Leana S. Wen is an emergency physician and visiting professor at George Washington University Milken Institute School of Public Health. Previously, she served as Baltimore’s health commissioner.

This is my worst fear. I’m in labor, with a high fever, straining to breathe through contractions while wearing a mask. The moment my baby is born, she is taken away from me. I can’t hold her. I can’t touch her. The only way I can get breast milk to her is to express it and give it to someone else to feed her.

If I survive the infection, it will be weeks before I can be sure that I’m no longer contagious and can be with my newborn. In the meantime, she will be tested to see whether she has acquired the infection. If she has, she could become critically ill and die.

That is what it could be like to give birth while infected with the novel coronavirus.

As a doctor who is 38 weeks pregnant, I have been asked many times about pregnancy and covid-19. I provide the facts. Based on the research so far, pregnant women do not appear to be at elevated risk for contracting the virus or of having worse outcomes because of it. However, pregnant people are considered medically vulnerable and should take extra precautions. There has been no documentation of covid-19 being transmitted in utero or through breast milk, but if a laboring woman were suspected of having covid-19, she would need to observe many safeguards — including being separated from her newborn — to avoid infecting the baby through respiratory droplets.

When I lay out these facts, I am calm on the outside. On the inside, I am filled with worry. Even in the best of times, childbirth is a time of uncertainty and major life changes. Add to that a world thrown dangerously off-kilter by a public health crisis, and the rising stack of unknowns can feel close to toppling.

Things are rapidly changing. My hospital used to encourage the whole family to be present at a birth. It will now allow only one person with me. Some New York hospitals are prohibiting visitors altogether. As the outbreak worsens, others might follow suit. If my hospital adopts this policy, I will understand the necessity. But I never imagined giving birth without my husband at my side.

I also never imagined being induced early because of hospital capacity rather than medical need. As the epidemic raged in places such as China and Italy, laboring women had trouble finding facilities to take them. A woman in Austria wrote about her decision to induce labor to stay ahead of hospital crowding. I want to go through natural labor. But will it get to a point that induction is safer?

If I were earlier in my pregnancy, I’d have other concerns. Many other women are confronting these right now. Because covid-19 is a new disease, there is no information about its effect in the first and second trimester. Given that pregnant women have suppressed immune systems, should they be exempted from certain types of work that have higher exposure risks? Should their partners? How can pregnant people otherwise reduce risks — including eliminating some in-person doctors’ visits?

The concerns will not end when the baby is born. When I had my first child, he needed care for jaundice. In China and Italy, many clinics closed, and newborns couldn’t receive vaccinations or checkups. Could this happen here? To protect our family and to follow social-distancing best practices, my husband and I will not have visitors at home. But what if we need help, as so many families do, during the physically and emotionally challenging postpartum period? What if my toddler became ill, or my husband? How could I care for them without putting my baby in danger?

Two and a half years ago, when I gave birth to my son, I had very different questions on my mind. I researched cribs and car seats; I asked friends for pediatrician recommendations. I found a lactation support group in case I had trouble breast-feeding. The biggest worry was how much maternity leave to take and how to find day care when I went back to work.

Of course, I had anxieties then, but this is different. Still, even as I face the inevitable uncertainty of the coming days, I’m grateful as well. I’m grateful for the ongoing research and our resilience in the face of difficult and rapidly changing circumstances. I’m grateful for everyone who is making great sacrifices and playing their part in reducing disease transmission. And I’m grateful to be bringing into the world a new life — a reminder of the hope, joy and love that binds us.

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