Pregnancy and post-partum. How to deal with the spread of the virus

by Claudia Ravaldi

This post is also available in: Italiano (Italian)

via HuffPost Italy

These are very complicated times for both public and individual health: while public health is threatened.

Published in Huffington Post Italy 09/03/20

by Claudia Ravaldi

These are very complicated times for both public and individual health: while public health is threatened by the new Coronavirus epidemic which is putting a strain on the organization of our healthcare facilities with a completely exceptional number of critically ill patients, the individual health – of the individual citizen – is severely tested not only by the possibility of contagion, but also by the stress associated with this new situation of alarm and uncertainty.

People, even those who are at low risk of complications or who live far from the areas where the Coronavirus first spread, have already been infected by insecurity, uncertainty and fear, especially as the restrictions imposed by the government and unfortunately implemented by the regions with methods of communication that are not always clear and authoritative.

Confusion in communications related to the Coronavirus epidemic has increased the uncertainty and anxiety of citizens, promoting the formation of two opposite poles: on the one hand the skeptics, convinced that this is little more than a bad flu, on the other the hypochondriacs, at the taken with the sanitization of one’s person and of all possible surfaces 24 hours a day.

In between, the uncertain, who in the meantime, go on with their usual life, as if nothing strange was happening in the rest of the world. If in the first weeks of the epidemic conflicting news circulated on the severity of the Coronavirus and its effective spread, to the benefit of the skeptics, in the last 48 hours it has become quite clear that we are facing an extraordinary emergency and we are required to behave appropriately. to the situation. An adult, mature, responsible behavior for oneself and for others.

In one word, civil behavior.

The closure of schools, the closure of public places, the order to stay at home are affecting the perception of our quality of life and are conditioning our lifestyle with not a few efforts (there are those who just do not resign themselves to change and continue to touch things and people without any respect). Adapting to change is a real stress: however big or small it may be, it is still a stress, a balancing act between old habits and new, healthier homeostasis.

In all this do’s and don’ts, plan and cancel, concede and forbid, people’s psychic and psychosocial well-being are undergoing a real frontal attack. We are asked to face an emergency and act responsibly but we do not know how to do it and the change in our behavior is much slower than hoped: it is not enough to announce new rules, we must give people time to internalize them and make them their own. .

The persistence of the virus in circulation depends on the speed of adaptation of the population: the faster we adapt, the shorter the life of the Coronavirus in our country. It is in everyone’s interest to focus our efforts on the best possible adaptation, respectful of ourselves and others. We all have to make this effort. All of us, young people, adults and the elderly, single or married, children or teenagers, in full health or with known chronic diseases, should quickly work to comply with the simple rules issued by the WHO, the Ministry of Health and our Government.

This “everyone” also includes pregnant women, new mothers and new fathers, their families and friends. We know well that the arrival of a newborn in the family triggers atavistic instincts of care even in the most unsuspected people: we know that newborns, with their feet, their perfumed skin and their wide open eyes are an irresistible attraction. Everyone wants to see the baby. Everyone wants to touch it. Everyone wants to pick him up.

Well, this ceremony, already quite discussed before the advent of the Coronavirus, today is fully part of the behaviors to be avoided. It should quickly be included among the obsolete practices, those that were once done and are no longer used now.

At this moment in Italy there are thousands of pregnant women and from January to today about 80,000 babies have been born (about 1200 per day). Most babies return home within the first three days after delivery. In the hospital, access is properly regulated, precisely to limit contacts and reduce the risk of contagion. At home, no one can regulate but ourselves. And this can be a serious problem where the new rules of conduct have not yet come into effect.

Chinese clinicians, who were the first to confront the Coronavirus, have evaluated the impact of the virus on pregnancy, on the pregnant woman and on the fetus and found that, although pregnant women have a risk of getting sick that is comparable to that of other people, at present it seems that the Coronavirus does NOT pass the placenta and therefore allows us to say, at least according to these first studies, that the baby in utero is safe. This allows us to channel all our efforts to reduce the risk of infection for pregnant women, in order to protect their health.

Pregnant women MUST therefore observe the same rules as for everyone: avoid going out in public places, avoid crowded places, keep a distance of at least one meter from others, avoid physical contact, wash your hands thoroughly with soap avoiding touching each other face, stay away from people who have signs or symptoms of respiratory infection in general, dedicate themselves to themselves and their baby, without other thoughts.

These public health provisions can be very difficult to maintain when, for example, the person with symptoms and signs of infection is their eldest child, their mother, or their partner.

