Her baby shower was March 7. A week later, she went to the grocery store for the last time.

And in two weeks, Natalie Tomko is due with her first child, a girl, in a time of unprecedented uncertainty.

“Every single day we learn that we can't make plans for anything,” said the Cranberry Township resident.

While the emotional toll due to the coronavirus has been devastating for a number of people, the fear of the unknown has particularly been punishing to expectant mothers.

Tomko said her parents, who live in Oregon, planned to come after their granddaughter was born to help out around the house.

Her husband's parents, who live in Hermitage, also planned to come, but those plans have been nixed as well.

“For me, you want your mom around,” she said. “It's an exciting time of life, and you want your mom around to rely on. Now she's not going to be here, and it's devastating to me.”

Precautions in pregnancy

Respiratory illnesses such as influenza typically cause more-severe infections in pregnant women, according to the Centers for Disease Control and Prevention.

But Dr. Stephanie Nicholas, an OB-GYN at UPMC Magee-Womens Hospital in Pittsburgh, said that doesn't seem to be the case with COVID-19.

While other comorbidities — conditions felt concurrent with the coronavirus, such as diabetes — can heighten the risk of severe illness, pregnant women are not experiencing more severe symptoms simply because they're pregnant, Nicholas said.

But that doesn't mean expectant mothers are worry-free.

“I think all of my patients who are expecting are worried,” Nicholas said. “I think the people in the first trimester are worried about how it impacts early development, I think people in the second trimester are worried about whether there is any maternal-to-fetal transmission, and people who are closer to delivery are worried.”

There seems to be good news on that front as well. Nicholas said there are reassuring data that the illness doesn't impact early development, and there is no evidence COVID-19 can be transmitted in utero.

“There have been some newborns who have been infected,” said Dr. Nipunie Rajapakse, a Mayo Clinic infectious diseases expert. “But it's still not clear whether that infection happened after the time of birth because they were in close contact with their mother who was infected, or whether this infection happens while the baby is in utero or through the placenta.”

To Tomko, however, a sense of heightened precautions is necessary. She's started having groceries delivered to her house via Instacart; anything coming into the house is disinfected, as was the spot where those items sat.

She leaves the house to go to doctor appointments, but that's it. Tomko and her husband already worked from home, which didn't change but was an even-more-welcome reality.

“It seems really excessive but we're taking all the precautions that we possibly can just to stay healthy and do our best to stay healthy,” she said.

Nicholas said even with precautions, it's necessary to have a support group as it can be unhealthy mentally not to have one.

“I don't think the answer is just to sequester yourself with no support,” she said. “Obviously, you want to reduce the likelihood that anyone exposes the newborn, so that kind of planning ahead will allow them to have some level of support”

Tomko's group — which includes a friend who's due four weeks after her, and another who has an 8-month-old — no longer meets in person, which she said can be difficult.

“Before all this happened, we were a support group for one another. It's just been hard to not get together with them,” Tomko said.

Delivery

Precautions are abundant in prenatal visits. Tomko said her husband isn't allowed in the doctor's office and building.

The same is happening during delivery in many hospitals.

Nicholas said because Magee tries to keep hospital staff at the lowest risk for exposure, only one visitor — the same visitor each time — is allowed to stay through the postpartum stay.

“That is, again, allowing the patient to have one support person, but trying to eliminate exposure to the staff as much as possible,” she said. “But, that being said, that does not mean there is no way to provide support by other means.”

A person who is not a health care professional, for example, can provide support through FaceTime or other camera-oriented software, Nicholas said.

In addition, doctors try to keep the amount of time patients stay in the hospital to a minimum. That fits in well with Tomko's plans.

“As long as the baby's healthy and I'm healthy, I'm very keen on getting out of the hospital as quickly as possible,” she said.

Nicholas said that while patients traditionally stay two nights after a natural birth and three nights following a cesarean section, Magee tells them they have the option to leave 24 hours after a vaginal delivery or after two days following a C-section.

“The main thing they're trying to achieve is getting rest, and if they can do that more comfortably at home and they can reduce their risk by not being in the hospital” they can, Nicholas said.

Dr. Christania Morganti, a Butler Health System pediatrician, said the shorter hospital stays and decreased visitor access also help keep the mother and child safe.

“I think the biggest thing is protecting the mother in the hospital, and that's happening at Butler and other places as well,” she said.

At home

The hardest part about expecting during a pandemic, Tomko said, is that families won't have much of an option to see the baby.

“The main thing is just, for pregnant ladies, it's just really hard to have to tell your family members that they can't come and meet your new baby,” she said. “That's just the most emotional part of this whole thing.”

While the first month of a newborn's life is typically rather isolated from much of the outside world, according to Morganti, parents seem to be cocooning themselves more than usual.

“Now, we're warning against even grandparents and others coming in,” she said. “I think it's even more severe isolation that we're used to, unfortunately.”

But because the health of infants is important, many pediatricians have continued their well-baby visits and are keeping the immunization schedule on time.

There are, of course, more precautions being taken — rooms are being cleaned more; patients come in every 30 minutes rather than 15; and there's no waiting in waiting rooms, Morganti said.

While there have been recorded cases of children younger than 5 years old dying with the coronavirus, Morganti said she hasn't seen if those are due to COVID-19 or if they're from other complications.

“In general, it's considered mild,” she said. “I haven't even had anybody that I've sent for testing at this point.”

And while COVID-19 eventually will pass and life slowly will return to a sense of normalcy, Tomko said she knows there will be a new normal following the pandemic.

“I don't know that we're necessarily just going to go back to how everything was before,” she said. “It's not going to be the same because we're still going to take precautions regardless.”