Roshani Mahadevan Schaefer and her husband knew for years that they wanted to start trying to conceive in 2020.
Her work as a humanitarian aid consultant meant a lot of international travel, and “it would be really hard to be pregnant going to refugee camps in Lebanon near the Syrian border,” she said. The couple stepped back from their work and vacationed in nearly 40 countries in 2019 in anticipation of a pregnancy the following year. As the start of spring neared, they kept tabs on the coronavirus outbreak in the United States but moved forward with their plan after a phone call with her doctor’s office.
“But in the matter of, I think that’s been two weeks, I feel like things have completely changed,” Mahadevan Schaefer said.
Women and their partners everywhere are trying to plan their families under a cloud of covid-19 unknowns. Too little is known about the disease for doctors to be able to answer questions from prospective parents. For many, waiting until later would bring with it its own set of concerns for health and finances.
Mahadevan Schaefer, 31, lives in Des Moines, and has been doing consulting for six years, assisting nonprofits in providing help to victims of wars, natural disasters and more. They’d long had a March preconception doctor’s visit on the calendar, but it was postponed as Iowa began enacting restrictions on gatherings. The provider’s office told Mahadevan Schaefer over the phone that, while covid-19 presented concerns, she and her husband could reasonably try to conceive since they were working remotely and planning to spend most of their time at home.
She will find out soon whether she is pregnant. “When we tried, it felt like the world looked a lot different than what it’s looking like now,” she said.
Would she try again right away?
“Every day I grapple with this question,” Mahadevan Schaefer said. “It’s just such a big question mark on whether the world will be safe.”
One development that shook her confidence was a report of a Connecticut infant dying, possible because of covid-19. Before she read the news, she was mostly concerned how potentially getting the novel coronavirus while pregnant would affect her own health.
What medical professionals know
Shannon Clark, a professor of maternal-fetal medicine at the University of Texas Medical Branch in Galveston, Texas, said she has been contacted by patients, friends, friends of friends and women on social media who are grappling with this decision right now: Can I go ahead and try to conceive? Or is it too risky?
She talks women through several steps.
Clark starts by reminding these women that this is not the first coronavirus — two others caused global disruptions in recent history: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Pregnant women who had SARS or MERS did not have an increased risk of miscarriage or stillbirth when compared with pregnant women who did not have the diseases, Clark said.
The data is still very limited, Clark said, but women who contract covid-19 do not seem to have increased risks of miscarriage, stillbirth or other complications, such as fetal malformation.
Clark emphasized that what the medical community knows about covid-19 is constantly changing. “We have not studied enough pregnant women to say for sure,” she said.
What the medical community knows about the seasonal flu — which is not a coronavirus — is also helpful to women trying to weigh the risks of conception, Clark said. Women who contract seasonal influenza while pregnant have an increased risk of delivering before 37 weeks. Their infants are also more likely to have low weights at birth, although that is likely tied to their prematurity, she said.
There is evidence that some women who contract covid-19 while pregnant are also giving birth early, but it’s not clear that the virus is the reason, she said. Clark emphasized that any severe illness, whether viral or bacterial, can increase the risks of birth defects if a pregnant woman has a prolonged high fever, especially during the first 14 weeks of pregnancy.
There are also unknowns surrounding the transmission of the virus in amniotic fluid, cord blood, breastmilk and more. It’s not clear whether the virus can be transmitted through bodily fluids such as semen, although it’s certainly transmitted during close person-to-person contact.
“So if a patient was to ask me, ‘Can I give it to my baby during pregnancy? Or during delivery?’ I would say I don’t know.”
Clark emphasized that having a preconception visit with a health care provider is more important than ever.
“Trying to conceive during this time, there’s no right answer. No one should tell a woman, ‘Yes, it’s perfectly fine,’ and no one should tell a woman ‘No, it’s absolutely not fine.’ She has to be informed. Ideally, if she’s trying to conceive or considering trying to conceive, she should talk to her obstetric care provider,” Clark said.
‘I don’t want to be in the hospital for any reason’
Cassie Greenwade and her husband planned to start trying to conceive their second child in May. Greenwade, 30, lives with her husband and their toddler in Sammamish, Wash., near the center of the country’s first coronavirus outbreak, in Seattle’s suburbs.
She works part-time as a nutritionist but is mostly focused on parenting right now. Her husband is a chiropractor. His office is still open, but business gets slower every week. Like many young couples, they don’t have a liquid emergency fund.
