Episode 1 - What COVID19 Means For Pregnancy & Postnatal Care
We kick off our Podcast with an insightful, informative and fear-reducing interview with the Fabulous Dr Guy Skinner, Melbourne Based Obstetrician and all round amazing guy, pardon the pun! Guy divulges the latest research on COVID19 and Pregnancy, as well as changes to Prenatal, Perinatal and Postnatal care with respect to the changes enforced by COVID19.
You can find Dr guy Skinner at:
[00:00:01] Welcome to the mama. Matters podcast, whether you're expecting you've recently given birth or you're just starting along your fertility journey. It's time to get down to the nitty gritty and sort fact from fiction. I'm your host, Rosie Dumbrell -physiotherapist and pregnancy expert. Mama Matters aims to provide an easily digestible, up to date and evidence based approach to pregnancy, birth and motherhood with a side dose of humour along the way, with interviews from the industry's leading experts and experience of my own adventures as a mother to three gorgeous boys under four. I want to share the stuff that helps to bring confidence throughout motherhood. Mama Matters is a podcast by Lenny Rose Active and this is what you can expect to hear in upcoming episodes…
[00:00:47] Being physically active is really import more than ever at this stage. And I strongly encourage that. I think that's the only way we're going to keep our mental health. Really.
[00:01:00] Welcome. Oh, so excited to be here. First episode of the podcast. Wow. Yeah.
[00:01:07] This has been bubbling under the surface for quite some time, but I guess just took a little bit of a push in the right direction from a good friend of mine. I'm so excited to have a platform on which to share my passion and also my knowledge and experience around pregnancy, birth and motherhood and also call upon my network in this area to provide you with the latest information and a really broad dose of experience to call upon. So, yeah. Not only my own experience in physiotherapy, prenatal yoga and pregnancy, fitness and wellness, but also being a mum to three beautiful little boys in the last four years. I certainly have had my own dose of, you know, pregnancy, insomnia and, you know, being up at 2:00 a.m. Googling this and that. And it really is my mission that women do not need to turn to doctor Google. And they have an easily digestible up to date and evidence based approach to pregnancy, birth and motherhood with a side dose of humour along the way. So our first guest is Dr. Guy Skinner, and he is a Melbourne based obstetrician. And his specialties over his years of practice are in twins, breech delivery, high risk pregnancy and laproscopic surgery. He has a passion and enjoyment for his profession that sees him strive to provide the best possible care for both mother and baby and a philosophy that knowledge is confidence. Having been cared for under Doctor Skinner for my most recent two pregnancies, I really couldn't go past calling on his expertise for today's interview, given he has such a cool, calm and collected nature and having felt just so respected, listened to and certainly not over intervened with, but knowing that I was at the hands of an incredible level of experience throughout the pregnancy and birthing process. So today Dr Guy Skinner joins us to talk about pregnancy and COVID19
[00:03:26] Along the way, though, I've been following pretty closely the topic around pregnancy, birth, breastfeeding and COVID19, but I haven't really come across the stats on incidence of pregnancy and COVID19 - globally or around Australia. Do you have any sort of data on what the numbers are?
[00:03:46] The best the best data we've had so far is out of China and we'll probably get a good dribble of data coming out of England in reference to pregnancy outcomes during COVID19. I think the data coming out of China is certainly just on raw figures, the best volume we've got, and are waiting further for that to come out looking at outcomes. Nothing really has changed much, which is fortunate, obviously, because the previous SARS epidemic and the swine flu, we had huge changes in risk to mothers and babies and women on ventilators because they were pregnant and had this swine flu that was very, very nasty in Melbourne. So that previously was a huge risk. But this (COVID19) doesn't appear to have the same incidence of problems, despite the fact that during pregnancy women are immunosuppressed, you don't seem to react and in the same way as the elderly and other immunosuppressed people do.
[00:04:48] Yeah, because obviously in a respiratory sense, women are often a lot more vulnerable in pregnancy as well.
So that's absolutely they can't they can't take a deep breath.
[00:04:59] Of course, once they're in the third trimester and they struggle to cough and they may struggle to move. So you've got all of those features. But the key thing is this virus doesn't appear to cause the lung inflammation and the water saturation that it does in the elderly.
[00:05:13] So it's why the lung response to the virus and how much it opens up, an inflammatory response that cause the lungs being so congested will affect things like the oxygenation.
[00:05:23] Having said that, if you're 36 weeks pregnant and you needing to be ventilated on a machine that's difficult and women have been ventilated, and that is very hard to do. So they are more vulnerable, but since they don't seem to have any more incidence of ventilation than the normal person.
[00:05:40] Well, that's comforting to know. What do we know about COVID19 in newborns?
