COVID-19 and pregnancy in Singapore: Booster shots, home recovery, and isolation at hospitals
What if you get COVID-19 while you’re pregnant? What happens when you give birth while COVID-19 positive? What are the risks and benefits of vaccination for you and your unborn baby? CNA Women presents this full guide to answer your questions.
The recent discovery of a new COVID-19 variant, which the World Health Organization (WHO) named Omicron, has sent countries around the world into a state of anxiety.
And because much is still unknown about it, it is also proving to be worrying for obstetricians, Dr Ng Kai Lyn, a consultant obstetrician and gynaecologist at the Advanced Centre for Reproductive Medicine (ACRM) Gleneagles, told CNA Women.
“Our worst fears would be that our pregnant women, already a vulnerable population in the pandemic, will once again bear the brunt of morbidity and mortality ... as Omicron makes its rounds,” said Dr Ng, adding that with the Delta variant, studies have shown increased morbidity in pregnancy.
“We are bracing for the possibilities of high transmissibility, increased risk of reinfection and vaccine resistance, when we have barely made it past the Delta variant,” she said.
We are bracing for the possibilities of high transmissibility, increased risk of reinfection and vaccine resistance, when we have barely made it past the Delta variant.
THE DELTA VARIANT REMAINS A HUGE CONCERN
Dr Ng’s worries about the Omicron variant are not unfounded, given that the Delta variant fuelled a surge in COVID-19 cases in Singapore in recent months.
Case in point: Just between September and October, National University Hospital (NUH) had five mothers who were COVID-19 positive at the time of delivery, according to Associate Professor Zubair Amin, head of the Department of Neonatology at Khoo Teck Puat – National University Children's Medical Institute, who spoke at a public forum webinar on pregnancy and COVID-19 back in October.
Compare this to all of 2020, he said, where NUH cared for around eight pregnant women who were infected with COVID-19 at various stages of pregnancy. None had the virus at the time of delivery, Assoc Prof Zubair added, and all managed to deliver healthy babies and breastfeed too.
“This is a traumatic change ... and from what I understand from the rest of public hospitals, situations have been pretty much the same,” he said.
Similarly, Professor Tan Hak Koon, Chairman of the Division of Obstetrics and Gynaecology at KK Women’s and Children’s Hospital (KKH), told CNA Women that the hospital saw 91 cases of pregnant women infected with COVID-19 at the in-patient wards, from May to October this year.
“This is a significant rise as compared to a few cases during the same period in 2020. What is most worrying is that the majority of this group of pregnant women infected with COVID-19 were unvaccinated or partially vaccinated,” Prof Tan said.
In a move to help Singapore transition to endemic living, MOH had announced on Oct 23 that home isolation would be the default mode of recovery for those with COVID-19. Pregnant women who are below 35 years old and less than 26 weeks pregnant qualify for the Home Recovery Programme (HRP).
But questions abound, including: If I am in early pregnancy but have complications, am I eligible for isolation at the hospital? What is the risk that I could transmit the virus to my unborn baby, regardless of where I am in my pregnancy?
CNA Women asked the experts these and more questions about what happens if you get COVID-19 during pregnancy.
1. VACCINATION AND BOOSTER SHOTS
I just found out I was pregnant – should I still get vaccinated?
Yes, you should still go ahead with the vaccination as evidence has proven that the vaccines are safe and effective in all stages of pregnancy, advised Dr Serene Thain, a consultant at the Department of Maternal Fetal Medicine at KKH.
“Pregnant women with COVID-19 infection are at increased risk of becoming severely unwell (for example, requiring oxygen, intensive care unit admission) if they catch COVID-19,” Dr Thain said. “They are also at higher risk of developing pregnancy complications such as preterm birth and stillbirth.”
If a vaccinated pregnant woman catches COVID-19, she is 90 per cent less likely to develop severe or critical illness compared to an unvaccinated pregnant woman, said Dr Thain.
However, if you are in your first trimester and feel unwell due to early pregnancy symptoms, you may want to seek advice from your doctor before proceeding with vaccination, she added.
