Covid positive mothers should continue breastfeeding, maintain physical distancing with baby rest of the time

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A COVID-19 positive mother should continue to breastfeed her baby but is advised to keep the infant at a distance of six feet from her the rest of the time, a senior doctor has said. Dr Manju Puri, Head of the Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, also said there is no evidence to support the concerns about the foetus contracting COVID-19 from the mother, but stressed that pregnant women must take all possible precautions to prevent the infection. Addressing the issue of vaccine hesitancy, she asserted that the COVID-19 vaccines do not have any adverse effect on reproductive organs or fertility.

Puri talked about the recent decision to administer COVID-19 vaccination during pregnancy and what precautions a COVID positive mother should take to protect her newborn. "A mother should continue to breastfeed the baby but is advised to keep the baby at a distance of six feet from her when she is not breastfeeding," Puri was quoted as saying in a health ministry statement.

A caregiver who is tested negative can also help in taking care of the newborn. Before breastfeeding the newborn, she should wash her hands, wear protective gear such as a mask, face shield. She should also sanitise her surroundings frequently.

"If there is no one else to take care of the child, a mother should wear a mask all the time, and maintain physical distance from the child as much as possible. The mother and the child should stay in a well-ventilated room. And she should regularly wash her hands and sanitise the surroundings," Puri said.

On the possibility of the foetus contracting the infection, she cited studies conducted in this regard. "We have done a couple of studies and found that the placenta, an organ that is formed in the uterus in which a foetus grows, acts as a protective barrier. There are a few cases where the newborns were found infected but we are not sure whether those babies got the infection inside the mother's womb or soon after the birth.

"Having said that, as I have explained that pregnant women must take all possible precautions to prevent the infection as COVID-19 can affect her and her child in many other ways," Puri was quoted as saying in a health ministry statement.

On how COVID-19 vaccines can help pregnant women, Puri said during the second wave, more women contracted COVID-19 during pregnancy compared to the first wave. "If severe, the infection can lead to serious complications during pregnancy, especially during the last trimester as the uterus is enlarged and presses on the diaphragm, compromising a woman's ability to cope with a fall in oxygen saturation," she said.

This may lead to a sudden fall in blood oxygen saturation and risk the lives of both the mother and the child, she said. Puri stressed the need for vaccination, saying it will help prevent severe diseases in pregnant women. "Also, vaccinating a mother is likely to give some degree of protection to the newborn as the antibodies developed in the mother's body post-vaccination will pass on to the developing foetus through her blood. In the case of lactating mothers, an infant gets these antibodies through the mother's breast milk," Dr Puri said.

About the fears of the possible effect of the vaccines on fertility, Puri said, "These are rumours that get circulated on ubiquitous social media. Misinformation is far more dangerous than the virus itself".

Though the COVID-19 vaccines are relatively new, these have been developed using time-tested techniques, she said. "Vaccines help the body develop immunity against a specific pathogen, it does not affect any other body tissue. In fact, we give some vaccines such as hepatitis B, Influenza, pertussis vaccine to women even during pregnancy to protect them and their unborn child from various diseases," she said.

Besides, regulators have approved the administration of the vaccines during pregnancy only after they were confident of their safety, she said. "There is no scientific data or studies that show that vaccines can cause infertility. These vaccines do not affect the reproductive organs in any way," she said.

Puri said that while pregnancy and childbirth are social events in Indian society, expectant mothers should take adequate precautions, including wearing masks and maintaining physical distancing even at home. "It is because she may not be going out, but her family members could be going out for work and she can contract the infection from them," she said.

"So, women should use all COVID precautions during pregnancy, and after childbirth, as it can prevent them from catching the infection and related complications," she said.

On what a pregnant woman should do if she shows symptoms of Covid-19, Puri said, first, if they have any symptoms of COVID, they should get themselves tested at the earliest, "as the sooner we diagnose, the better we can manage the disease".

The management of COVID-19 is almost the same during the pregnancy as it is for others, but it should be done only under the strict supervision of a doctor, she said. "A woman should isolate herself, drink plenty of fluids, check her temperature and oxygen saturation every 4-6 hrs. If the temperature does not come down even after taking paracetamol, she needs to contact the doctor. If there is a fall in oxygen concentration or if there is a decreasing trend for example if it is 98 in the morning 97 in the evening, and then drops further the next day, she needs to get in touch with her doctor," Puri said.

Besides, women who have associated illnesses such as diabetes, high blood pressure, cardiovascular disease, obesity, etc, need to be more careful, as they may need hospitalisation. "So, consult your doctor and keep in touch with your doctor throughout the recovery period. We strongly recommend an overall health check-up post-COVID recovery to ensure that the mother and the foetus are doing fine," she said.

The doctor further said there is an increase in mental health problems among women during pregnancy and post-childbirth. These are times when a woman undergoes a lot of hormonal and physiological changes.

She has poor coping skills and needs social support. In the absence of this social support, she can feel lonely, helpless, and depressed. Isolation for 15 days is difficult for everyone, but more so for pregnant women and postnatal mothers. During this time, the additional anxiety about her child's health can severely affect her mental status. So, it is important to provide constant support and assurance to women during this time. The family should stay in touch through video calls, and observe any change in her mood and seek medical help if she looks and feels depressed.

Asked about the main advice to women patients, Dr Puri said, "We ask them to stay safe, take adequate precautions and follow Covid-appropriate behaviour. Take vaccine as and when it is available to them. Avoid meeting many people."

"If they have symptoms suggestive of COVID such as fever, sore throat, loss of taste or smell or exposure to a COVID-positive person they need to seek medical help immediately, should not delay the diagnosis and should not self-treat. And lastly, we also counsel all our pregnant women about various contraceptive methods during pregnancy and offer them postpartum Intra-Uterine Device (Cu T), which can be inserted immediately after childbirth or caesarean delivery. It saves them of an unnecessary visit to the hospital after childbirth and reduces the risk of an unplanned pregnancy," Puri stated.