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Pregnancy and Coronavirus

Advice for Pregnant Women and those who care for them

Advice from Royal College of Obstretricians & Gynaecologists

On this page we provide advice for pregnant women and those who care for them during the coronavirus outbreak and this period of self-isolation.  We found the RCOG’s Q&A style of providing information easy to read and understand, which is why we have set it out in full below.  Also, we’ve maintained all the links in their original text, and we’ve added links to relevant pages on this website.  Finally, we check their information regularly to see if there have been updates, and the last check was at 11.20am on 1st April.

The RCOG’s guidance will be updated on a regular basis as new data becomes available.

Sign up here with the RCOG to receive the latest updates by email when the guidance is updated

Generally, pregnant women do not appear to be more severely unwell than the general population if they develop coronavirus. As this is a new virus, how it may affect you is not yet clear. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or long-term conditions.

If you are pregnant you are more vulnerable to getting infections than a woman who is not pregnant. If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you have coronavirus.

If you develop more severe symptoms or your recovery is delayed this may be a sign that you are developing a more significant chest infection that requires enhanced care, and our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or use the NHS 111 online service for further information and advice.

As this is a very new virus we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage. There is also no evidence that the virus can pass to your developing baby while you are pregnant (this is called vertical transmission). Two cases of possible vertical transmission have been reported. In both cases, it remains unclear whether transmission was prior to or soon after birth. Another recent report from China of four women with coronavirus infection when they gave birth found no evidence of the infection in their newborn babies. Expert opinion is that the fetus is unlikely to be exposed during pregnancy. It is also therefore considered unlikely that if you have the virus it would cause abnormalities in your baby and none have been observed currently.

Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused this or the doctors made the decision for the baby to be born early because the woman was unwell. As we learn about the risk of pre-term birth and coronavirus infection, we will update this information.

 

The most important thing to do is to wash your hands regularly and effectively as soon as you come from public places to your home or workplace. There is useful advice on the NHS website on the best way to reduce any infection risk, not just for coronavirus, but for other things like colds and flu.

Pregnant woman were placed in a vulnerable group by the Chief Medical Officer on 16th March. This means you have been advised to reduce social contact through social distancing measures.

Based on the evidence we have so far, pregnant women are still no more likely to contract coronavirus than the general population. What we do know is that pregnancy in a small proportion of women can alter how your body handles severe viral infections. This is something that midwives and obstetricians have known for many years and are used to dealing with. As yet, there is no evidence that pregnant women who get this infection are more at risk of serious complications than any other healthy individuals.

What has driven the decisions made by officials is a desire to be very cautious about pregnant women. We know that some viral infections are worse in pregnant women. At the moment, there’s no evidence that this is the case for coronavirus infection, but the amount of evidence is still quite limited.

All pregnant women should follow the advice given on the Keeping Safe page on this website for preventing infection to yourself and to others, and on keeping your social distance.

If you or someone in your house is possibly infected then follow the advice given on the What to Do If Unwell page on this website.

A link to the UK Government’s guidance – which is also clearly laid out in the two links mentioned above, can be found HERE.

Pregnant women who can work from home should do so. If you can’t work from home, if you work in a public-facing role that can be modified appropriately to minimise your exposure, this should be considered and discussed with your occupational health team.

More detailed advice for pregnant women, including those who cannot work from home, such as healthcare workers, is being developed and will be made available as soon as possible.

Attending antenatal and postnatal care when you are pregnant and have a new baby is essential to ensure the wellbeing of you and your baby.

If you are well, you should attend your antenatal care as normal. If you have symptoms of possible coronavirus infection, you should postpone routine visits until after the isolation period is over.

The following practical advice may be helpful:

  • If you have a routine scan or visit due in the coming days, please contact your maternity unit for advice and a plan. You will still need to attend for a visit but the appointment may change due to staffing requirements.
  • Some appointments may be conducted on the telephone or using videoconferencing, provided there is a reasonable expectation that maternal observations or tests are not required.
  • If you are between appointments, please wait to hear from your maternity team.
  • If you are attending more regularly in pregnancy, then your maternity team will be in touch with plans.
  • If you miss an appointment and haven’t heard from your maternity team, please contact them to rearrange the appointment.

Whatever your personal situation please consider the following:

  • If you have any concerns you will still be able to contact your maternity team but please note they may take longer to get back to you
  • If you have an urgent problem related to your pregnancy but not related to coronavirus, get in touch using the same emergency contact details you already have. Please do not contact this number unless you have an urgent problem
  • If you have symptoms suggestive of coronavirus contact your maternity services and they will arrange the right place and time to come for your visits. You should not attend a routine clinic.
  • You will be asked to keep the number of people with you at appointments to a minimum, including children.
  • There may be a need to reduce the number of antenatal visits. This will be communicated with you. Do not reduce your number of visits without agreeing first with your maternity team.
  • More detailed advice for pregnant women, including those who cannot work from home, such as healthcare workers, is being developed and will be made available as soon as possible.

If you are in the UK, you should follow the advice given by the Foreign and Commonwealth Office, which is being regularly updated in line with the evolving situation.

