, are any more vulnerable than women of their same age group who are not pregnant.
Starting point is 00:04:50 Certainly, we know that in pregnancy, immune systems are altered a little bit, and we think that people are more susceptible, but that doesn't appear to be what's happening. The pregnant population doesn't seem to be at any greater risk than their non-pregnant peers at this time. Health officials say there are certain groups of people where the virus seems to impact them more. We're talking about seniors, men. There's no good data about the share of tests that are given to men and women respectively. But in Florida, nearly 60% of the confirmed coronavirus cases are male,
Starting point is 00:05:16 and 70% of the deaths are male. Okay. And you know, one question I had is, you know, we've been talking a lot about at-risk groups, the elderly, people with underlying health conditions. And so even though it doesn't look like pregnant women are more susceptible to this virus, are they considered an at-risk group? I think we recognize that pregnancy is a unique state, and that certainly could put people at risk. state and that certainly could put people at risk. We also recognize that some pregnant women do also have some of those underlying medical conditions, diabetes, hypertension, obesity. So we within ourselves recognize that pregnancy could potentially be a risk factor and it's really important for us to share education around safety, how to protect yourself from getting the infection, how to recognize the symptoms and seek medical care. So we, as a group of obstetricians, certainly are promoting good health care for the pregnant
Starting point is 00:06:09 woman in the context of this virus, because you're right, we don't really know. We're learning as we go. And, you know, I know, you know, you're still learning as you go. But what do we know today about the effect that this virus has on a pregnant woman? For example, does she get sicker than another woman in her age cohort? Based on what we know from the experience in the literature and speaking with our colleagues, the majority of women, 70 to 80 percent of women, experience a mild form of the infection, a sore throat, a fever, some respiratory symptoms, cough, sniffles, but essentially pass through it and recover without any significant consequence.
Starting point is 00:06:48 There certainly is a small portion of women who do become very unwell, but even those women have recovered. And in fact, there's no reported maternal death from COVID to date. That is very reassuring to hear. That is very reassuring to hear. This was Karen Mannering from Hearn Bay just a week ago, six months pregnant and admitted to the QEQM in Margate. I've got to do this for me and the baby. I've got to. Hear my breathing now.
Starting point is 00:07:16 She has come out the other side. It took every ounce of my being to be able to pull through, to see my family again and for my little baby. You know, I think now I'd like to move on to what I think is probably worrying a lot of pregnant women. This is something that worries me, is the potential effect that this virus could have on the fetus and so what do we know right now about how this could affect an unborn baby i know this is this idea of vertical transmission right can you pass the coronavirus to your child so in theory there are other viruses that can pass from mom to babe in utero and so there's always that potential. Thus far we have not seen any teratogenic effects meaning the virus causing
Starting point is 00:08:15 any structural abnormalities for babes being exposed in the first trimester. We've not seen any increased risk in first or second trimester pregnancy loss. There have been some reports of preterm deliveries, but mostly the choice to deliver was because of trying to facilitate the health and well-being of the mom, that it wasn't a spontaneous preterm birth. So thus far, it seems that there isn't a significant impact on pregnancy. There's one case report of a vertical transmission where a babe had the infection identified after delivery, but that is one case report. So that does identify that is the potential, but there isn't a significant group of babies that have been identified as
Starting point is 00:08:57 being infected. So I think we certainly are continuing to learn. We're certainly taking as many precautions as possible. We recognize that if you have any type of respiratory illness in pregnancy, it can affect the growth and well-being of babes. So we do recommend in women who have had the infection and they've recovered that we do an ultrasound to look at babe's growth and well-being and heighten our surveillance of that mom and that babe. But certainly we don't have any strong evidence to support that there is going to be an effect on baby. Right. This idea that there's one case of vertical transmission, is it possible that that transmission didn't happen in utero? Is it possible that the baby contracted the coronavirus after it was born?