[00:05:46] Newborns are getting it. And we believe it's through horizontal transmission. That is once the baby's out of the womb. Yes. And that isn't causing an increase in problems for the baby. There are a number of positive babies, and newborns that have had it, they don't get the same issues. It's a very mild disease. They don't get the lung inflammation and we don't have a huge fear for the baby if it does contract the virus. In China, there were two schools of thought; one was to keep the baby with the mother and allow for a horizontal transmission. And the other one was to take the baby away for two weeks, bottle feeding the baby, keep it completely separate to the infected mother and or father, giving the baby to other members of the family for two weeks. That second option didn't appear to improve the outcome for the baby. So our thought in Australia and our policy in Australia, is to keep the baby with the mother and horizontal transmission occurs. We're not too stressed, and obviously there'll be due precaution taken for the neonatal, we’ll be monitoring it. But we don't think that it's going to cause an excess in big problems. And the stress of taking the baby away from the mother is just too great.
[00:06:56] I know this is a crazy time, I just can't imagine having to go through that. I know that the Centre for Disease Control (US) did have some recommendations around separating women who have tested positive for COVID19 and their newborn babies or if they were a person is under investigation. But they also had as a caveat that it would be taken under individual case.
[00:07:30] That’s right, in America we are seeing separation, but yeah, it's with whether to do it or not, given our setup, we don't believe that it's going be that much of an advantage. And the risk is too small to consider given the stress it causes on the family and the mother, and that currently in Australia because of that the protocol is to not separate the baby and mother.
[00:07:52] And that's government policy, and our college policy and the College of Paediatrics is not to separate. I mean that mother could choose to do that. But no, we would advise them as there being no material benefit. So the downside is just enormous. So we think it's just keep them together, and similarly for breastfeeding. There's no evidence that COVID19 travels in breast milk. It's not excreted into the breast milk from them. So given this, there's no such is no harm. One thought is to express the milk and then give it in a bottle, a partner or non-infected person so that somebody else is feeding the baby is a reasonable thing. The other thing is to put an N-95 mask over the mother and exercise due caution. You are trying to restrict horizontal transmission and just breastfeeding is normal.
[00:08:42] Yeah. And so also just jumping back a little bit; At the moment, the data doesn't look like there's any vertical transmission. So it doesn’t look like transmission of the virus to the unborn baby in the uterus is happening at the moment, why the virus gets into the human cells through the ACE receptor and that isn't found at all on the human placenta.
[00:09:06] So in theory, theres no way it can vertically go through whilst the woman is pregnant and all of the babies that we've found within an hour or two of birth having been tested positive coronavirus in their blood.
[00:09:19] One thought is that early transmission during the birthing process, being a vaginal birth or caesarean section, fluids from the mother, of course, the baby can ingest in the process, and can get the virus that way. So we believe that's the way it's coming rather than through the placenta prior to birth. The only way you could do define if the baby's going to get it before birth would be to do an amniocentisis to test the blood from the baby and actually prove that the baby's blood contains it. So at the moment, because we don't have any evidence of the receptor there, we think that it can’t have vertical transmission.
[00:10:00] That’s also got to give a little bit of comfort,
[00:10:07] “Given the fact that it causes quite a lot of illness in some people in very high fevers, which can result in an increased incidence of miscarriage. There's that issue that that potentially will come to the fore over the next six to twelve months, really getting data out of that. But very much a severe illness, respiratory illness in the first trimester can cause a miscarriage. So yeah, that can be a concern, but it's very hard to control it.
[00:10:29] And we obviously don't have a lot of data on that. The data I was looking at is mostly of women in the third trimester and obviously around time of birth;
[00:10:40] So we also we don't, and we don't advise either caesarean or vaginal birth, either one. It doesn't appear that either one gives them necessary benefit at this stage.
[00:10:48] Again, the data might come out in the long term showing one advantage, one or the other, in the same way as HIV transmission is reduced with caesarean section of the vaginal birth. Despite this, we may find that eventually that might be the case, but currently there is nothing to suggest that.
[00:11:05] Okay, and so from an obstetric point of view, with antenatal care, is there any sort of major differences that a woman can expect?
[00:11:16] I mean, if or when she contracts the virus, obviously more observation, making sure that there's no issues with the baby, we would probably do extra ultrasounds and monitoring.
[00:11:28] If she became quite unwell with it, just to make sure that the rest of the blood perfusion to the baby and the well-being and the growth of the baby is all normal. There is some evidence of that in China. There were a few babies born delivered early that may be associated with women who got severe disease in the third trimester, 36 weeks onwards. Something like that. And they may need to be delivered because they're just a lot harder to ventilate at that stage. But the data's not big enough to say that it's definitely going to be the case.
[00:11:58] Just before we finish up, I know that there's some angst around perhaps the reduction of that number of people that are allowed to attend a woman's antenatal appointments and birth, and what's happening with that in Australia at the moment. Is a support person still able to attend the birth like doula or midwife?
