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Speaker 1:
You're listening to the CONVERSATIONS podcast with Emory Gynecology and Obstetrics. This series is a continuation of our popular video series created to highlight the need for ongoing conversations around women's reproductive health.
Speaker 1:
Hi, everyone. Welcome back to our podcast with Emory Gynecology and Obstetrics. Today we are having a wonderful conversation with one of our assistant professors here at Emory University's Department of Gynecology and Obstetrics, and that is Dr. Dawn Russell. Today we're going to be talking about how to have a healthy pregnancy in the time of COVID and we felt like she would be the perfect person to have this conversation with. Dr. Russell, thank you so much for making time to speak with us today.
Dawn Russell:
My pleasure.
Speaker 1:
So I know that I mentioned to everyone that you are an assistant professor here within our department, but is there anything else about you in particular that you'd love to share with anyone who's listening about yourself, as a physician, as an educator?
Dawn Russell:
Well, I think it's important to know that I am coming in not as an infectious disease expert and not as somebody who's labeled as an expert, except by experience. I've had over 25 years of helping moms get their families started and have over that time become almost obsessed with helping them do it in a healthy way. So this is exactly my soap box and I'm absolutely thrilled to talk about it. I also would mention that I'm up at Johns Creek, which is a specific Emory clinic that we opened within the last two years. Very excited to spread the Emory brand name and support up to our women up in the north area.
Speaker 1:
That's amazing. So you mentioned it right off the top, and I think this is probably the biggest question you get from any one of your patients, which is, "I am pregnant. How do I do this in a healthy way?" So help us sort of wrap our heads around what does a healthy pregnancy look like and how can someone really foster a healthy pregnancy?
Dawn Russell:
So I think the most important thing to remember is that pregnancy is not an illness. It is a healthy, healthy process. And from there everybody can use their own common sense and even their own healthy habits to help a healthy pregnancy. So, first of all, where does that start for all of us, it's exercise, nutrition and healthy mindset. So the first thing I asked my pregnant patients to do, and in fact, my non-pregnant patients to do, is please, this is a time to really get good habits going. So start with a really good nutrition plan. Now, not everybody knows what that is, and I think we all need to admit that. So starting from looking at your plate and understanding that what's on it, you should recognize. If you can't recognize it or it's been processed so far beyond recognition, probably not the best of things to give yourself.
Dawn Russell:
The simple tricks, like shopping in the edge of the grocery store for the things that you can identify. And other than that, I often will give out as a reference nutrition.gov. The FDA and government did a fantastic job putting together a website that can actually give you useful information and even put meal plans together for you. So if you're unsure about nutrition, that's a good place to start.
Dawn Russell:
The other side of the nutrition is the exercise. So there's this nasty rumor out there that pregnant people can't start exercise or they can't exercise. And I'm here to debunk that rumor, we need you working out, we need you exercising. We need you keeping healthy, and there's not really limits on heart rate and you can lift weights. So under almost all circumstances, healthy, pregnant women can do healthy things. Along those lines I also encourage things like meditation. Now, this is something that people have kind of gone overboard in the past and thought it was weird, or crunchy, or different, but it's really not. It's about being mindful and understanding that your brain needs exercise and rest, just like your body needs exercise and rest. So that really is the general recommendation is that pregnant women are women and they're healthy women. And so what you do that is healthy is going to lead to a healthy pregnancy.
Speaker 1:
Well, it sounds so simplistic when you put it that way, that it makes you realize that probably one of the biggest barriers for people really understanding how to be healthy in the time of pregnancy is a lot of fear, right? And it's a lot of trying to navigate the unknown of what do I do in my body that is now changing and different? And it sort of makes you move against what you know to be true. Like you said, like nutrition and exercise and all of those things?
Dawn Russell:
Well, and I don't think that ... Unfortunately social media and some media haven't helped always, because there's definitely a lot of fear mongering, fear encouragement out there. And I'm here to take that away and say, "No, trust yourselves, trust your bodies. Start to use your common sense." Remember, your great-great-grandmother did not have random things on internet and Instagram. She did it right, because you're here. So remember to use your common sense.