“I wouldn’t feel right, financially, bringing in another kid and adding more stress on both me and my partner. … I don’t want to be stressed out being pregnant,” said Greenwade, adding that hospital restrictions on partners and visitors continue to tighten in Washington state.
The couple isn’t willing to withdraw from their retirement savings to afford another baby, which they say they would have to do. As small-business owners, Greenwade and her husband pay for medical expenses out of pocket, and additional financial stress isn’t what the family wants right now.
She is also worried about health issues during and after pregnancy, including potentially contracting covid-19 postpartum.
“It lays you on your butt, and you have a fever for quite a while. That’s not something you want to have when you have to take care of a newborn, too,” Greenwade said.
Mahadevan Schaefer, the humanitarian aid consultant, said that the potential for absolute restrictions on hospital visitors worries her, too: “As a nonwhite female, I’m also worried about potentially giving birth without an advocate present for my health, since the mortality rate for nonwhite mothers during birth can be higher than white females,” she said.
The incentives to wait are many. But the other side of the discussion is compelling, too: Mahadevan Schaefer said she knows that the journey to conception is sometimes long under the best of circumstances. Delays could also mean professional complications. She’d thought about looking for a full-time role with a nonprofit eventually. That would most likely mean waiting even longer, as parental leave benefits only kick in after a certain amount of time with the company in many instances.
“It just really felt like the right time. We waited for a while to make sure we were making smart decisions, financially stable in great jobs, and really kind of calculated it out, if you will, and now it just feels like this — and obviously this is something incredibly unpredictable — but it’s a huge wrench in what we had planned,” Mahadevan Schaefer said.
Tia Partridge, 32, is a massage therapist who developed postpartum preeclampsia — a dangerous condition in which a mother develops high blood pressure and excess protein in her urine — after the birth of her first child. Her health history would automatically place her in the high-risk category during a subsequent pregnancy, she said.
Partridge’s son is now 18 months old. She and her partner wanted their children to be about 2.5 to 3 years apart, and they had planned to start trying to conceive again soon.
But they are holding off because of health fears. They, too, have seen covid-19 take a swift toll on the Seattle area from their home in the suburb of Federal Way, Wash.
“I don’t want to be at the hospital for any reason if I don’t have to,” Partridge said.
Not always a choice
For other women, the decision to halt their fertility journey wasn’t their choice. On March 17, the American Society for Reproductive Medicine recommended that clinics halt elective procedures that are the only path to biological parenthood for some couples.
Jessi Bartello, 32, of Ankeny, Iowa, and her husband started trying to have a family right after they were married in 2010. After a year without success, testing revealed that both Bartello and her husband had medical issues that presented significant hurdles to conception. They proceeded with two rounds of in-vitro fertilization that led to two pregnancies and two miscarriages. They tried embryo adoption, but Bartello did not become pregnant.
“We moved on to domestic adoption and were able to take our daughter home from the hospital,” said Bartello, who works as a community coordinator at the couple’s church.
The Bartellos were content being a one-child family. The medical procedures and the adoption process had been lengthy and painful. There was a lot of lingering heartache.
“After three years, we both decided we weren’t done. We landed on trying embryo adoption again. We were two months into medication, two weeks out from our transfer date, when covid-19 shut the process down,” Bartello said.
There would be no embryo transfer in the immediate future, and Bartello is feeling the effects of the hormone withdrawal.
“I was on estrogen and getting ready to start my shots of progesterone. When I stopped my estrogen abruptly, it wasn’t terrible, but I have noticed I am shedding a ton of hair,” she said.
Bartello said that she and her husband have felt sad, mad, disappointed and hopeful — but that most of all, covid-19 has been a reminder that “we aren’t normal. We don’t get to jump into bed on a whim and have fun trying for kids. … We are mad because it is a hard process to begin with, one that is out of our control — medication, my body, my cycle, the right placement of an embryo, etc., all have to align to try for a baby. And now, government officials are a part of me trying for a baby. It has just added to the reality we can’t do it on our own.”
Clark, the professor of maternal-fetal medicine, experienced infertility when she and her husband tried to start their family when she was 40. She said she empathizes with women who want to add a baby to their family and are facing unknowns and closed doors.
“I think it’s really tough for women right now to not know how long this is going to last. And if they were already ready and in the mind-set that they were ready to try for that first baby or another baby or to go through fertility treatments and take that next step, when someone tells you, ‘You know what, it’s not the best time,’ that’s a hard pill to swallow.”