About Your Pregnancy

To all of our pregnant patients of Miami Center of Excellence:


Many of you have seen us in the office during the past week where we have been able to discuss the following topics and answer most of your questions. We have created the following document with questions that many of you have asked, and these answers come directly and only from trustworthy resources like the ACOG (American College of Obstetricians and Gynecologists), the SMFM (Society for Maternal Fetal Medicine, High Risk Pregnancy Experts), and the CDC (Centers for Disease Control and Prevention). Hopefully, this will answer some, if not most, of your questions. If you still have concerns, don’t hesitate in addressing them at your next prenatal care visit, or if urgent, call our office and our nurses will help you out or reach me to help you.

Remember, we are here for you and to take care of you.

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Please note: Emergencies related to pregnancy and gynecology should call our emergency line, proceed to the nearest emergency room, or call 911.

Am I at a higher risk of getting COVID-19 because I am pregnant?

  • Currently, very little is known about COVID-19 and its effect on pregnant women or if it affects the health of the baby after birth. At this time, there are no recommendations specific to pregnant women regarding COVID-19.
  • Pregnant women are known to be at greater risk of severe morbidity and mortality from other respiratory infections such as influenza and SARS-CoV. BUT, based on a limited number of confirmed COVID-19 cases, pregnant women do not appear to be at increased risk for severe disease due to coronavirus.
  • It is unclear if COVID-19 can cross through the transplacental route to the fetus. As of today, none of the infants born to mothers infected have tested positive for COVID-19.
  • Right now, we have not evidence of it being present in the amniotic fluid or breast milk.
  • Updated information as of April 3rd, some pregnant women with COVID-19 have had preterm births, but it is not clear whether the preterm births were because of COVID-19. (Information from ACOG.)

Will I be able to breastfeed if I have COVID-19?

  • No evidence of virus has been found in the breast milk of women infected with COVID-19.
  • But the infected mother could possibly transmit the virus through respiratory droplets (ex: by sneezing or coughing) during the period of breastfeeding.
  • Specific instructions would be given if you have COVID-19 and decide to breastfeed to make it as safe as possible.

What do I do if I am a pregnant healthcare professional?

  • Pregnant healthcare professionals should follow risk assessment and infection control guidelines when exposed to patients with suspected or confirmed COVID-19 (your workplace should have them in place).
  • Facilities may want to consider limiting exposure of pregnant healthcare professionals to patients with confirmed or suspected COVID-19 if feasible based on staffing availability. We can provide you with a letter asking for your duties to be modified so that you do not work directly with these patients, but we can’t guarantee that your workplace will be able to do so.

Should I still get the flu vaccine?

  • Influenza activity continues to be high across the United States.
  • We know that influenza can cause severe respiratory distress in pregnant women.
  • I encourage every pregnant woman to get the flu vaccine. We don’t have it available in our office anymore during this season but you can still get it at most major pharmacies as well as some PCP offices.

How can I prevent getting COVID-19?

  • The same way as everyone else: SOCIAL DISTANCING!!!
  • The best way to prevent illness is to avoid being exposed to this virus.
  • It spreads between people who are in close contact (within about 6 feet) or through respiratory droplets when an infected person coughs or sneezes.
  • Stay home!!! If you can work and/or study from home, do so. Don’t leave your house unless you definitely need to (ex: come to your prenatal care visit, go buy groceries, go get medications at the pharmacy, etc.).
  • Avoid people who are sick.
  • Wash your hands often (with soap and water or alcohol hand sanitizer).
  • Try not to touch your face. That way, even if your hands are in contact with the virus, you won’t bring it into your nose or mouth.
  • Clean and disinfect high-touch surfaces daily (ex: doorknobs, desks, toilets).

What symptoms should I watch out for? What should I do if I suspect I am sick?

  • COVID-19 symptoms: fever more than 38 degrees Celsius (100.4 degree F), or one or more of the following: cough, difficulty breathing, shortness of breath, gastrointestinal symptoms.
  • If you suspect that you are sick, please don’t come to our office. We are not able to test for COVID-19 in our office, and also, you will be putting our other pregnant and gyn patients at risk of getting infected.
  • If you are sick, call the office and we will direct you to a testing facility or look online for the nearest COVID-19 testing facility.
  • If you are experiencing shortness of breath or difficulty breathing, you should go directly to the emergency room.
  • Being positive for COVID-19 DOES NOT MEAN YOU WILL BE HOSPITALIZED.
  • Once you get tested for COVID-19, unless you have pneumonia or have other medical conditions that put you at risk for complications (ex: asthma, HIV, diabetes, hypertension, chronic lung disease, chronic liver disease, take immunosuppressive medications, chronic kidney disease, elderly, etc.), the next step is to self-isolate at home for at least 15 days so that no one else gets the virus from you.
  • If you are stable, you wait for the result at home while self-isolating.

Should I wear a facemask?

  • Definitely wear a facemask if you are sick (ex: if you are coughing or sneezing).
  • Facemasks may be in short supply and they should be saved for caregivers.
  • UPDATED INFORMATION: As of April 3, the CDC says all people, including pregnant women, can wear a cloth face covering when they are in public to prevent the spread of COVID-19. Face coverings are recommended because studies have shown that people can spread the virus before showing any symptoms.
  • The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance. (From CDC guidelines.)