All individuals, including pregnant women, should ensure they have adequate insurance arrangements prior to travel. You should also check that your travel insurance will provide cover for birth and care of your newborn baby if you give birth while abroad.

If you are pregnant and you have either:

  • a high temperature
  • a new, continuous cough

You should stay at home for 7 days. Do not go to a GP surgery, pharmacy or hospital. You do not need to contact NHS 111 to tell them you are staying at home. You do not need a test for coronavirus. At the present time, only people with severe symptoms who require overnight admission to hospital will be tested.
You should contact your maternity unit to inform them that you have symptoms suggestive of coronavirus, particularly if you have any routine appointments in the next 7 days.

You should use the NHS 111 online coronavirus service, or call NHS 111 if:

  • you feel you cannot cope with your symptoms at home
  • your condition gets worse
  • your symptoms do not get better after 7 days

If you have concerns about the well-being of yourself or your unborn baby during your self-isolation period, contact your midwife or, out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.

The process for diagnosing coronavirus infection is changing rapidly. At the current time, only people with severe symptoms who require at least overnight admission to hospital will be tested.

If you do require a test, you will be tested in the same way as anyone being tested, regardless of the fact that you are pregnant. Currently, the test involves swabs being taken from your mouth and nose. You may also be asked to cough up sputum, a mixture of saliva and mucus.

If you test positive for coronavirus, you should contact your midwife or antenatal team to make them aware of your diagnosis. If you have no symptoms, or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you might be treated in a hospital setting.

You may be advised to self-isolate because:

  • You have symptoms of coronavirus, such as a high temperature or new, continuous cough
  • You have tested positive for coronavirus and you’ve been advised to recover at home
If you are asked to self-isolate, you can visit our Self-Isolation Advice page to found out more about what to do and how to cope.

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 7 days. If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.

The NHS guidance on self-isolation currently recommends people should:

  • Not go to school, work, NHS settings or public areas
  • Not use public transport
  • Stay at home and not allow visitors
  • Ventilate the rooms where they are by opening a window
  • Separate themselves from other members of their household as far as possible, using their own towels, crockery and utensils and eating at different times
  • Use friends, family or delivery services to run errands, but advise them to leave items outside.

You may wish to consider online fitness routines to keep active, such as pregnancy yoga or Pilates.

You should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for possible/confirmed coronavirus and request advice on attending routine antenatal appointments.

It is likely that routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect other patients.

If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged 14 days after your recovery, to check that your baby is well. This 14 day period may be reduced as more information on how infected people are as they recover becomes available.

If you have recovered from coronavirus and tested negative for the virus before you go into labour, where and how you give birth will not be affected by your previous illness.

Pregnant women are advised not to attend maternity triage units or A&E unless in need of urgent pregnancy or medical care.

If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your midwife or, out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.

If attendance at the maternity unit or hospital is advised, pregnant women are requested to travel by private transport, or arrange hospital transport, and alert the maternity triage reception once on the premises, prior to entering the hospital.

As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour, are being advised to attend an obstetric unit for birth, where the baby can be monitored using continuous electronic fetal monitoring, and your oxygen levels can be monitored hourly.

The continuous fetal monitoring is to check how your baby is coping with labour. As continuous fetal monitoring can only take place in an obstetric unit, where doctors and midwives are present, it is not currently recommended that you give birth at home or in a midwife led unit, where only midwifes would be present.

The RCOG will keep this advice continually updated as new evidence emerges.

There is currently no evidence to suggest you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus, so your birth plan should be followed as closely as possible based on your wishes.

However, if your respiratory condition (breathing) suggests that urgent delivery is needed, a caesarean birth may be recommended.

It is not recommended that you give birth in a birthing pool in hospital if you have suspected or coronavirus, as the virus can sometimes be found in faeces. It may also be more difficult for healthcare staff to use adequate protection equipment during a water birth.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. In our previous version of the guidance it was suggested that the use of Entonox (gas and air) may increase aerosolisation and spread of the virus, but a review of the evidence suggests there is no evidence that Entonox is an aerosol-prone procedure, so there is no reason you cannot use this in labour.

 

If you go into labour, you should call your maternity unit for advice, and inform them that you have suspected or confirmed coronavirus infection.

If you have mild symptoms, you will be encouraged to remain at home (self-isolating) in early labour, as per standard practice.

Your maternity team have been advised on ways to ensure that you and your baby receive safe, quality care, respecting your birth plan as closely as possible.

When you and your maternity team decide you need to attend the maternity unit, general recommendations about hospital attendance will apply:

  • You will be advised to attend hospital via private transport where possible, or call 111/999 for advice, as appropriate
  • You will be met at the maternity unit entrance and provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room
  • Coronavirus testing will be arranged
  • Your birth partner(s) will be able to stay with you throughout, but visitors should be kept to a minimum

As this is a new virus, there is limited evidence about managing women with coronavirus infection in women who have just given birth; however, there are no confirmed reports of women diagnosed with coronavirus during the third trimester of pregnancy having passed the virus to their babies while in the womb.