What are the risks and benefits of vaccination for me and my unborn baby?
We now have very robust real-world data demonstrating that the mRNA vaccines are safe in pregnancy, said Dr Thain.
“Over 170,000 pregnant women in the US have received an mRNA vaccination (either Pfizer BioNTech or Moderna) and there have not been any safety concerns raised,” she said.
The benefits, according to Dr Thain, include antibody production in pregnant women, which has been shown to be transferred passively across the placenta to the baby in pregnancy, which could confer protection to the baby after birth as well.
Pregnant women with COVID-19 infection are at increased risk of becoming severely unwell if they catch COVID-19.
It’s also worth noting that mRNA vaccines are not live vaccines and therefore do not cause one to get infected with the virus, nor does it change the DNA or genetic makeup of the pregnant woman or her baby, she said.
As for the risks, Dr Thain pointed out that the side effects from vaccination for a pregnant woman are no different from non-pregnant individuals.
“Side effects are temporary and common ones include pain at the injection site, muscle ache, fatigue or fever. These side effects are self-limiting and will go away in a few days with ample rest and adequate hydration.”
I get COVID-19 before my second dose, should I wait until I give birth?
If you are partially vaccinated (or as yet unvaccinated), had an earlier COVID-19 infection and recovered, you are recommended to receive a single dose of the mRNA vaccine at least three months after the date of the diagnosis, said Dr Thain.
“There is evidence that a single dose of the mRNA vaccine would further boost immunity against COVID-19. A booster dose is not yet recommended at this time,” she added.
2. VACCINATION AND FERTILITY TREATMENT
Should I delay getting vaccinated or taking the booster jab if I'm undergoing fertility treatment?
Couples should complete their COVID-19 vaccination before they start fertility treatment, if possible, said Dr Jessie Phoon, Director and Senior Consultant of KKIVF Centre at KKH.
This is because any side effects or symptoms arising from the COVID-19 vaccination may disrupt their fertility schedule and treatment.
3. TESTING POSITIVE FOR COVID-19
What’s the first thing to do if I test positive for COVID-19 at home?
As pregnant women can become more severely ill with COVID-19 compared to non-pregnant women, you should get a confirmatory Polymerase Chain Reaction (PCR) test if you test ART (Antigen Rapid Test) positive, said Dr Lim Min Yu, President of the Obstetrical & Gynaecological Society of Singapore (OGSS).
Dr Lim added that you should head to a polyclinic or Public Health Preparedness Clinic (PHPC) near where you live. If you are unsure, you can use this link to locate a nearby clinic: https://flu.gowhere.gov.sg/.
Continue to stay home and self-isolate – preferably in a room with an attached toilet – while waiting for your PCR results, which you will receive within two days of the test.
If your PCR results come back positive, continue to self-isolate while awaiting further instructions from the Ministry of Health (MOH), said Dr Lim.
Should I inform my gynaecologist?
Yes, it is a good idea to inform your gynaecologist if you are pregnant and have tested positive for COVID-19, said Dr Lim. But don’t make your way to the clinic, make a phone call instead.
Once your PCR test is confirmed positive, the MOH case management task group (CMTG) will be informed and they work very quickly to connect with you and expedite your transfer to a hospital, said Dr Anupriya Agarwal, a senior consultant obstetrician and gynaecologist at Advanced Centre for Reproductive Medicine (ACRM) Gleneagles.
“Patients are arranged to be admitted to any of the public or private hospitals that offer obstetric services. This depends on the patients’ preference, her medical condition as well as the financial issues or insurance coverage,” added Dr Agarwal.
What if I am unvaccinated?
If you are unvaccinated, you will need to be hospitalised for closer monitoring, regardless of the stage of pregnancy, said Dr Ng of Gleneagles Hospital.
“The level of concern is, of course, higher if the woman is unvaccinated as we know that complication rates are higher in pregnant unvaccinated women compared to those who are vaccinated,” she added.