Starting point is 00:09:40 The way the case is reported is reported as a direct vertical transmission. So I have to assume, because there aren't very many details published about it, that the babe was tested immediately after delivery, which would then lend favor to it having been a vertical transmission. But absolutely, you could have what we call horizontal transmission, which is picking it up from the mom or a health care provider or another family member. But there's an abundance of caution being placed around caring for babies, making sure that moms who have the infection deliver are masked so that they can't spread the, shed the virus to the baby.
Starting point is 00:10:15 The health care providers in the hospital environment are masked, gloves shielded so that they're not spreading the virus as well. So I would hope that that information is as accurate as it could be, because it certainly does create a sense of stress and anxiety for moms. But again, only one case report, which is comforting in the sense that there hasn't been an abundance of these cases reported. Okay. And I'm hoping we can also just touch on the effect that this virus has on babies, on newborns. And I ask this question because I understand that a six-week-old in Connecticut who had tested positive for coronavirus died in late March. The governor of Connecticut says the newborn was rushed to a hospital
Starting point is 00:10:57 unresponsive and could not be revived. And so what do we know about the effect this virus has on babies that contract it? So I have to say that's a little bit beyond my scope and breadth of knowledge. Any mom who has coronavirus in pregnancy has been a consultation with pediatrics to talk about sort of how to care for the newborn baby, how to monitor the newborn baby. So what the pediatricians are sharing with new moms, I'm not as familiar with, so I would hate to step out of bounds. Absolutely fair. And so now I'm hoping we can talk about the special protocols and safeguards that your
Starting point is 00:11:47 hospital is putting in place to help protect women and infants. And so what is Mount Sinai doing? So first, we have reduced the number of in-person prenatal visits to the ones that we consider to be the most paramount and essential. Every other visit that would have happened is not cancelled, but is done in a virtual manner, either through a teleconference, a telephone call, or a video conference. So we're still providing the routine visits that you would have. We're just doing it in a slightly different manner. Anytime anybody's coming for a prenatal visit, we are doing a telephone screen before. We are also then pre-screening before any elective procedures. So if you're having a cesarean section or an induction of labor, we're not canceling visits
Starting point is 00:12:36 if you screen positive. We're just organizing the safety of that visit and organizing testing ahead of time so that we know how to care for these moms safely, just like yourself. You had some symptoms, you came in and were tested so that we knew how to care for you safely. We didn't deny care. We really just want to make sure we do the care in the safest way possible. Yeah, absolutely. When we talk about labor and giving birth, what kind of guidelines is Mount Sinai putting in place? I know that there are different guidelines at different hospitals across the country and also across the world. I understand there are limits being put on visitors or even spouses during labor and delivery, depending on where you're located. So at Mount Sinai, we have a no visitor policy, but we do have a recommendation or a guideline
Starting point is 00:13:23 to support the presence of one support person through the labor, the delivery, and the immediate postpartum period. That support person has to be screened negative and diagnosed as negative, or if they've had the diagnosis, that they are 14 days since their diagnosis and they themselves are feeling well. For the moms, they are screened at the hospital entrance, and then they come up to labor and delivery, and they are are feeling well. For the moms, they are screened at the hospital entrance and then they come up to labor and delivery and they are screened again. And if they are screened negative,
Starting point is 00:13:52 then we proceed with our routine labor and delivery care. If they are screened positive, then they are placed in an isolation room and treated with an abundance of caution for the health care provider and themselves. Can I ask you, how do you come to that decision, the decision around support people and visitors? I know in New York, for several days at least, partners or any sort of support person wasn't allowed to be at the birth of the child. Carly Bertolino lives in constant fear of contracting COVID-19. This week, more worry. News from her doctor that she may have to give birth without her husband in the delivery room. You picture this milestone since you're a little girl and
