How to Navigate Your First Trimester During the COVID-19 Pandemic

The coronavirus pandemic is causing some changes in pregnancy care and that can be scary. But experts offer advice on how to handle your first trimester, as well as any potential complications.

"I found out I was pregnant a month ago, in early February," says Laura, who asked that her name be changed to protect her anonymity. "The coronavirus wasn't even on the horizon." But now that there are more than 455,000 confirmed cases in the United States, and more than 16,000 deaths, Laura's first pregnancy looks very different than she originally imagined.

"I definitely feel constrained in my house," she says. "I'm worried for my next appointment—that maybe my husband won't be able to come or they'll cancel it and I'll have to keep waiting to be able to go back to the doctor. It's that uncertainty—that you really don't know what's going to happen until it happens."

Finding out you're pregnant often brings about a slew of feelings, from excitement to overwhelm, fear to absolute joy. But during a historical global pandemic, those navigating the beginnings of something as life-changing as a pregnancy are facing a host of additional challenges that can make this time nothing short of confusing. Thankfully, there are tools someone in their first trimester can use to prepare for the road ahead, including gaining knowledge of the virus from reputable sources and building a support system via FaceTime and other telecommunication options. But speaking with your doctor first and following their orders and directives is imperative.

"Everyone's prenatal course and history—obstetrics history, medical history, pregnancy history—is going to be different," says Jennifer Butt, M.D., a board-certified OB-GYN practicing in New York City. "Some people may need more frequent appointments in general, while some people are considered 'low-risk.' There are also certain appointments that are time-sensitive. So it's always important to have a conversation with your doctor and to discuss your concerns with them and work something out."

Cropped shot of a pregnant woman touching her belly
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What to Ask Your Doctor During COVID-19

During that conversation, you should ask your doctor what steps they're taking to ensure minimal personal contact with others, in an attempt to mitigate any potential exposure to or spread of the coronavirus. While there are only limited studies available, and not too much is known about the virus, as of right now it's not believed to be transmitted from a pregnant person to their fetus. However, pregnant people may be at an increased risk of contracting the virus, given their weakened immune system. So make sure your doctor is doing what they can to protect their patients. This may include telemedicine, where you are not required to visit your doctor in person, but can instead speak with them via Skype or another online service.

"I'm still seeing patients, but I am making certain accommodations," says Dr. Butt. "I'm trying to schedule and space people out to minimize the number of people in the waiting room. I'm only seeing pregnant patients, and if some patients feel comfortable, we're willing to defer certain appointments a week or two out. For visits, I'm not allowing husbands, partners, or kids to come to the appointment—just the patient. There's no point in further exposure for everyone."

Pregnant people left to experience these pregnancy moments alone are becoming increasingly common as medical staff try to protect themselves and others from coronavirus infection. Recently, the NewYork-Presbyterian hospital network has banned any partners and/or support people from entering their delivery rooms. Pregnant patients now have to give birth alone.

"I think people are concerned and wondering if they need a contingency plan. Questions have shifted from 'Should I travel?' and 'Should I stay home to work?' to concerns about resources, including hospital resources for labor and delivery," says Dr. Butt.

Because certain areas are being hit harder by the virus than others, again, it's important to discuss any possible contingency plans with your medical provider.

How to Navigate Miscarriage During COVID-19

Of course, these necessary changes in patient care can be difficult for those experiencing pregnancy for the first time, those who want to share these first-time moments with their partner and/or support person, as well as those who are experiencing pregnancy complications, including miscarriage.

"We went to an ultrasound on Friday, our first, which was already really weird and heavy because of coronavirus conditions," writes Meryl Pataky, 37, a freelance sculptor living in Oakland, California, on Instagram. "[My partner] wasn't allowed in the room and we had to FaceTime. There was no fetal heart rate. What we hoped would be a silver lining to all of this madness ended up being more anxiety, more grief." Pataky tells she's waiting for another ultrasound to determine whether or not she'll require a D&C to ensure the pregnancy has passed safely.

Dr. Butt says that if you are experiencing miscarriage symptoms and are worried you're losing the pregnancy, to first contact your physician. "There is going to be different scenarios in which some patients may need to actually go to the emergency room, unfortunately," she says. "And there may be some scenarios where the patients are able to pass the pregnancy at home."

That's why if a patient thinks they're miscarrying, they should speak to their doctor about what types of symptoms and how much bleeding they're experiencing. "That will be at least one determining factor of next steps in their care," adds Dr. Butt.

Focus On Your Mental Health

While it's important to maintain physical health during this time, and to keep lines of communication open with your physician so you can be made aware of any potential changes in care, it's also important that you maintain your mental health. Pregnancy can be a source of anxiety and stress under normal circumstances, and what we're experiencing right now is anything but normal. As a psychologist who specializes in maternal and reproductive mental health, I have seen firsthand how the added weight of this global pandemic is negatively impacting pregnant people, which is why it's important to lean on others during this time—just not physically.

"Stick to a routine and just accept that routine as your new normal," suggests Dr. Butt. In other words, if you normally worked a 9 to 5, keep that work schedule, just at home. If you normally worked out after work (and you've been cleared to continue those workouts by your health care provider), keep that appointment, just work out at home. And, if necessary, limit the amount of news you're consuming and make sure you're only learning about the virus via reputable sources.

"I would say that my social calendar is perhaps more full than it was before this virus," says Laura. "Every night we have a new group of friends or a new group of family members we're seeing through video chat. There's just a lot of checking in—I check in with my husband's family every day, and I check in with my parents every day."

These check-ins can be extremely beneficial, especially since pregnancy can feel isolating all on its own, even without shelter-in-place directives. It may also help to reach out to other pregnant women who, like you, are experiencing pregnancy at such a strange and uneasy time.

"I spoke to another woman who is pregnant at my work and told her I'm pregnant last night. I felt like there are so few people who understand what we're going through at this very moment; she's one of the few people who does," explains Laura.

Pregnancy can be a discombobulating experience: You're facing an unknown—parenthood—and all the challenges, successes, joys, and pains that it brings. Taking this forced time of solitude to prepare your home, your body, and your mind for motherhood, could be a grounding exercise that helps you maintain your mental health during an otherwise trying time.

"I need to realize that this is a time for me to rest and a time for me to get my house ready for the baby; to get my mind right for the baby," says Laura. "I just need to try to think of it as a blessing, rather than a hindrance."

Jessica Zucker is a Los Angeles-based psychologist specializing in women's reproductive and maternal mental health and the author of the forthcoming book I Had a Miscarriage: A Memoir, A Movement (Feminist Press, 2021).

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