Speaker 1:
Well, and to the point that you spoke about things sort of fostering fear and a lot of misinformation, we know candidly that we're in a time where there's such increased focus around how do I have a healthy pregnancy in the time of COVID. And I think there's so many questions. Certainly if you go on Google right now and you Googled pregnancy and COVID, you would have a barrage of misinformation. And so we're hopeful that we can debunk, as you said, some of that today, but also to help remove some of the fear around that. So I think one of the number one questions that I saw when I was sort of Googling COVID and pregnancy, are pregnant women at an increased risk for COVID because of their pregnancy?
Dawn Russell:
So there's two parts to that question. The first part is, am I at increased risk of getting COVID because I am pregnant? And the answer to that is that we don't think so. Again, you're a normal woman and women and old people are at risk of getting COVID of course if they don't follow certain precautions, which we'll get into a little bit later. The other part of that question is, what might COVID do to me if I am pregnant?
Dawn Russell:
And please remember that we are a year into this pandemic. And so there's a lot of things we know, and there's a lot of experience we've had, but there's also still some things we're figuring out. One of the things that we have figured out is that pregnant women can get sicker than some others sometimes when they get COVID. Now, the very important part of that statement is sometimes, it does not appear to be a high risk. It appears to be a low risk. However, for that reason we of course want our pregnant women to avoid getting COVID, but they're not at increased risk because they're pregnant to get the COVID, but they may be at increased risk for complications or getting sicker if they do get COVID.
Speaker 1:
Taking that into consideration, should pregnant people be doing something differently in order to lower their risk of catching COVID? Should they be doing anything different than what we know is sort of like the right things to do in order to lower your risk?
Dawn Russell:
So the brief answer is no, and we're not going to leave it at that. Everybody needs to be following the pillars, which are washing your hands, wearing a face mask, and keeping at least six feet of social distance. So those same things apply to pregnant women, I would hope most people are following them. If pregnant women specifically, if any person feels that they're in a situation that other people are not respecting those pillars, or if they are feeling that there's just too much social interaction or too much increased risk, they should feel free to remove themselves. But again, I'm going to say them again, because they're important. Wash your hands, wear a face mask, and keep social distancing.
Speaker 1:
Well, when you think about this idea of doing all of the right things in order to lower your risk of catching COVID, I think probably the most pressing concern right now for pregnant persons is vaccination. So we've made tremendous advances in order to get vaccines out into our communities. And so a lot of pregnant people are asking the question, "Should I get vaccinated?" And they want to know what are the risks to themselves and to the fetus. Can you answer that?
Dawn Russell:
I can do the best I can. The truth is, is nobody can fully answer that question, but I'll explain why. First of all, I'd like to just put a positive note on the fact that as humans in just less than a year of having a pandemic we created a vaccine. So I want to create that it's just a very positive aspect of where we are in medicine and science right now. The catch is, is that this is a newer vaccine. It uses a methodology that we haven't used before. So as a result we don't have really great data on pregnant women. In fact, we have basically none. However, we can use our knowledge and we can use our experience and say that what we do know about this way of giving a vaccine is there's not a theoretical risk that it would be any harm to a mom or a baby.
Dawn Russell:
People will throw around the phrase mRNA. And unfortunately that gets confused with our actual DNA and genetics. This is a [inaudible 00:10:38] way of getting the vaccine to ourselves, but it's not something that sticks around. It is not something that affects our DNA. It's not something that affects our genetics. So it won't affect our fertility. It won't affect us in any long-lasting way. For that reason we also feel it's going to cross the placenta. So we really don't feel that this will affect the fetus in any way, which is often a mom's first question.
Dawn Russell:
And then the next question is, is it going to be harmful to me? And we don't think so. So nothing about our theories, our little experience so far, and I do emphasize it's not a lot of data, suggest that this is going to be harmful for pregnant women. So for that note, what came out is that most people have kind of left it up to the doctor and patient. Considering what I said earlier about pregnant women getting sick or potentially if they got it, many of us are definitely offering the COVID vaccine to our pregnant patients. And even in some cases potentially encouraging if somebody is high risk or could be exposed a lot. But the bottom line is we don't know, to be very honest. We also don't think that going to be a large concern.
