The United States has the highest maternal mortality rate in the developed world. Even under the best of circumstances, giving birth here is terrifying. The novel coronavirus pandemic has left medical professionals overworked, which means they have less time than ever to provide quality care to pregnant and laboring people. Some hospitals are forcing people to give birth alone, without a spouse or any other support person, making them more vulnerable to injuries and abuse, and potentially causing lasting trauma.
And now, many states have seized this opportunity to shut down abortion clinics, forcing people to have babies they never intended to—even when doing so may endanger the mother’s life or well-being, and in some cases even when the baby has catastrophic birth defects. I run a small maternal health nonprofit, and have been inundated with messages from terrified women. None of them know what or whom to believe. Many feel forced into giving birth in ways they never expected to. Some have been told that the hospital will separate them from their baby at birth to slow the spread of the disease.
So what do we know about pregnancy and COVID-19? The truth is, not much. While news reports and doctors may make confident assertions to pregnant women, the reality is there is almost no research on how this affects pregnancy. Here is what we do know so far.
Are Pregnant People More Vulnerable to COVID-19?
The short answer is that there is no conclusive, reliable data suggesting that pregnant people are more vulnerable to COVID-19—or that they’re not.
Early data from China does not show a proportionally higher rate of the virus among pregnant people. But all of the existing research has only looked at people who sought medical care, usually in hospitals. This means that researchers have only looked at the most serious cases. It’s certainly possible that the rate of mild cases in pregnant people is higher. We don’t have the data to know for sure, but for now, there’s no reason to believe that pregnancy increases the risk of the disease.
Similarly, there is no data showing that pregnancy increases the risk of COVID-19 complications. What we do know is that pregnancy changes the immune system. In theory, this might make it more difficult for the body to fight off the infection. Similarly, a later pregnancy taxes the cardiovascular and respiratory systems. This could increase the risk of serious complications, especially in pregnant people with gestational diabetes, pre-eclampsia, and cardiovascular health issues.
Does COVID-19 Cause Birth Defects?
We don’t know.
Most media reports about COVID-19 and birth defects are based on a small study out of China that looked at nine pregnant women. Their babies were just as healthy as other babies, but it is impossible to make sweeping recommendations or draw reliable conclusions from such as small sample size. That study looked only at women who got the coronavirus during the third trimester, which is when a fetus is already mostly developed.
We do not have any research on pregnant people who contracted the virus in the first trimester of pregnancy—primarily because the virus is so young that these people would not yet have given birth. Most fetal development happens during the first trimester, so infections and other injuries during this time are much more likely to cause birth defects.
Research on other coronaviruses suggests that they may increase the risk of preterm labor, miscarriage, and childbirth complications. Developing a fever during the first trimester also correlates with an increased risk of birth defects because high temperatures may alter development. So pregnant women should discuss with their doctors the risks and benefits of taking anti-fever medication, particularly in light of emerging evidence that certain anti-inflammatory drugs may increase the risk of COVID-19 complications.
Can a Pregnant Person Give COVID-19 to Their Baby?
Yes. Babies can contract the virus in much the same way as adults and children do. And because mothers are in such close contact with their children, the risk of transmission may be high. For this reason, some hospitals now recommend routine separation of mother and child if the mother has COVID-19. This is a strategy that may backfire. Research consistently suggests that these separations are bad for both the mother and baby. They cause health problems, make breastfeeding difficult, and may even cause neurodevelopmental delays.
Moreover, staying in a crowded hospital nursery with caregivers and babies who may have been exposed to the disease is unlikely to reduce a baby’s risk. Coupled with the increased stress of separation and the physical harm it may cause, separations may increase, not lower, the risk of health complications.
We do not know if a baby can get COVID-19 in utero. Most research suggests that vertical transmission of similar viruses is either rare or nonexistent. But only one study has specifically tested COVID-19. That study examined just nine pregnant people. None of them transmitted the virus to their babies, but it is possible that a larger sample might yield different results. Some newborns have tested positive for the virus. This is likely because of early contact with an infected parent or healthcare worker, not exposure in utero.
How Does Coronavirus Affect Childbirth?
There is, so far, no direct evidence that coronavirus affects childbirth—though similar viruses may increase the risk of birth complications.
However, COVID-19 may absolutely affect a person’s birth experience. Women across the country have reported extremely restrictive birthing environments, including being forced to give birth alone. Giving birth amid a pandemic may also increase the risk of getting the virus, since healthcare workers are more likely to have been exposed to the virus than members of the general public. People expecting a baby should ask their healthcare providers what they can expect during birth, and should switch caregivers if they can’t get a clear or satisfactory answer.
COVID-19 and Breastfeeding
Just one study has assessed whether COVID-19 might spread through breastmilk. Researchers looked at only six samples of milk, and found no evidence of the virus. The small sample size makes this data far from conclusive. However, other viruses do not spread through breastmilk, and nursing mothers who have the disease may be able to pass protective antibodies to their babies through their milk.
Danielle Downs Spradlin, IBCLC, a lactation consultant and owner of Oasis Lactation Services, emphasizes that we should always begin with breastmilk as the default, biologically normal food. She emphasizes that breastfeeding may reduce other means of virus transmission.
“It’s ridiculous to think that human milk poses more of an infection risk than giving birth in a crowded hospital that lacks personal protective equipment,” she said.
“We have evidence that human milk reduces infections in the respiratory and gastrointestinal systems,” she explained. “We know that co-morbidities increase the risk of death and serious complications from COVID-19. The logical thing to do is reduce co-morbidities. We also know that lactation is associated with a decreased risk in type 2 diabetes for postpartum parents. Type 2 diabetes is a significant risk factor for COVID-19 fatality.
“In a crisis situation, public health recommendations generally lean toward lowest intervention and least need for technology. Direct feeding at the breast/chest provides a renewable food source that does not require exposure to the immediate environment. Nothing touches containers that could be contaminated. The food product does not touch air that could be contaminated. There is no risk of rot as the milk is made fresh constantly.”
Managing COVID-19 When You’re Pregnant
There’s so much we don’t know about COVID-19 and pregnancy. We might not have answers for years. This forces families to make potentially life-altering decisions with limited information—and often under much pressure from doctors, health workers, and family members.
There’s one thing we know for sure: families need options now more than ever. They need more choices about where, how, and with whom they give birth. They need to be able to choose whether to give birth. Instead, they have fewer choices as governments move to shutter abortion clinics and healthcare providers limit birthing people’s options.
Several states have closed abortion clinics in the wake of the crisis. Many hope to ban abortion even when a baby is likely to die at or before birth. We are rapidly moving toward a world in which people are forced to give birth alone, in crowded and dangerous hospitals. Women who might once have chosen abortion to protect babies doomed to die at birth will now have to watch those babies die in the delivery room without a partner present, and while risking contracting a lethal virus.
The ability to control what happens to your body, to make decisions for your baby, to shape your own future as much as possible, matters more—not less—during a pandemic. Choice is a moral good.