From the Midwife’s Desk: COVID and Pregnancy

Living through a pandemic is not an event that every generation will be able to claim.  COIVD-19 has altered our daily lives, filled many of us with fear, has claimed the lives of loved ones, or perhaps caused serious illness. As COVID became a reality for us in the United States, I sat down with plenty of women and couples who had started to doubt whether they should proceed with starting a family. Some decided it would be best to wait to attempt pregnancy. There was so much that was unknown about the virus, how it could affect pregnant women, how it could affect a fetus, and how long it would go on. Under the pressure of lockdown some relationships faltered and ended and their family planning along with it.  

As the pandemic continued and it became clear that we had no idea how long it would go on for, some couples picked up their delayed plans for pregnancy and others made new plans. The pandemic offered an unexpected option of work from home and perhaps less need for child care. Women who thought they would delay pregnancy because they couldn’t imagine managing commuting, being away from a baby and nursing while working, now found they didn’t have to worry about those things. They were given lemons and made lemonade.

The creation of vaccines created relief in some pregnant women and apprehension in others.  As health care workers were on the front line and amongst those advised to get vaccinated (with some compelled to do so), they were the first in the office with concern and questions.  

• How do we know if the vaccine is safe?
• How will this affect my baby?
• What are the negative side effects?
• Can I get an exemption letter?
• Should I let unvaccinated people around my baby?
• If I get the vaccine, is it safe for me to breastfeed?

As providers we utilized guidance provided by the Centers for Disease Control and our health institutions. We tried to comfort women through their apprehensions, combat fears, and replace falsehoods and rumors with facts.

I want to use this time to share some of the facts regarding COVID-19 and pregnancy with you.  Always make sure to discuss any of your health care concerns with your chosen health care provider. 

The Facts 

Pregnant women are a vulnerable population for most pandemic viruses. From Zika to Influenza to the COVID-19, viruses have proven to be harmful to pregnant women and their fetuses.  Pregnant women tend to do poorly with respiratory illnesses due to the accommodations the body is trying to make to carry the pregnancy (Fuentes-Zacarías et al., 2021). While pregnant women are not more at risk to catch COVID -19, they are at increased risk for severe illness due to infection when compared to women who are not pregnant (Centers for Disease Control and Prevention, 2022).

Symptoms of COVID-19

The following are symptoms that are associated with the COVID-19 virus:

• Fever, chills, fatigue, headache, muscle aches and pains
• Cough, shortness of breath, difficulty breathing, 
• Congestion, runny nose and sore throat
• Nausea, vomiting, diarrhea, loss of taste or smell

According to the CDC, in the United States, between January 22, 2020 - January 24, 2022, there were 166,935 reported cases of pregnant women infected with COVID-19. During that time 27,854 were hospitalized and there were 267 deaths. Pregnant women with COVID-19 are more likely to end up in the intensive care unit if they contract the disease. Ten percent of the reported cases required ICU care, however, pregnant women who became infected with COVID-19 after vaccination and booster are more likely to be asymptomatic and avoid hospitalization. A total of 19,687 of those infections occurred during the third trimester (Centers for Disease Control and Prevention, 2022). 

How to Lower Your Risk of Contracting COVID-19 

There are steps that can be taken to lower your of contracting COVID-19:

• Get vaccinated. Studies have shown that getting vaccinated is safe and that it reduces the risk for COVID infection and the severity of disease if it is contracted. If you have questions about vaccine and safety during pregnancy, the CDC recommends that you contact MotherToBaby (see the Additional Resources section at the end of this article for more details).
• Limit your interactions with others, especially those who are unvaccinated.
• Avoid interactions with those infected with COVID-19, including family members,
• Wear a well-fitting mask; KN95 and N95 masks are the most effective, double masking is also very effective.
• Wash your hands with soap and water when possible, and hand sanitizer when convenient.
• Test if you think you may be infected (this includes feeling unwell, or experiencing any of the symptoms listed above). 