Who can be with me during the delivery and postpartum period?

  • Due to the COVID-19 pandemic, Baptist Hospital has modified its Labor and Delivery rules and right now, they allow only ONE ADULT to accompany you during your labor, delivery and postpartum period. You will not be able to receive other visits during your stay at the hospital. (Just so you have an idea, the only patients in the hospital that can have ONE companion are pregnant and pediatric patients. All other patients are currently unable to receive visits as part of the effort to stop the COVID-19 spread).

Take care, be safe and stay home!

Sincerely,
Dr. Randy A Fink, MD
Dr. Rafiné Moreno-Jackson, MD
Dr. Lauren Abern, MD
Stephanie Fink, MSN, NP, CNM

References:
ACOG (American College of Obstetricians and Gynecologists) Practice Advisory. Novel Coronavirus Covid-19. March 2020.
SMFM (Society for Maternal Fetal Medicine). Outpatient Assessment and Management of Pregnant Women With Suspected or Confirmed Novel Coronavirus (COVID-19).
CDC. Pregnancy and Breastfeeding.
CDC. Coronavirus 2019.

Let's Talk About Your Pregnancy

Pregnancy is the most beautiful and exciting time for the mother to be as well as her partner, family and friends! The expectant mother may experience anxiety about the unknown about the pregnancy and potential complications. What is normal and what is not gets confusing when your family and friends tell you one thing and your practitioner tells you another. Then if she looks at the internet, things may get even more confusing!

We are here to help you navigate the unknown and answer the questions you may have and order the appropriate tests to assure that you have a healthy pregnancy. This site will only start with the basics of the do's and don'ts. On your right hand column you will find PDF files in pink which are handouts we give out in our office. The Prenatal policy handout is our most updated information booklet about our office policy and general prenatal information and warnings.

We also encourage you to read prenatal books, take classes and engage our office staff in dialogue with any questions you may have.

How to Have a Fit Pregnancy

Whatever you age, exercise and proper nutrition are the key elements to achieving a healthy and happy pregnancy. We recommend continuing with the exercise that you already are performing unless there is a risk of injuring yourself. If you are having complications, we may have you avoid exercise during that time period or change the type of exercise you are performing. Keeping your heart rate at or below 140 is recommended. If you find that your heart rate is higher than 140 decrease the intensity of your work out to bring it down.

Diet and Nutrition

Pregnancy is a time to make positive dietary choices. It can be tough to stop a food you may love or restrict an item, but it is imperative to avoid the foods we discuss with you at your appointment. For a list of what to avoid please open the Prenatal policy handout. Also, be aware that some foods may be pulled from the market from the CDC due to contamination issues. Please keep current on your news and follow the CDC recommendations. If you would like to have an update from our office you will need to join our practice Facebook page for dietary or other obstetrical alerts. You may "like" us at https://www.facebook.com/MiamiOBGCenter to receive practice updates and news. We also appreciate our patients so much when you share your baby photos with us!

Other considerations

Your cat: It is not recommended to change the cat litter when pregnant, please have your partner do this activity. Cat feces may be contaminated with toxoplasmosis which is dangerous for the pregnancy. Please do not get rid of your loved pet!

Smoking and drinking: Most people are aware not to smoke or drink alcohol during pregnancy. If you have difficulty abstaining from either smoking or drinking then please let us know so we can get you the help you need.

Caffeine: Some studies on caffeine during pregnancy have led to the conclusion that the two do not mix well together, as caffeine may increase the possibility of miscarriage and low birth weight. An excessive amount of caffeine is generally regarded as 200 mgs or more per day. We recommend 100mg or less, but remember in one study consuming 200mg or more of caffeine during pregnancy increased the risk of miscarriage, so be careful.

Home safety: There are many hazards around the house for pregnant women, but almost all can be easily avoided. Try to stay clear of aerosol cans, industrial strength cleaners and fumes from paint, solvents and strippers. It also pays to take is a little easier around certain parts of the house such as the stair case.

What is perineal massage?

Prenatal perineal massage (olive and wheat germ oil) and warm baths start approximately 6 weeks before your due date. Perform daily or three times a week to increase your pelvic floor "awareness". It is not necessary for everyone to perform this, but this information is available for those patients interested. This exercise may decrease your chance of tearing during the birth.

  • Use warm olive oil; be sure to urinate before beginning.
  • Relax
  • Have your partner insert one clean, oiled finger into your vagina about 1-1 ½ inches
  • Do a Kegel so they can feel the muscles to be worked. Tighten and relax….
  • Now do a Kegel with 2 fingers in the vagina, tighten … then relax..
  • With 2 fingers in the vagina, apply downward pressure as in and ironing motion.
  • Repeat this motion while periodically doing Kegels to make sure this area is relaxed. Some people recommend doing this for no more than 5 minutes per day.
  • Others find it takes a good 10-15 minutes to get the muscles relaxed. Inform your partner if they are applying too much pressure or needs more lubrication, etc.
  • Gradually graduate to 3-4 fingers.
  • We can go over this with you are the time of your prenatal appointments if needed.