Starting point is 00:14:37 not having my husband there potentially is, it's heartbreaking. Emotionally, and you want your husband to be there if, God forbid, anything happens. I would imagine there's a lot of factors that you have to consider when you're trying to make decisions around this. Well, every institution is different, but we ourselves at Sinai, in the current moment, recognize the birth of a child is a life-altering event, and we want to be respectful and recognize the birth of a child is a life-altering event and we want to be respectful and recognize the importance of that event. We also have a significant population of women who have pregnancy complications. These are high-risk pregnancies, whether it's concerns for mom or concerns for babe, and we want to be supportive of that high-risk nature of the
Starting point is 00:15:21 pregnancy. But we have to balance it against the risk of the disease. So we're always weighing the sort of ethics of that, and it's certainly fluid. It may change tomorrow. Looking at the disease prevalence of the population, if it dramatically increases, we may have to dramatically change our approach. But right now, we are recognizing the importance of that support person and the importance of that birth in that family's life. I put that question to the head of nursing with Health PEI today. She said they're really looking at this on a case-by-case basis, trying to determine what they can allow
Starting point is 00:15:55 while still ensuring the safety of the parents, of the baby, and other patients in the hospital. I also think there are people who may feel nervous about the idea of being at a hospital right now in general. So to give birth or to go for any other reason. I know that there was an uptick of home births during the SARS epidemic in 2003. Previously, I would have favored a hospital birth. But given the uncertainty today, I'd like to keep my stress level low just in case I'm turned away from a hospital and be in the comfort and safety of my own home.
Starting point is 00:16:33 And I wonder if you think that could happen again or if you're already seeing it happening? I absolutely could see it happening and, you know, low risk, uncomplicated, healthy mom, followed by midwifery and a home birth or a birth center birth is, you know, completely appropriate. Jessica Breitschwert says it is especially important for her and her husband to witness their daughter's birth together. I feel like my stress level has come down a bit since we decided to go with the home births and knowing that he can be there. There's so many unknowns, you know, but I tell myself there's also plenty of births that don't go as planned in the hospital. I think our hospital does have a high proportion of women who require obstetrical care because they aren't that low risk on complicated pregnancy.
Starting point is 00:17:23 So certainly that may not be a choice for some of the women that we care for. So we do have to make sure the hospital's safe. So how do we do that? Every person in the hospital who has any contact with a patient in any way, shape or form is masked. And that mask is what prevents respiratory droplets from spreading, which is how the disease is transmitted. You know, we're masking nurses and physicians and administrators. We're masking the guy who serves the coffee at the second cup. So we are working as best we can to keep everybody safe within the hospital environment. The hospital, as a corporation, recognizes that where you may be able to slow down elective
Starting point is 00:18:01 surgeries, where you may be able to slow down routine care, moms and babies come and they don't sort of stop because there is a virus in the community and a pandemic. Babies are born and so we have to make sure that we put an abundance of precaution and safety around that because that's one aspect of health care that cannot slow down or change. I want to pick up on something Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. I want to pick up on something that you alluded to a little bit earlier. You know, the idea that this can be an anxious time under the best of circumstances for women. These are not exactly the best circumstances. You know, I think that's probably fair to say.
Starting point is 00:19:03 the best circumstances, you know, I think that's probably fair to say. I wonder if you see a toll being taken on your patients in terms of stress right now. How are they feeling? Absolutely. I think, you know, at the best of times, having a new baby, particularly if it's your first baby, is a whole new experience. It's scary. It's new.
Starting point is 00:19:23 You're learning new things. You're delivering a baby. That baby's learning new things. So it is a stressful and anxious time. There's a significant risk for postpartum anxiety and depression. But when you put now a new mom with a new baby in isolation, that magnifies the impact of stress and anxiety. There isn't that community to help support that mom. There isn't the mom groups. There isn't the breastfeeding classes that you can visit, which become sort of a social network of support. So that certainly makes people anxious and nervous. You think of a new mom with a new baby. She's breastfeeding.