If you are young and healthy overall, you have a better chance of not experiencing severe disease due to COVID-19.  But some of us are at more risk than others for contracting COVID. This includes:

• Those who are front-line workers or work in a facility that doesn’t allow for social distancing or good ventilation
• Those who live in a community with high transmission or low vaccination
• Those who have certain diseases or health conditions such as obesity, older age, hypertension and pre-existing cardiovascular disease.  

What to Do if You Become Sick

Take precautions early if you believe you have contracted COVID:

• Let your health care provider know within 24 hours.
• Follow the CDC recommendations for quarantine and isolation (those may change, so make sure to check out updated information Care Recommendations). 
• Use precautions, such as not sharing food, dishes and bathrooms with others in your household to not infect others.
• Have others in your household tested.
• Clean and disinfect surfaces that are touched by others in your household.
• Make sure to take care of yourself, treat your symptoms with medications or comfort measures that are safe for pregnancy.

How COVID May Affect Your Pregnancy

As mentioned, pregnant women who are infected with COVID-19 during pregnancy are more likely to experience negative outcomes when compared to women who do not have COVID. Some of the negative outcomes can include:

• Preterm labor (delivering a baby prior to 37 weeks gestation)
• Stillbirth
• Preeclampsia (severe high blood pressure in pregnancy)
• Maternal hypoxia (poor oxygenation for the mother) which can negatively impact the baby
• Placental damage

As Muslims, we understand that hardships experienced in this life may be a test from Allah.  This pandemic may surely count as one, and Allah knows best. What we can do in this time of uncertainty is protect each other by following good medical guidance. This can help us to protect each other, the Ummah of Prophet Muhammad, and our non-Muslim brothers and sisters. 

It is important for us to take care of each other in the best way we can. No matter your decision regarding vaccination, take measures to avoid spreading the illness. Prophet Muhammad, peace and blessings be upon him, recommended that during the plague, Muslims should limit all mobility: traveling, visiting each other, and avoiding the sick. He also encouraged quarantine to keep the plagues from spreading. The Sunnah clearly emphasizes: “If you hear that there is a plague in a land, do not enter it; and if it (plague) visits a land while you are therein, do not go out of it” (Sahih al-Bukhari, 2005b)” (Piwko, 2021).

Due to the severity of negative outcomes associated with COVID-19 infection during pregnancy, I recommend you protect yourself and your loved ones in the best way possible. Our religion is one that encourages us to seek knowledge that is useful, beneficial, and for us to be critical thinkers. I love that about Islam. I love that Allah wants us to use the intelligence He has given us. The Prophet Muhammad, peace and blessings be upon him, advised:

“Take advantage of five before five: Your youth before old age; your health before sickness; your wealth before poverty; your free time before preoccupation; and your life before death.” 

In this time of pandemic, let us be grateful for the health that we have and the science that can help to protect us by Allah’s will. Let us also stay clear on the facts that can help reduce our disease burden and hopefully get this virus under control so we can return to some level of normalcy, inshaAllah. May Allah bless you with health. Ameen.

Additional Resources 

MotherToBaby

This online resource provides experts to answer questions in English or Spanish by phone or chat. The free and confidential service is available Monday–Friday 8 am–5 pm. In the U.S. call  1-866-626-6847 or Chat live or send an email at MothertoBaby.

Melissa Fleming is a Muslim wife, mother of four, daughter, sister and auntie. She is a Nurse-Midwife and Lactation Consultant in Maryland and has had the pleasure of attending to women and their babies in both birth center and hospital settings.She is a founding board member and health services director for Faith Families of African-Descent Meeting for Marriage & Parenting Support (FFAMM, INC.), a service organization focused on helping Africans of the diaspora connect with the African continent through travel and service. She has been working on increasing maternal/child and women’s health care in The Gambia through this collaboration. You can learn more about this project here: FFAMM Projects. Melissa is active in her local community with service and youth groups.