4. HOME RECOVERY PROGRAMME
Am I eligible for the Home Recovery Programme (HRP)?
According to an MOH spokesperson, the HRP is the default care recovery process for fully vaccinated pregnant COVID-19 patients who are less than 26 weeks pregnant. These patients would first be clinically assessed to be suitable for home recovery.
If I am recovering at home but still feel sick, can I request to see a doctor at any hospital?
While you are recovering at home, an Obstetrics & Gynaecology (O&G) doctor will call you on designated days to ensure you are recovering well, said Dr Tan Wei Ching, a senior consultant at the Department of Obstetrics & Gynaecology at Singapore General Hospital (SGH).
Should you require medical assistance during HRP, such as for prolonged fever and persistent diarrhoea or vomiting, you can request for a telemedicine consult, said MOH. The telemedicine provider will then assess you and arrange for conveyance to a hospital, if necessary.
Under what circumstances while on HRP should I call my gynaecologist immediately or head to the hospital?
You should head to the hospital in the event of any acute obstetrical emergency, which refers to life-threatening health issues for pregnant women, said Dr Tan.
For example, if there is significant bleeding or signs of preterm labour or severe high blood pressure, she said. As risks are different for each patient, at their routine visits, pregnant women should consult their obstetricians about what to look out for.
If you develop emergency symptoms such as chest pain or shortness of breath, call 995 for an ambulance to take you to the hospital, said MOH.
Do I have a choice between doing HRP or being isolated at hospitals?
If you are 26 weeks pregnant or more, said an MOH spokesperson, you will be assigned by MOH to hospitals with Obstetrics & Gynaecology services for care management. Some of these hospitals include KKH, NUH and SGH.
If you are 26 weeks pregnant and more, and wish to recover at home, you can make an appeal to MOH, who will assess your situation on a case by case basis.
How can I make sure that those living with me at home don't get infected with COVID-19?
According to MOH, you should:
- Ensure that there is no face-to-face contact with other household members while receiving food and other items. They can leave the items outside your room door.
- Wear a surgical mask and ensure that nobody is outside the door before opening the door.
- For groceries and food to your home, opt for contactless delivery.
- If you live alone and you need to collect deliveries, ensure that no one is outside the door and do not interact with anyone.
What if my household has only one shared toilet?
The MOH website recommends that you take these precautions:
- Close the toilet lid before flushing.
- Clean and disinfect the washroom after each use and do not allow other family members to use it for at least 20 minutes after.
5. RECOVERING AT AN ISOLATION WARD
What is the onboarding process like at the hospital and what should I pack?
If you’ve tested PCR-positive but do not satisfy the criteria for HRP based on gestation of pregnancy and presence of other comorbidities, you will be contacted by the MOH case management task group to be admitted to one of the three public hospitals via dedicated transport such as an ambulance or SHNGrab, said Dr Tan of SGH.
Medication and meals will be provided by the hospital, said Dr Tan, so you’re advised to pack:
- Toiletries and personal care items.
- Phone and/or tablet (don’t forget the chargers) to allow multidisciplinary virtual meetings with the medical teams and also to maintain communication with your family.
- Books and other reading materials to help you pass the time as you’ll be confined to the isolation ward.
Can my husband and/or loved ones see me or drop off food at the hospital?
Your husband and family will not be able to visit you when you are in the isolation ward, said Dr Tan, as the hospital would need to consider the safety of your family members and minimise their exposure too.
What if I am still not cleared of the virus after going through the 10-day isolation period?
Vaccinated individuals who are medically fit for discharge, will be discharged on Day 10, said KKH’s Dr Thain, adding that day one would be the day your PCR test comes back positive. You don’t have to do an exit PCR swab.
Unvaccinated individuals who are medically fit for discharge, will be discharged on Day 14 without the need to do an exit PCR swab.
Earlier discharge may be possible on a case by case basis if the patient's test result meets the discharge criteria; which includes a negative PCR result, she added.