[00:12:17] At the moment, there's a bit of a moving feast, but it's all about cross contamination between all the individuals to reduce the risk of exposure to staff and myself included in settings. So the least people attending from that perspective, the more effective that becomes. Obviously, if a woman is infected or partner is infected, the cross contamination within a household is very high. So if you or your husband have it, then that is almost certainly the other personal contact contracts it very quickly. So we believe that having the partner that doesn't really overall change the risk profile.
[00:13:03] SO what about a standard non infected woman?
[00:13:09] So no, no extra people are currently allowed in. So that's everyone's take on this.
[00:13:16] So the idea out there is just absolute bare minimum, both either at appointments and I know some people and some doctors have banned partners from participating in appointments. Currently that's a bit harsh. And yes, again, it's the same thing. If one's infected, almost certain that the other has got it too.
[00:13:34] So what about if someone's got a doula lined up and obviously that means that they're not going to be able to go through with that for the birth, would they be able to face time that person into the birth or like how could they?
[00:13:49] Yeah, absolutely. They certainly could do around a facetime or zoom or something like that. Yeah. Other family members is certainly no problems, just not in the flesh, but certainly they could do that and still get advice and support. There's no harm in doing anything like that.
[00:14:04] Yeah, that's great. Okay. And then. Yeah, just to finish up once. Is there any sort of additional precautions that we can take other than obviously all of the usual hand and respiratory hygiene and self isolating? Is there anything else that you can suggest that a woman can do to help themselves ?
[00:10:00] The key is to decrease exposure. And I think staying calm, staying healthy and well and staying active. I mean, this is a huge stress. And we talk about the virus. But the huge stress of isolation and mental health aspect is a very big part of it. And I think it's so important to get out and about to do things whilst you still keep to that social distancing policy, getting out walking and doing things, but separate to everyone. I mean, you're not going to catch it by walking along the street or walking in a park by yourself or with one other person well away from you. So we'd strongly encourage you to be physically active. And I think mental health often does come through physical health. That person that is just going to sit there, there mood and their feelings, the anxieties, and their fears are only going to grow further.
[00:15:09] And I think that's not going to have a positive effect.
[00:15:12] Yes and so many well meaning family, friends can sometimes undermine their confidence when they really should be supporting them and being involved in how they're feeling and what they're doing and so forth. But being physically active is really important more than ever at this stage.
[00:15:26] And I strongly encourage that. I think that's the only way we're going to keep our mental health intact really.
[00:15:32] I'm so glad to hear that. It's music to my ears. Well I feel like there are a lot of positive take homes from that. I think pregnancy is a time even as like someone who is myself, a health professional, I still want Google in the middle of the night quite frequently knowing that I shouldn't be doing that. So I think we need as the perspective on it, and someone who does bring all that information together. Yeah. So I'm grateful that you could take the time out today. Busy and also five kids of your own! Not sure how you do it, but if you've got any tips on how to, like, turn up so dapper in the morning after no sleep..! I'm super remembering after having Leo think you're in it like 6:30 at night and then maybe like ten o'clock. And then you delivered him about 1:30 and then had to go do a couple of C-sections and then come back and say something at 4:00. And then you went home and you'd also been to the gym and you're back at 9:00 a.m. with a smile on your face, looking fresh. Haha! That's, again, you know, a whole other whole other topic of conversation. Thank you again so much. Now hoping we'll chat again before I have the fourth baby. You never know.
[00:17:01] All right. Well, thanks. Settle on that will you. Thank you. Bye bye.
[00:17:07] It really is such an incredible and almost surreal time that we are living through at the moment. And my heart really goes out to all the pregnant and new mamas out there. I can't imagine what it would be like going through this in such a vulnerable period. I do have three of my own children and the youngest of which is only nine months at the moment. And, you know, that is definitely quite, quite a scary time. But I do really believe passionately that knowledge is confidence and having access to quality, up to date and the right information can really help us to understand how to act and how to move forward in the best way rather than moving and acting out of fear and panic.
So I really hope that you found Dr. Guys’ information really helpful and found some solace in some of the information around things maybe not being perhaps quite so dire if we were to contract COVID19 in pregnancy and also just to gain a little bit of understanding or context around why policies have moved the way that they have in Australia.
So if you would like to reach out further to Dr. Skinner, head on over to his website, https://drguyskinner.com.au/
Or you can also reach out to him on his social handles @drguyskinner
Our next guest is Dr. Amanda Waaldyk, who is a Chinese medicine doctor and fertility specialist. And we're going to be chatting or delving into fertility and COVID19, and how fertility treatment in particular has been affected by recent policies around elective surgery, to not only provide you with the background and the why behind current policies, but also provide you with some ways that you can support yourself naturally and stay as positive as possible throughout these incredibly challenging times. Thanks so much for joining. And if you enjoy listening to the podcast, please share us on your social media and #mamamatters and we hope to chat to you again soon. Bye-Bye.