Speaker 1:
Well, in that same vein when you think about the potential risks versus the theoretical risks of the vaccine, I would imagine that a pregnant person, one of their greatest fears would be, "If I become sick, if I get COVID as a pregnant person, what is the risk of passing the virus onto my fetus or newborn child?" Do we have information around that?
Dawn Russell:
We do, and it's mostly good news. So it appears that there is very limited to no crossing of the virus across the placenta. Now there have been some questions of some case reports, but overall we don't feel that that's how this transmits. Remember, this is a respiratory virus, so not blood. So we really don't feel that this virus likes to cross the placenta. So we really don't think that that's going to be a huge risk. Now, when the baby comes out, mom needs to breathe and mom will breathe around baby. So we do know that there's a risk with that, but there's been a remarkably small number of babies who've been COVID positive with COVID positive moms. This is all really reassuring too. So we will encourage moms who are COVID positive to wear a face mask around their baby and to wash hands like crazy. But we do feel that it's a lower risk, although possible. And we've seen a reassuring limited number of COVID positive babies from COVID positive moms.
Speaker 1:
Well, that is encouraging to hear. And I know that as you mentioned sort of helping prospective moms do everything that they need to do in order to mitigate the risks of catching COVID, to do all of the things that they need to do. What do you say to patients who are just flat out concerned about going to the hospital for their prenatal visits? They're like, "I'm trying to stay away from as many sick people as possible, but I know I have these prenatal visits." What would you say to the person who's worried about being exposed?
Dawn Russell:
So there's a weird kind of catch 22 on that. So yes, you're going to a place where there might be more sick people. But on the other hand, you're also in the hands of the people are being hyper clean and hyper actionable about all of the risks. So we really have not seen much if hardly any transmission to our patients from our healthcare facilities.
Dawn Russell:
The risk going to the grocery store or going out in a social situation is so much higher because they don't have such strict guidelines what we do at the hospital. I think the clinic and the hospital might be one of your safest places. I'm not saying you should go hang out there. Might be one of your safer places to come and you'll see the precautions that we are taking, which quite frankly are probably over the top, but that should give you some comfort that you are safe in coming in. And we still want to see you for your prenatal care. And it's still important that we follow the things that we usually would follow in pregnancy.
Speaker 1:
So, when we think about following all of the necessary steps, I know in a pre-COVID world there would be lots of things to think about for a pregnant person, right? Everything from your appointments to your delivery, your birth plan, all of those things. And we obviously are hearing both anecdotally and through news and all of the places that we get information that our actual hospital capacities are being strained under the number of people who are COVID positive, who need hospital support. And so if I'm a pregnant person, should I be worried about the fact that I may not be able to actually have my doctor or obstetrician there to help me deliver?
Dawn Russell:
Absolutely not. We have fail-safes in place. You will always be taken care of and taken care of well, especially in the Emory system. We have somebody there all the time, and that's true for Johns Creek, at Decatur and at Midtown. So we will always find a safe place for you to deliver your baby. And we will always have somebody there to take care of you. As well, the labor and delivery units have made precautions to make sure that they are open to take care of our pregnant patients. So at this stage I would consider it incredibly unlikely to have to worry about having a bed or being well taken care of.
Speaker 1:
I think that would be comforting for someone, because you know this more than I would, that the relationship that's developed between a pregnant patient and their obstetrician is something where you want to make sure that the plan that you have in place as much as possible, and the person that you've developed that plan with is going to be there for you. So I think that that's comforting to hear, but let's think about post pregnancy, right? If I have managed to do all of the things that I need to do, I've been washing my hands diligently. I'm wearing my mask, social distancing, and I'm delivering and I have my baby. Should I be concerned about breastfeeding? Because we do know that you can be asymptomatic and still have COVID. So what do you say to someone who's concerned about the breastfeeding aspect of post-pregnancy?
Dawn Russell:
Well, to be honest, that's easier and harder, because the universal answer is still breastfeed, even if you're COVID positive. So we know that that is such a healthy thing for mom and baby, it would not be worthwhile to give up. So we will encourage you to be extra cautious with washing hands and face masks, but we do still encourage the breastfeeding. And we absolutely will help you with those if you do find that you're COVID positive. We are screening people as they come into labor. So we do at least have a result like that, that can help guide how you're dealing with your baby and how you're breastfeeding.