Starting point is 00:19:56 She's up every two to three hours caring for babies. Sleep deprivation at the best of times can be stressful, but to do that in isolation is even more stressful. You know, we often look to our moms or our friends or our sisters for support when we have a new baby, and that's not going to be able to happen as easily. We usually think of having a baby as a very joyous time, but these women are certainly feeling that stress and anxiety, and I feel for them. You know, when I had my first baby, it was, you know, it was stressful. Even though I'm in the business, it still felt stressful. So I can recognize and understand how uncomfortable moms must be feeling. Absolutely. You know, it's really sad to think that there are a lot of grandparents who also won't necessarily be able to meet their grandkids, even just for a little while. Though I will say
Starting point is 00:20:41 the best piece of advice, this is my first baby, the best piece of advice that I've received from a very good friend of mine is perhaps this is your very first lesson in needing to lose a little bit of control because this is just an entire lifetime of realizing that you're not really in control. Yes. Yeah, parenthood is a balance of trying to keep one step ahead of those kitties. But certainly, yeah, it's a unique time. I think the advantage of social media in this situation is that there are alternatives for family members to meet the new baby, between FaceTime and Skype and Zoom and all these different opportunities, and being able to take pictures and transmit them from, you know, cell phone to cell phone,
Starting point is 00:21:26 I think that's helpful. We didn't see that in SARS. We've not seen that in the past. But the alternative is every time you pick up your phone, you go on Facebook or you go on Instagram, and you're bombarded with information. And sometimes the way information is presented is a bit challenging, you know, X number of cases and this many deaths, but they don't talk about how many people have recovered or how many people did well and didn't get sick from the virus other than mild symptoms. So we're overwhelmed by the negativity and we're seeing it globally. So where social media creates a unity, it also creates, I think, an overwhelming
Starting point is 00:22:02 presence of this pandemic in your mind and your heart. And it's hard when it's reinforced like that to not get overwhelmed by it. Even us as health care providers are feeling overwhelmed by it. Dr. O'Dell, before I let you go today, I wonder if you might have any advice, any words of comfort or reassurance for anxious pregnant women out there who are listening to this right now? I think the key things are that pregnant women are not at increased, appear to be at increased risk. If you do get the infection, most people recover safely. Well, a small portion of women get sick, but even those women recover and do well. We are not seeing a huge impact on babies. We're not seeing a huge impact on babies. We're not seeing a huge
Starting point is 00:22:45 impact on pregnancies. And we are doing the very best we can with the most up-to-date knowledge in order to make sure that we keep moms and babies safe no matter where they have their care. And so I would say, yes, it's an anxious time, but know that we are on top of it and doing the very best that we can to keep you safe. Okay, Dr. Wendy Whittle, thank you so much for all the work that you're doing and for taking the time to talk with me today. So, so appreciative. You are very welcome, and take care of yourself, and best of luck. All right, so one more thing before we go today.
Starting point is 00:23:35 The question of how the coronavirus affects newborns. Dr. Whittle mentioned that this isn't her field of expertise. And so we wanted to find out a bit more about that. And we called Dr. Srinivas Murthy. He's a pediatrician and an infectious disease specialist who teaches at the University of British Columbia. Dr. Murthy says, like for everyone else, there are a whole lot of unknowns when it comes to this topic. But the one thing that we know for sure is that infants can get the disease. Dr. Murthy says it's impossible to know for now whether infants
Starting point is 00:24:05 get COVID-19 at the same rates as everyone else because not enough infants have been tested to be able to determine that. He says infants seem generally to have relatively mild symptoms with few complications. There have been a very small number of COVID-related infant deaths around the world, but he said the autopsies for those cases haven't been completed. So even there, nothing definite has been learned yet. I know for a lot of people listening, this might not be a super satisfying answer for you. We're going to continue to follow this story and we'll keep you posted on any updates. In the meantime, Dr. Murthy's advice for parents of infants, take care of your child like you would otherwise, with the added requirement of practicing physical distancing for yourselves and your babies.
Starting point is 00:24:53 That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.

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