Being pregnant in a pandemic

There’s no denying that the COVID-19 pandemic has had a huge impact on women’s pregnancies and experience of motherhood. It’s caused increased risk, loneliness and loss of support. I think that it’s fair to say that the pandemic probably has a lot to answer for in terms of maternal mental health. For me theres no denying that I found this pregnancy challenging. We were a month into the first national lockdown when I found out that I was pregnant, which was also 4 months after our miscarriage and just after Evelyn’s 2nd birthday. At this time we knew very little about COVID-19 and it was killing hundreds by the day. Pregnant women were in the at risk category having to isolate as much as possible and children were believed to be vectors of the virus, increasing your risk of contracting it further. We were definitely nervous about how safe it was to be pregnant and how different antenatal services would be. Naively we had hoped that by the time George was born maybe the pandemic could have improved, but little did we know that we’d actually be going into another lockdown on the day that he was born! Our beautiful boy was born on the covid maternity ward on 20th December 2020, our lockdown baby.

Being pregnant and being a parent to a young child, I felt particularly vulnerable to any additional stress. I feared that I didn’t have the resilience to cope so going into a pandemic felt like going into survival mode. I worked as a GP throughout the pregnancy. Early on in the pandemic our whole household contracted COVID. The pregnancy itself was more medically complicated throughout and I was induced again for obstetric cholestasis. We also had work done on the house (an orangery built) which though it was supposed to be finished by the time I was 32 weeks, it wasn’t fully complete until the beginning of February when George was 6 weeks old. It’s fair to say that we had a few challenges, though it’s surprising what you can cope with when you don’t have the choice. However, I do think that the anxiety, stress and exhaustion of being pregnant in a pandemic left me running on empty for the birth and post partum period.

The pandemic has forced women in any patient/customer/client facing role to inform their employer of their pregnancy very early on, maybe much sooner than they would have wanted to. When I found out that I was pregnant I needed to tell my employer early as I needed to stop seeing high risk patients (i.e. those with suspected or confirmed coronavirus), and from 28 weeks I needed to avoid seeing any patients face to face altogether. Announcing the pregnancy so early on and so soon after an early miscarriage felt like it was tempting fate. In addition, complicating my work situation was the fact that I was 6 weeks into working my 3 month notice to resign as a salaried GP when I found out that I was pregnant. I was about to leave a secure job and become a freelance locum with no maternity leave or pay. A decision that I had made prior to the pandemic and prior to finding out that I was pregnant! Although it wasn’t ideal and nerve wracking changing job roles during the pandemic, especially as I would be limited to what consultations I could offer practices, the career decision still felt right for me. Doing so would provide me with the flexibility that I required to achieve a better work life balance, one which would be even more important now that I was pregnant. I went on to work as a locum in multiple GP surgeries in the South East of Wales up until I was 36 weeks. Although I travelled a bit more and on a few weeks worked every day, on the whole my work life balance was better.

As we went into lockdown, Evelyn’s nursery closed but we were lucky to find a nanny who could look after her for us to continue going to work. Though during periods of self isolation working from home with Evelyn around wasn’t the easiest. We found that the only way to get anything done was to tag team it, though without fail she would always want the other parent who was trying to work. I take my hat off to the parents who needed to work from home for months on end, plus homeschooling on top! Fortunately, after 8 weeks Evelyn’s nursery reopened to key-workers. However on the day that Evelyn was due to start back, Rob became unwell and was admitted to hospital with suspected bacterial meningitis. He was really poorly and it was horrible not being there for him in person, limited to FaceTime calls and wondering when we would see him again. Fortunately Rob turned a corner and was discharged home after 2 days in hospital. Though it had felt like much longer! He was still unwell though so we were advised to keep a close eye on him. Whilst Rob was in hospital, Evelyn and I also became unwell, though fortunately both of our illnesses were mild and short lived. Evelyn developed diarrhoea and a high fever and I had a headache and mild temperature . We were later all diagnosed with COVID-19.

In addition, whilst Rob was in hospital I needed to be assessed on the early pregnancy assessment unit because of bleeding. I was 6 weeks. The saying “it never rains it pours” couldn’t have been more apt for those few days. I found it a lot to deal with and particularly harder as it was all out of my control. Fortunately everything was ok with the pregnancy but being alone as I found out if I had miscarried was tough. Although Rob couldn’t have been there because he was in hospital, I couldn’t have anyone else with me for support and needed someone to look after Evelyn. The pandemic has meant that women have had to attend appointments, scans and hospital visits alone which has highlighted how invaluable and essential it is to have your partner there in person. To experience the milestones, to share the weight of the nerves and difficult decisions and to receive bad news. I was very fortunate that George was ok but things could have been very different. My heart goes out to the women who’ve gone through such horrible and traumatic experiences alone because of the pandemic.