6. GIVING BIRTH WHILE COVID-19 POSITIVE
If I have to give birth while in isolation, can I request for my own gynaecologist to deliver my baby?
According to SGH’s Dr Tan, if you were already assessed at the hospital before starting your HRP, an SGH doctor will call you on designated days, and your obstetrician will, as far as possible, attend your delivery.
However, for patients who were transferred to SGH and had their pregnancy care elsewhere, their doctors from other hospitals would naturally not be attending to their delivery at SGH, added Dr Tan.
What’s the risk that I could transmit the virus to my baby pre-birth or during labour?
Overseas studies have shown that mother-to-baby COVID-19 transmission pre-birth is very low, said Dr Tan.
“There is always a small risk that transmission can occur during birth and after delivery, hence the importance of adhering to current recommendations of mask wearing and strict hand hygiene,” she explained.
Will I be separated from my baby after I give birth?
If you are COVID-19 positive at delivery, it does not necessarily mean that you and your baby have to be separated, said Dr Yvonne Ng Peng Mei, Clinical Director and Senior Consultant at the Department of Neonatology at Khoo Teck Puat - National University Children's Medical Institute, National University Hospital (NUH).
Added Dr Yeo Kee Thai, a neonatal consultant at the Department of Neonatology in KKH: “Newborns who are well would typically remain with their mothers during the isolation period, in order to encourage breastfeeding and mother-infant bonding.”
Depending on the mother’s, as well as the baby’s condition, hospitals may provide the option for you to room-in with your newborn. The neonatal doctor will provide counselling for you to make an informed decision on where and how the baby will be cared for, said NUH’s Dr Ng.
She added that a baby born to a mother who is COVID-19 positive at the time of delivery does not stay in the nursery with other babies as there is a small chance of the baby being infected and potentially infectious to staff and other babies.
If the baby and/or mother require a higher level of medical care, they will likely be separated, she said.
Some parents, too, opt for the mother to be separated from her baby, either for personal or medical reasons, said Dr Ng of NUH. “In this situation, the baby will be in a single room separated from the mother while we monitor the baby for possible COVID-19 related symptoms and conduct PCR swab tests.”
Can my husband visit my newborn at the hospital while I serve out the remaining time of my 10-day (or 14-day) isolation period?
Your husband, if he is not infectious, can visit and stay with your baby (otherwise healthy), said Dr Ng of NUH.
He will be guided by the nurses and doctors, until your baby is discharged.
Can my newborn go home with my husband or loved ones before I’m discharged?
Should the parents prefer to have the newborn home earlier with the father or an alternative caregiver, said Dr Yeo of KKH, this can be discussed with the medical team and may be allowed if a plan can be made for the care of the newborn.
But if the entire family is infected with COVID-19, your baby will stay at the hospital until he or she can be discharged with you, said Dr Tan of SGH.
7. BREASTFEEDING YOUR BABY
Is my breast milk “safe” for the baby, especially if I am still infectious (or have just recovered)?
Your breast milk is safe for the baby as COVID-19 does not spread through breast milk, said Dr Ng of NUH.
“Breast milk from a mother with COVID-19 infection or who has recovered from infection contains specific antibodies that can inactivate the virus,” she explained. “In addition, breast milk naturally contains many bioactive substances for the baby’s optimum growth and development.”
This is my first baby and I don’t know what to do – who can I turn to for breastfeeding help while isolated at the hospital?
Whether a mother has COVID-19 or not, doctors, nurses and lactation consultants in all maternity hospitals will be your first point of contact, said Doris Fok, who is a certified lactation consultant at the Department of Obstetrics and Gynaecology at NUS Yong Loo Lin School of Medicine.
“After hospital discharge post-delivery, you can also contact hospital breastfeeding support helplines or community breastfeeding helplines (for example Breastfeeding Mothers’ Support Group Singapore), for additional help,” Fok recommended.
If possible, ask your friends and family for help with other matters, such as housekeeping, food, emotional and physical support, while you concentrate on breastfeeding your baby, said Fok.
CNA Women is a new section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.