Speaker 1:
I think that that's information that for anyone who wants to maintain that very important aspect of care for their child, I think that's encouraging to hear. And it sounds like you don't have to do anything differently than what you're doing pre-pregnancy in order to mitigate the risks as much as possible?
Dawn Russell:
That's absolutely correct. We really are still encouraging breastfeeding, and I'm proud of our organizations that we've done that from the beginning. We've recognized that there's a fear factor that we need to override with a health factor. So we've continued to encourage breastfeeding and the data is bearing that out that it's still a healthy thing to do.
Speaker 1:
Something that you mentioned that I think is really the key to a lot of the questions that you can find whether again anecdotally or doing your research, it's just that fear factor. And I think it boils down to one of the biggest questions is like, "I'm just scared about risking exposure, and how do I feel better about doing the things that I need to do in order to go to my appointments and not feel scared about that? To exercise, to do all of the things that I know I should be doing without being completely sort of paralyzed by fear?"
Dawn Russell:
This is where some of that meditation or mindfulness can come in, because I can sit here all day and tell you that if you wear a face mask and wash your hands and stay away from people or at least distance, I can tell you all day that that's going to protect you. But it won't matter if the fear has kind of instilled itself in your brain. So this is where it's really important that you find a way that you can calm your brain. You can work on, how do I sit down and make myself feel happy and enjoying my pregnancy, because you should, and there's not really reason not to. There are often in life and in history things that we have been fearful of, but there's no reason that you can't enjoy this as long as you're taking your precautions. But again, that's where something like meditation or mindfulness practice might help you overcome some of those fears so that they don't ruin your enjoyment of your pregnancy.
Speaker 1:
I think that's such a great place to end this conversation, because for all of the prospective patients and for those who are currently pregnant or considering getting pregnant, the idea of not being able to enjoy your pregnancy, I think is probably the biggest barrier for anyone right now who's sort of in those beginning stages. So I would say, Dr. Russell, that you've given us a lot of really great information about the ways that people can both be safe, be smart, as you said, but also enjoy what should be a really wonderful time in your life.
Dawn Russell:
That's why I leave with an emphasis, that is please understand that you can do smart things and also enjoy your pregnancy, so that you can have a healthy pregnancy as well as a healthy baby.
Speaker 1:
Well, thank you so much, Dr. Russell, for spending time with us today. For anyone who's listening to the podcast, we will have a transcription of this, so you'll be able to see all of these answers transcribed for you. We'll also be sharing this on the Department of Gynecology and Obstetrics here at Emory, our website. All of the information about Dr. Russell and the team over at Johns Creek will be in the description for this episode as well. Thank you all so much for listening and we will chat with you again very soon.
Speaker 1:
Thank you so much for joining us for the CONVERSATIONS podcast with Emory Gynecology and Obstetrics. We hope you enjoyed this episode. Please visit us online at www.gynob.emory.edu, and follow us on social media at Emory G-Y-N-O-B. -
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Resident CONVERSATIONS is a continuation of our popular video series created to highlight the need for ongoing conversations around women’s reproductive health. We are always excited to celebrate the important role Emory Department of Gynecology and Obstetrics plays in the provision of excellent women’s health care.
Director/Producer: Bryetta Calloway
Audio Engineer: Matthew Owen
Videographer: Nader Nikopour
Photography: Katie Tiller
Location Constellations in Atlanta
Brought to you by: Emory Gynecology and Obstetrics -
Resident CONVERSATIONS is a continuation of our popular video series created to highlight the need for ongoing conversations around women’s reproductive health. We are always excited to celebrate the important role Emory Department of Gynecology and Obstetrics plays in the provision of excellent women’s health care.
Director/Producer: Bryetta Calloway
Audio Engineer: Matthew Owen
Videographer: Nader Nikopour
Photography: Katie Tiller
Location Constellations in Atlanta
Brought to you by: Emory Gynecology and Obstetrics