Having COVID in addition to bleeding, early pregnancy exhaustion and looking after Evelyn mainly by myself as Rob was so fatigued, had been pushed to my limit. I was physically and mentally exhausted, and scared for the baby. I remember thinking that if by some miracle the baby managed to survive and didn’t suffer any birth defects or complications then he would be the strongest baby who could overcome anything! At this time I remember feeling like everything was against us and the pregnancy, so we decided to tell our close family and friends about the pregnancy. I needed their support no matter what the outcome was going to be over the next few days/weeks. Although we didn’t know this at the time, there is no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage and current evidence suggests that if you have the virus it is unlikely to cause problems with the baby’s development. However, pregnant women are at higher risk of getting seriously ill from COVID-19 and if this occurs late in pregnancy, there may be risks to the baby.

For me, pregnancy after loss felt like a constant conflict of hope and fear. Each happy moment tainted by the what ifs. I bled several times in the first and second trimesters, the first being on the day that I found out that I was pregnant! By the time that I had my 20 week anomaly scan I’d already had 5 other scans and been to the pregnancy assessment unit 3 times. Fortunately all episodes of bleeding were mild and short lived – a result of a small collection of blood in the womb initially and then a low lying placenta subsequently. Nevertheless, with it being a pregnancy after loss I was already very anxious, so to experience bleeding on top was pretty testing. Whenever I started to relax and feel reassured that things were going to be ok, I’d go on to bleed again – a reminder of how precious and fragile the pregnancy was. Because of this I worried about getting attached. I wanted to protect myself from the potential pain of another miscarriage. However, the reality is, the pain is probably just as intense no matter how ‘prepared’ you are.

My anxiety about losing the pregnancy further increased when my dating scan picked up a womb abnormality. Initially they thought that I’d developed a heart shaped womb (arcuate uterus) which could increase the risk of late miscarriage. Also they weren’t sure if I had amniotic folds/sheets or amniotic bands. The former being common and benign (although potentially can cause breech presentation) and the latter being rare and posing dangerous risks to the baby (deformities). Although Rob and I are medical, we didn’t know much about all of these issues so were initially really worried. I wasn’t due to be reviewed by an NHS consultant until around 20 weeks, but I couldn’t wait as the unknown was sending my anxiety into overdrive. We arranged to see a private obstetric consultant instead. I’m so glad that we did as we got the answers and reassurance that we desperately needed instead of weeks of nervously waiting. It turned out that the appearance of my womb was actually more likely to be from scarring, probably from the womb infection (Endomyometritis) that I’d had after Evelyn was born. The consultant also reassured us that I most likely had the more common amniotic folds. Fortunately all of this didn’t put me at increased risk of late miscarriage, but could affect the baby’s growth and increase the chance of breech presentation. I had extra growth scans and a presentation scan to monitor things. Luckily all subsequent scans were fine. My womb stretched to a normal shape, George’s movement weren’t restricted and he was head down. Although these extra scans meant that my pregnancy was more medicalised, I was just happy to see his little face and to see him healthy.

From 20 weeks I developed symphysis pubis dysfunction (SPD), a fairly common pregnancy complication. SPD causes pelvic girdle pain and stiffness, a result of laxity and inflammation of the ligaments. In order to manage and minimise progression of the symptoms, women are advised to avoid sitting on the floor, kneeling and carrying heavy objects as much as possible – obviously all pretty impossible when you have a toddler to look after. I was nervous about how my body would manage the rest of my pregnancy and cope with childbirth now that I had SPD. This was also a particular worry due to my background of scoliosis and lumbar fusion. Although a lot of women have relatively mild symptoms, I have known women to require crutches or become wheelchair bound at the end of the pregnancy because of SPD. I was also really frustrated to have developed SPD because I had been determined to maintain a good fitness level and to minimise weight gain. With Evelyn I had felt so de-conditioned by the pregnancy that the birth really took it out of me. I was nervous about how to exercise safely so arranged a virtual physiotherapy session. I was given an exercise video and advice which helped me to better manage my symptoms. I also bought Serola maternity support belt on their recommendation. The belt made a huge difference to my symptoms and I wore it daily to get me through the last few months of the pregnancy. It even helped in the first few weeks post partum when my body took a little while to recover and improve from the SPD and birth.

I knew that being pregnant whilst having a toddler was no mean feat, but I didn’t appreciate how draining it would be. Though theres no ‘perfect’ time to have a second child, I found being pregnant whilst looking after a little one in the midst of her terrible twos really hard. The night wakes and early mornings were tough on top of the pregnancy tiredness. The tantrums out and about meaning that I often had to carry Evelyn horizontally whilst she kicked and screamed became even more physically demanding with an ever growing bump. The inconsolable meltdowns and hours of resisting bedtime and naps (not helped by the move from a cot to a big bed) tested my tolerance and patience big time! Its fair to say that I felt as though my physical and emotional resilience was very low. Although work provided me with a ‘break’ from parenting, it was still draining in itself and the time apart from Evelyn was tough especially towards the end of the pregnancy when Evelyn became very attached and demanding of me – perhaps she could sense that a big change was coming.

