There are benefits to holding off on pregnancy during the coronavirus pandemic
- Some couples who'd planned on trying to get pregnant this spring or summer are halting their plans due to the unknowns about how the novel coronavirus might affect them, their future children, or their birth plans.
- While the American Society for Reproductive Medicine has guidelines discouraging couples from beginning fertility treatments during this time, no organisation has yet suggested couples should stop trying to conceive naturally.
- Couples should consider their own medical histories, mental health, and finances before deciding whether or not to proceed, OB-GYNs told Insider.
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Takayla Lightfield and her husband are used to having their family planning goals interrupted. Since first trying to have a baby in December 2018, they've halted for uterine polyp surgery, elevated thyroid levels, and getting medication to help Lightfield ovulate.
Now, the novel coronavirus may table their efforts yet again.
"Should we even be trying to have a baby right now since so much is unknown about this pandemic?" Lightfield, a 35-year-old doula in Minneapolis, asked her OB-GYN.
While the coronavirus has forced some couple relying on fertility treatments to postpone their family planning goals, others like Lightfield are grappling with making the decision on their own.
On one hand, trying doesn't mean achieving pregnancy, and perhaps by the time a child is conceived and born the medical system will be back on its feet. Plus, there's no strong evidence that pregnant women are particularly at risk for contracting or having serious complications from Covid-19.
On the other, getting pregnant during the pandemic could mean fewer or more remote prenatal visits, delivering alone, and less access to healthcare facilities should complications arise.
Here's what OB-GYNs say couples should consider before moving forward or holding back from pregnancy plans.
There aren't guidelines yet for people trying to get pregnant naturally, and more research is needed
On March 17, the American Society for Reproductive Medicine issued guidelines for clinicians to postpone "new, nonurgent treatments" for infertility in light of the many unknowns about how the novel coronavirus affects pregnant women and their babies. The move can also spare supplies and space for Covid-19 patients.
But the American College of Obstetricians and Gynecologists has not yet taken such a stance on natural conception, though the organisation is revising related guidelines now, according to Dr. Laura Sienas, an ACOG spokesperson and a maternal fetal medicine fellow at the University of Washington.
In the meantime, couples should consider what the research has shown so far: Pregnancy doesn't seem to make women especially susceptible to Covid-19, and pregnant women with the illness tend to fare well. One investigation of 147 pregnant women in China who either had or were suspected to have Covid-19 found that only 8% had severe cases, and 1% had critical cases.
Still, because pregnant women are at greater risk of complications from other respiratory infections like the flu, ACOG considers them at-risk population for Covid-19. Plus, some studies suggest moms can pass Covid-19 to their babies in utero. One study has shown that infants are more at risk of severe infection from the condition than older kids.
Ultimately, there's still a lot researchers and doctors don't know, including whether the medications being tested for Covid-19 are safe for pregnant women and how the virus could affect the first trimester, Sienas said.
"There is concern since other viruses can have significant impacts in the first trimester," she said. "If you can delay conception until more is understood, you can be more knowledgeable in deciding if you would like to accept those risks."
Women with underlying illnesses or those who expect a complicated pregnancy may be better off waiting
After experiencing a miscarriage in January, Haley Neidich and her partner were eager to start trying for their second child in March. But they made the tough decision to hit pause in part because Neidich's pregnancies have been complicated and she expects to need careful monitoring during her next one too.
"This is the first time that I am letting go of the idea that we have any sense at all of when we will feel safe enough to start trying," Neidich, a 35-year-old therapist in Florida, told Insider.
Considering how much medical intervention you may need or want is a good idea when considering this decision, experts say. Dr. Patricia Shay, an OB-GYN at Grand Rounds in San Francisco, told Insider people with chronic, pre-existing conditions may want to be particularly cautious.
"Respiratory, cardiac, and any conditions that impair the immune system would be the conditions that I would be most concerned about," she said, since contracting Covid-19 can be more dangerous in those instances.
Consider the mental health and financial toll
Neidich and her partner decided to postpone when considering the mental health toll of caring for their "very busy" 2-year-old while pregnant during an unpredictable pandemic.
"As a psychotherapist with a sub-specialty in perinatal mood and anxiety disorders, I am aware of the factors which increase someone's risk of trauma and other mental health complications during and after pregnancy," she said. "Given that I myself had a recent loss, I am aware of the impact that the stress of simply being pregnant during this time could have on me and the pregnancy."
Neidich also wants to be able to lean on family and friends during pregnancy - something that, physically, is not an option right now. "Pregnancy is hard, especially the first trimester, and I need my support system here with my physically in order to get through it and still be a good mom to my daughter," she said.
Shay also encourages patients to consider their mental health before proceeding with family-building plans.
"Covid-19 is causing significant stress and anxiety in some, and social distancing can be difficult to cope with over a long period of time," she said. Couples should also take into account potential financial challenges related to job losses and insurance changes, too.
Talk to your healthcare provider before making a decision
A reproductive health provider should be able to provide guidance as couples consider the pros and cons, Shay said.
"Many offices are offering telemedicine or virtual visit options and preconception counseling would be well suited for a visit like this," she said, adding that they can take into account individual factors like your medical history and any lifestyle changes you could make to "optimise your health prior to conception."
For Lightfield and her husband, a conversation like this led them to a conclusion.
"Our plan has been delayed so many times in the past by other things out of our control that we talked about it and decided to keep trying," she said. They don't want an even bigger age gap between their kids - their daughter just turned 4 - and are accounting for any extra time it may take to get pregnant or health issues they may encounter.
Now, Lightfield feels excited and relieved. "I was feeling really depressed just thinking about having to wait longer," she said. "I'm glad my husband and I are in the same page, and that our OB-GYN didn't discourage it."
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