Information about coronavirus disease (COVID-19) for pregnant women and women in labour

The purpose of this leaflet is to provide the patient with information about the coronavirus disease (COVID-19) and pregnancy, childbirth and the postpartum period.

What is coronavirus disease?

Coronavirus disease is a disease caused by the coronavirus SARS-CoV-2, which was discovered at the end of 2019.

The main symptoms of the coronavirus disease are fever, cough and shortness of breath. Shortness of breath can occur in more severe cases when the virus has damaged the lungs and caused pneumonia.

Most people with coronavirus disease experience mild symptoms. However, some people may develop a severe illness leading to serious medical complications.

How does coronavirus disease spread?

Coronavirus disease spreads mainly from person to person via droplet infection and direct contact. A person can become infected with the virus when an infected person coughs, sneezes or talks in the immediate vicinity of other people. The virus spreads most easily in gatherings where people interact, shake hands, hug, share food or sing together. One can also become infected by touching their face and eyes after touching a contaminated surface. As the virus spreads through close contact, people living together often infect one another. A person who is infected but has no symptoms can also infect other people. To prevent the virus from spreading, people around the world have been asked to stay at home and avoid close contact with other people.

What are the symptoms of coronavirus disease?

Symptoms usually appear within four to five days after exposure to the virus, but in some people, symptoms may occur within 14 days of exposure. Some people may have no symptoms.

Symptoms may include:

headache
loss of smell
nasal congestion
cough
fatigue and weakness
muscle pain
runny nose
loss of taste
sore throat
fever

Some people may have gastrointestinal symptoms such as nausea and diarrhoea.

In most people, the symptoms disappear within a week. However, coronavirus disease can present in more severe forms, such as pneumonia, impaired gas exchange, heart problems and even death. The risk of serious complications is higher in the elderly and in those with comorbid conditions such as heart disease, chronic kidney disease, diabetes, chronic lung disease, hematopoietic diseases, obesity, immunodeficiency (due to HIV infection or taking certain medications), asthma, cystic fibrosis, hypertension, etc.

Are pregnant women at higher risk of developing severe illness?

According to current information, pregnant women are not at greater risk than other people.

What should be done if symptoms occur?

Many symptoms of coronavirus disease (fever, cough) are non-specific and may occur with other viral infections of the respiratory tract. If you develop a fever, cough or other symptoms of coronavirus disease, call your GP or the GP helpline 1220. Your GP will decide if a COVID-19 test is necessary and will advise you on what to do next. Weekdays from 08:00 to 17:00, you can call the GP helpline 1220. Doctors on the GP helpline can issue referrals for testing to people with a suspected illness who can be identified using Smart ID or Mobile ID.

If you develop shortness of breath or other severe symptoms, call the ambulance on 112.

Can the virus pass to the baby during pregnancy?

Experts believe that intrauterine transmission of the virus from mother to foetus is possible, but it is very uncommon. However, a newborn can become infected during or after childbirth. If becoming infected with the coronavirus coincides with childbirth, measures can be taken to reduce the risk of spreading the virus to the baby.

Does having coronavirus disease cause complications during pregnancy?

According to currently available information, having coronavirus disease does not cause any additional problems during pregnancy. Pregnant women with severe symptoms (shortness of breath, pneumonia) have a higher risk of giving birth prematurely, i.e. before the 37th week of pregnancy.

How is coronavirus disease treated?

There is no specific treatment for coronavirus disease. Most people with mild symptoms have to stay at home until the symptoms go away. Mild symptoms include fever and cough without shortness of breath.

To reduce fever, you can take 500-1000 mg of paracetamol every 4-6 hours, with a maximum daily dose of 4000 mg. Paracetamol as an antipyretic is generally a safe choice for pregnant women.

People with severe symptoms and comorbidities may need to be hospitalised. If the need for hospitalisation arises, the condition of the foetus will be monitored in the hospital.

Is it possible to prevent coronavirus disease?

A vaccine against coronavirus disease is not yet available. However, there are precautions that can be taken to reduce the risk of infection.

The Health Board has issued the following recommendations:

Wash your hands. Wash your hands under warm, running water with soap. Use an alcohol-based hand sanitiser, if necessary.
Social distance. Avoid coming too close to individuals who cough or sneeze. If you are standing too close to someone who exhibits signs of the disease, you may also fall ill.
Avoid touching your eyes, nose and mouth. If you touch your eyes, nose or mouth with contaminated hands, there is a chance of transmission of the virus.
If you experience mild symptoms of a respiratory disease, observe regular hand hygiene requirements carefully and, if possible, stay at home until you are recovered.
Observe respiratory hygiene. When you sneeze or cough, cover your mouth and nose with a disposable tissue. Immediately safely dispose of the used tissue and clean your hands. If you do not have any tissue, use your sleeve (part of your forearm), not your bare hand, to cover your mouth.
Covering your mouth and nose prevents the spread of germs and viruses. If you sneeze into your open hand, you may end up spreading germs and viruses to other people and objects that you touch.
Wearing a mask in Estonia is not compulsory but doing so is a very good additional measure in connection with maintaining the required distance from others, along with proper hand and respiratory hygiene. Anyone who has developed any symptoms must wear a mask in public places or where direct contact is unavoidable. Anyone who has been in close contact with an individual who has been diagnosed with coronavirus disease should wear a mask even if they do not yet have any symptoms. It is also a good idea to wear a mask in enclosed, crowded spaces such as stores, shopping centres, public transport, etc. This is strongly recommended in those areas that witness new outbreaks of the disease. A mask should also be worn outdoors if you are in a crowded place and it is not possible to maintain the required distance from strangers. It is very important to place, wear and remove the mask properly in order to avoid being infected. Always sanitise your hands after removing your mask.

If possible, avoid travelling. Experts recommend avoiding travelling to destinations where the coronavirus disease spreads rapidly.

What are the measures based on?

We make all decisions based on the available information and the epidemiological situation in Estonia. The measures may change as evidence-based information becomes available and as the epidemiological situation evolves.

We rely on the recommendations agreed by the Estonian Gynaecologists' Society, the Estonian Midwives' Association, the Estonian Society of Paediatricians and the Estonian Society of Perinatology for the coronavirus disease epidemic.

The latest information can be found on our website https://www.sunnitusmaja.ee/covid-19-info/

Are there any changes regarding antenatal appointments?

Your midwife will help make a plan for antenatal appointments.

You have to pass the checkpoint upon entering the building when coming for an appointment with a doctor and/or midwife. We will assess your risk of infection, ask you to sanitise your hands and provide you with a disposable protective mask to be worn at all times during your stay in hospital.
From 22 September, it is not allowed to come for the first trimester and foetal anatomy ultrasound examination with a companion.
This also applies to all other outpatient appointments. Please come to the appointment without children and a companion.
Your midwife may perform several examinations at once to reduce the need for face-to-face appointments.
Your midwife may suggest replacing some appointments with a telephone consultation (a remote appointment).

These changes can be stressful. It is worth remembering that their main purpose is to protect you from infection.

When coming to give birth

When you come to the hospital, your body temperature will be checked, you will be questioned about the symptoms of coronavirus disease and you will be tested for coronavirus. If the result of your test is positive, a medical mask must be worn during delivery and your companion will not be allowed to attend the birth. Having coronavirus disease is not an indication for a caesarean section.

Can a companion attend the birth if we are both healthy?

The father of the child or a family member living with the woman giving birth may attend the birth and stay in the family ward.

Unfortunately, we cannot allow doulas and other alternative support persons in the maternity ward.

The family member attending the birth must be healthy and follow the additional safety precautions set by the hospital.

A surgical protective mask must be worn throughout the hospital stay and the companion is not allowed to leave the maternity ward or the hospital.

Can I breastfeed?

Breastfeeding has several benefits for both the mother and the baby. It is unlikely that the coronavirus could be passed from mother to baby through breast milk. However, the virus can be transmitted through close contact with the baby. You can protect your baby by washing your hands often and wearing a face mask while feeding and caring for the baby.

If you are unable to breastfeed due to your condition, we recommend that you pump breast milk. Strict adherence to hygiene requirements is necessary to prevent bacterial contamination of milk. When pumping breast milk and using a breast pump, always wash your hands thoroughly with soap and water and dry with a clean towel.

How to cope with stress and anxiety?

In the current situation, it is normal to feel sadness, anxiety or worry.

You can take care of yourself as follows:

limit exposure to media
exercise regularly and eat healthy
try to find activities to enjoy and do at home
communicate with friends and family

It should be remembered that most people do not become seriously ill when infected with the coronavirus.

Where can I find answers to my questions?

If you have any questions, you can always contact your midwife or GP. They can answer questions such as:

what symptoms should be of concern;
what should I do if I suspect exposure to the coronavirus;
what medications can be used to treat coronavirus disease during pregnancy; and
where to find support when I feel anxious or depressed.

The answers to these and many other questions depend on the specific situation.

Where can I get more information?

The more we learn about the virus, the more the expert recommendations change. The latest information on how to protect yourself and your family can be obtained from a healthcare professional or from the Health Board's website https://www.terviseamet.ee. The national website is www.kriis.ee, the crisis hotline is 1247 and the GP helpline is 1220. Be sure to follow hospital websites www.itk.ee and www.sunnitusmaja.ee and the Women's Clinic news on social media https://et-ee.facebook.com/naistekliinik.

ITK976
Approved by the decision of the Care Quality Commission of East Tallinn Central Hospital on 21.10.2020