In addition, I also became increasingly apprehensive of the extra pressure that would soon be put on us when George arrived. I wanted to prepare Evelyn (and us) as much as possible and better manage her increasingly challenging behaviour. I did the ‘positive parenting solutions’ online course before George was born. They had lots of useful tips which we implemented and Evelyn responded well to. However, needless to say, when George actually arrived Evelyn’s behaviour got a lot worsened. I plan to talk about this and my post partum experience more in another blog but ultimately these challenges were made harder because I put a lot of pressure and blame on myself for her behaviour. I felt that in order to ‘fix things’ I needed to be the perfect mum and this became increasingly overwhelming. Alongside the sleep deprivation, my anxiety escalated and my mood lowered. During this time I discovered the Big Little Feeling’s toddler course which helped massively and was better suited to us. Their approach is practical, realistic and sensitive. It was empowering for both Evelyn and us. At this time I also started Cognitive behavioural therapy (CBT). Fortunately, I was able to access this quickly because of Health for Healthcare professions (HHP), a free service for NHS staff and students. CBT really improved my mental state as it helped me to be kinder and more forgiving of myself, removing the blame and pressure I put on myself. This in turn helped relieve a lot of my anxiety and lift my mood.

I had a 50% chance of developing Obstetric Cholestasis (OC) again after having had it with Evelyn. OC is a pregnancy specific condition which affects your liver, resulting in bile acid accumulating in the blood which causes itch, lethargy and sometimes jaundice. In severe cases OC can potentially cause still birth. Since I have had Evelyn, there is emerging evidence that it is only at very high bile acid levels(>100) that there is a significantly increase risk of still birth. Nevertheless, for now, early induction of labour is still often recommended to reduce the risk of still birth. With Evelyn I developed OC at 34 week and had bile acid levels of 88. With George I didn’t developed it until I was 38 weeks and my levels were lower at 44. Though it was still a huge blow to have developed OC again, it was one that I was more prepared for. I was still very anxious and worried but it wasn’t as debilitating as first time round. It helped that my bloods weren’t as bad this time and that I was already term. I was given the choice to monitor or induce. Having found the induction of labour very difficult with Evelyn, I was keen to avoid/delay induction if possible and allow my body to go into labour naturally. I opted to have monitoring (regular CTGs and a scan) and a couple of sweeps instead.

However, complicating my care was the fact that I was in self isolation – I had been in contact with my dad who subsequently tested COVID positive. This meant that I couldn’t be on the normal maternity assessment unit or deliver on the labour ward. This presented logistical challenges to my care and meant that I was in hospital for long periods each day, however I was just grateful to still receive the care and monitoring that I needed whilst in self isolating. It was hard spending the last week away from Evelyn before George was born. Missing out on precious time of Evelyn as our only child, but George’s safety had to come first. It was also tough having the pregnancy become very medicalised, especially as I had been practicing hypnobirthing. Nevertheless, the extra time that I had when I was in hospital meant that I was actually able to finish reading my hypnobirthing book – just in time! I can’t recommend hypnobirthing enough and only wish that I had done it in my pregnancy with Evelyn. Hypnobirthing definitely helped me to approach this labour with a much more positive, confident and empowered mindset. I felt better equipped to manage my contractions and obstacles that could come my way. It also helped Rob feel more helpful in both the run up to and during labour as he had specific ways and things to help me through the labour. I plan on talking about George’s birth story in another blog but in summary despite the two sweeps I didn’t go into labour naturally. My liver function worsened and I was induced at 39 weeks. Fortunately I only required my waters to be broken to start off my labour. George was born naturally, but unfortunately I had to go to theatre for a retained placenta and a large post partum haemorrhage.

Despite all of the challenges that came our way during this pregnancy there have still been many positives and at the end of the day we’re so lucky to have our beautiful healthy boy with us. As it wasn’t my first pregnancy I was able to gain reassurance and safety in the knowledge that my body had done it before. This meant that I didn’t fret as much over the smaller things, which helped give me the headspace to better cope with the big things that happened – and there were many big things! I was able to use what I’d experienced and learnt from pregnancy and motherhood so far to create a more positive mindset as I prepared to become a mother again. Practicing hypnobirthing this time provided me with the tools to approach labour differently and importantly I felt empowered going into childbirth. Though the pandemic gave us many more challenges than we ever could have imagined, I think that the quote “strength grows in moments when you think that you can’t go on but you keep going anyway” is a good way of looking back on it. Although I expect that we’ll all look back on this time and wonder just how we did it, through our shared experiences, though we have been apart we’ve not been alone.

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