I understand well the emotional state that is created in these cases, the feeling of having to protect and take care of everyone and therefore of “having” to expose oneself to risk, hoping to have luck: we are in a new condition, never seen before for our generations, and therefore everyone’s responsibility and some small renunciations are needed, especially in view of childbirth and the puerperium, which are very demanding moments, from the point of view of physical and mental resources, and therefore we must prepare to face them in the best possible way and we must delegate to others everything that can be delegated.

The women who return home must be aware that in addition to the normal load linked to the puerperium, a cross and delight of new motherhood, they also have the load given by the ongoing epidemic.

As of this writing, three infants are hospitalized because they tested positive for the diagnostic test; I dare not imagine the concern of the parents and their anguish. Newborns, once out of their mother’s womb, have the same risks as all of us of encountering the virus and getting sick: we still know nothing about how the coronavirus behaves in newborns, and this lack of scientific knowledge calls for further collective caution. .

How to behave – What is the most appropriate code of conduct? Here are some tips to better manage relationships in these complicated weeks.

1) Wish mum and dad from a distance and ask if they need some practical help.

2) Stay away from the child’s home, at least until the coronavirus emergency has passed, and favor telematic contacts (eg video calls).

3) If the parents, who perhaps fall into the category of skeptics, invite you home, avoid gatherings anyway: let’s learn from the Magi, and let’s approach the child with moderation, deference and respect, one at a time, asking for permission WITHOUT touching him.

4) If we co-live with new parents, let’s remember a simple rule: our behaviors and our personal choices can impact the health of new parents and the child, so we must remember to avoid crowded places and occasions of contagion, stay away, wash our hands, DO NOT touch our face, DO NOT touch that of the child or even his hands or other parts of his body that he can then put in his mouth. This applies to all visitors: even if I am the grandmother, the aunt, the godmother or the best man at the wedding of the mother. Even if I’m Queen Elizabeth. Being one meter away from the new family is what is needed in this historical moment.

5) If we have small children potentially exposed to the infection and possible privileged carriers, do not go to visit the newborn.

6) If we want to show our affection to the new mother and to the new father, we can do so by doing many other things for them, shopping, cooking, running small errands or services, but limiting direct contacts as much as possible.

The newborn at the time of the Coronavirus is very comfortable in the arms of his mother and father. It does not need other arms that come and go: if we know how to wait, there will come a more appropriate time for cuddling in safety.

Physical and psychological consequences of the epidemic – We are facing for the first time since the war a situation of public emergency never experienced before. This feeling of alarm, confusion about what to do, lack of control and forced waiting for better times can trigger considerable anxiety and strongly affect our behavior and our state of mind. Considering that pregnancy and post-partum are two moments that already in normal conditions are associated with an inner revolution and a long series of changes on the individual, couple and relational level, it goes without saying that having to face the physiological aspects of the change even the health emergency can trigger a very important stress.

It is quite typical of new mothers to associate loving care of the newborn with increased alertness, protectiveness and concern, especially during the first experience of parenting or following previous complications. This background of worry and control tends to diminish as, week after week, the parents and the child begin to know each other better and become more confident and confident in their abilities.

Inserting an anguished worry such as the one we are experiencing these days into this delicate dynamic balance can transform care into anxiety and natural protection into overprotectiveness. Mothers, in turn, need to feel protected and not have to add worries to those that can usually run through their heads after giving birth.

Fathers can partly exercise this protective work, but in turn, in a moment of this type, they too need a secure base to be able to orient themselves, because they are people, not automatons, and it is never pleasant to see the your partner worried and not being able to do anything.

Babies in all of this have microscopic wireless antennas and they notice very well if the mother is scared and the father cannot reassure her. This results in a general sense of tension and nervousness, which is not good for anyone.

For these reasons it is important that pregnant women and new parents adopt the small precautions indicated by the WHO and the Ministry of Health, asking relatives and friends to respect them without ifs and buts.

This practice is enough to drastically lower the risk and prevent anguish and anxiety from overwhelming us for no reason. In the current state of knowledge, it would not seem that COVID-19 pneumonia has particular physical consequences specifically dangerous for pregnant women and newborns (as was the case for SARS): the information is not yet sufficient to draw definitive conclusions, because it’s all new, and we’re all going through it together for the first time.

Many national and international bodies are closely monitoring the development of the situation and are contributing to the creation of guidelines and protocols of behavior. Particularly noteworthy are the activities coordinated by the Istituto Superiore di Sanità in Italy, and at an international level the positions of the American College of Obstetricians and Gynecologists (ACOG) of the Centers for Disease Control and Prevention (CDC) and of the Sexual Health Agency . and United Nations Reproductive (UNFPA).

The current recommendations are summarized and published (with constant updates) also on the site of the CiaoLapo ETS Association for the protection of pregnancy and perinatal health ( www.covid.ciaolapo.it ).

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