As if pregnancy is not stressful enough, COVID-19 has added an extra dimension of uncertainty to the process. Dr. Barbra Fisher, MD, PhD, maternal-fetal medicine specialist at Northwest Perinatal Center in Portland, recently helped us understand how getting vaccinated during pregnancy benefits both pregnant patients and newborn children. Here, Dr. Fisher answers some of the most common COVID-19-related questions she receives from patients about pregnancy, birth and reproductive health.

COVID-19 rules and restrictions at hospitals are frequently changing, and they may vary from hospital to hospital. Please check with your hospital or birthing facility to know what COVID-19 rules are currently in place.

Q: Is it safe for me to get a COVID-19 vaccine during pregnancy?
Dr. Fisher: “Yes. In fact, it’s recommended to get a COVID-19 vaccine during pregnancy. We know that COVID-19 infections can potentially be very harmful to pregnant mothers and their developing fetuses. Vaccination is the best way to prevent those complications.”

Q: If I had COVID-19 during pregnancy, will my baby have any COVID-19 antibodies for protection?
Dr. Fisher: “Yes, studies show if you have had either a COVID-19 vaccination or infection, the antibodies cross the placenta and are passed to the fetus. A recent study conducted in pediatric hospitals in 17 states showed vaccination during pregnancy offers protection to the newborn and reduces COVID-19-related hospitalizations by about 60% in the first six months of life.”

Q: What are the risks for a pregnant person who gets COVID-19?
Dr. Fisher: “Data show pregnant people with a COVID-19 infection are at increased risk for severe illness compared to non-pregnant people.”

These risks include:

• 70% increased risk of death from COVID-19
• Increased risk of pre-term delivery (delivery before 37 weeks of gestation)
• Three times the risk of ICU admission
• Three times the risk of invasive ventilation (needing a machine to help breathing)
• 2.4 times the risk of extracorporeal membrane oxygenation (ECMO, a machine that helps the heart and lungs)
• Increased risk of high blood pressure during pregnancy, including preeclampsia

“Additionally, people with existing medical conditions and those 35 or older have an even higher risk of such outcomes and fetal complications, including stillbirth, if they are infected with COVID-19 while pregnant.”

 Q: Is there a point during pregnancy when receiving a COVID-19 vaccine will benefit the fetus the most?
Dr. Fisher: “The best time to be vaccinated during pregnancy is as soon as possible. It’s the best way to prevent a COVID-19 infection in the mother. It may be that getting vaccinated later in pregnancy passes more COVID-19 antibodies to the newborn. However, we’ve seen some pregnant patients choose to wait to be vaccinated for that reason, but while they were waiting they became exposed and infected.” 

Q: Can I have visitors at the hospital or in the delivery room? Do they need to be tested? Vaccinated?
Dr. Fisher: “The visitation policies have changed often and may vary from hospital to hospital. The best advice I have is to check with the hospital or facility where you plan to deliver your baby. I do hospital work in the Providence system, and at this time pregnant patients are having pre-admission COVID screening. If they weren’t pre-screened because they showed up in labor, they may be screened when they arrive. There are no visitors under 16 years old permitted, and there are other limitations such as number of support people during labor and during the postpartum stay. If you had your baby two years ago the whole family could be there, but that’s not the case where I work at Providence in Portland right now. Before COVID, I may have had the 8-year-old big sister of a new baby be there for the birth, but that is not happening anymore.”

Q: Do I need to wear a mask when delivering my baby?
Dr. Fisher: “No. When delivering a baby, you do not have to wear a mask. Any visitors, however, are required to wear a mask the entire time.”

Q: How will COVID-19 affect what happens when I bring my baby home from the hospital? Can others hold my baby?
Dr. Fisher: “Yes, others can hold your baby. But because a newborn’s immune system is still developing and they are vulnerable to infection, I would take additional precautions. So to be safe, I would want to make sure any person holding my newborn baby has no COVID-related symptoms and is fully vaccinated. I would also consider asking that person to wear a mask. Frequently washing your hands, wearing masks and being vaccinated all add additional layers of protection that minimize risk. Follow your local guidelines and consider the level of community spread in your geographic area when having visitors.”

Q: Can siblings or family come stay with us at home with our new baby?
Dr. Fisher: “Similar to the decision-making we all have to make at this time, I would ask myself: are visitors vaccinated? Are they healthy and without any COVID-related symptoms? Are they travelling to see me from a community with low community spread numbers? The benefits of family support may outweigh any potential risks, and each family has to navigate this tricky question and do what makes them feel most comfortable. I again recommend ensuring that people coming into your home are vaccinated, do not have COVID-19 symptoms, and I may ask them to wear a well-fitting mask.”

Q: Can I request an early discharge from the hospital?
Dr. Fisher: “This question is a great one to ask your provider. Many patients have wanted to leave the hospital earlier than they may have previously after giving birth due to the increased restrictions due to COVID-19. For example, they want grandparents and siblings to see the new baby. We have seen a lot of patients, if they are medically stable, able to leave one day after a vaginal birth and two days after a cesarean delivery. Discharge must be medically appropriate with a clinic follow-up plan in place, though, and the patient cannot have high risk conditions such as high blood pressure. The baby must also be ready for discharge.”

Q: If I have to have pre-admission COVID-19 testing, does my partner need to be tested, too?
Dr. Fisher: “Please check with your hospital or birthing facility as many may have different rules and protocols. At Providence hospitals, for example, we have not been testing guests. However, all people entering the hospital including health care providers, patients and visitors are screened at the door for symptoms.”

Q: Will I be able to breastfeed after receiving a vaccine?
Dr. Fisher: “Yes. It has also been shown that breastfeeding passes neutralizing antibodies for COVID-19 to your baby. This is encouraging. Studies are underway to evaluate whether breastfeeding by vaccinated mothers reduces the risk of COVID-19 in the baby .”

Q: Can I breastfeed while infected with COVID-19?
Dr. Fisher: “Yes, having COVID-19 should not stop you from providing your baby with breast milk. And there are steps you can take to avoid passing a COVID-19 infection to your baby.”

If you are infected with COVID-19:

• Wear a mask when you are holding or feeding your baby. The best mask to wear is an N95 or KN95.
• Do not put a mask or covering over the baby’s face.
• Wash your hands frequently.
• While you are infected you may want to consider bottle feeding. Wash your hands before touching the breast pump.
• If possible, have someone who is healthy help care for your newborn while you are infected. They can also help with bottle feeding. They should wear a mask and keep their hands clean when in contact with your baby.

Q: Will getting a COVID-19 vaccine make me infertile?
Dr. Fisher: “It will not. There are no data to support this claim.”

Q: If I need a blood transfusion, is there risk from receiving blood from someone who is vaccinated?
Dr. Fisher: “No. There is no risk from receiving a blood donation from someone who is vaccinated. Additionally, there is no way to know if the blood was donated from someone who was vaccinated or not. Blood donors are not required to share their vaccination status.”