Yes, if you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus.

Yes, if that is your choice. Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth.

There are some reports from China which suggest women with confirmed coronavirus have been advised to separate from their baby for 14 days. However, this may have potential negative effects on feeding and bonding.

A discussion about the risks and benefits should take place between you and your family and the doctors caring for your baby (neonatologists) to individualise care for your baby.

This guidance may change as knowledge evolves.

Yes. At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk.

The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.

A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team.
This guidance may change as knowledge evolves.

If you choose to breastfeed your baby, the following precautions are recommended:

  • Wash your hands before touching your baby, breast pump or bottles
  • Try to avoid coughing or sneezing on your baby while feeding at the breast
  • Consider wearing a face mask while breastfeeding, if available
  • Follow recommendations for pump cleaning after each use
  • Consider asking someone who is well to feed your expressed breast milk to your baby.
  • If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

We understand that it must be an anxious time if you work in healthcare and you are pregnant, especially following the Chief Medical Officer’s advice on 16 March 2020 for all pregnant women to minimise social contact as a precautionary measure. To the best of our knowledge, most pregnant healthcare professionals are no more personally susceptible to catching the virus than their non-pregnant colleagues.

There is no convincing evidence that coronavirus infection can affect your baby’s growth, but as other similar viruses have been known to cause fetal growth restriction, an extra ultrasound scan 14 days later is advised, as a precaution.

If you become unwell due to infection with coronavirus, it may occasionally be necessary to deliver your baby early to help you to recover. In this situation, the baby may need to be delivered prematurely.

You should discuss your individual circumstances with your local Occupational Health department.

Further guidance for pregnant healthcare workers is being sought urgently and will be published in our next update to the guidance.

Additional advice from
the Royal College of Midwives

NCT support for expectant and new mothers

If you are pregnant or planning a pregnancy, you may already have been in touch with NCT (National Childbirth Trust), the UK charity for parents, for information or to book a course. NCT has already changed its way of offering antenatal preparation courses so provision is now online via live, interactive courses. They are also continuously updating their website since the coronavirus outbreak, so information is accurate and aligns with the advice from the RCM and the Royal College of Obstetricians & Gynaecologists (see above). 

Please note the following:

Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and well-being of women in childbirth. At times like this, when coronavirus is heightening anxiety, that reassurance is more important than ever. While we concur with decisions to restrict access to birth partners who have or are suspecting of having coronavirus in order to safeguard the health of the woman and the maternity staff supporting her, NHS Trusts and Boards should continue to follow guidance allowing birth partners access to the maternity suite.

Localised restrictions by Trusts and Boards on visitors may mean that partners are not able to attend routine antenatal appointments or stay with women on antenatal or postnatal wards. It is important to note that this should not apply to a partner being in the labour and birth room. Such advice does not comply with current guidance from NHS England, or the RCM and RCOG, as above.

More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or long-term conditions.

If you are pregnant you are more vulnerable to getting infections than a woman who is not pregnant. If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you have coronavirus.

If you develop more severe symptoms or your recovery is delayed this may be a sign that you are developing a more significant chest infection that requires enhanced care, and our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or use the NHS 111 online service for further information and advice.

Sadly we cannot allow a partner, or anyone else that has tested positive for Covid-19, to attend a birth. This is to protect you, your baby, the medical staff and other patients from catching the virus. Try to think about who else might be able to support you.

Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused this or the doctors made the decision for the baby to be born early because the woman was unwell. As we learn about the risk of pre-term birth and coronavirus infection, we will update this information.

 

Doulas offer helpful, additional support to women in labour and where they can be accommodated in maternity services, they should be. Check out the policy on doulas and birthing partners with your midwife. More HERE.

Based on the current evidence, babies are not at greater risk of contracting the virus than others and do not have more severe symptoms. It is fine to take your newborn baby outside for a walk – but within the measures as set out by the Government. That means only going out once a day and maintaining social distancing from those outside your household.

Staying active during pregnancy is important for your physical and mental health. There are plenty of resources available online, including pregnancy yoga sessions and other exercise classes. Even under the current restrictions, you can still go out for walks in places that aren’t busy, as long as you stay two metres from others. Getting out in the fresh air can be really beneficial.

If you are in your first or second trimester (less than 28 weeks pregnant), with no underlying health conditions, you should practise social distancing but can choose to continue to work in a patient-facing role. If you choose to continue working, it is strongly recommended the necessary precautions are taken. You should avoid, where possible, caring for patients with suspected or confirmed coronavirus infection. If this is not possible, you should use personal protective equipment (PPE) and ensure a thorough risk assessment is undertaken.

Some working environments, such as operating theatres, respiratory wards and intensive care/high dependency units, carry a higher risk for all pregnant women of exposure to the virus and all healthcare workers in these settings are recommended to use appropriate PPE.

If you are in your third trimester (more than 28 weeks pregnant), or have an underlying health condition – such as heart or lung disease – we strongly recommend you avoid direct patient contact. It is better to work from home where possible, avoid contact with anyone with symptoms of coronavirus, and significantly reduce unnecessary social contact.

We encourage employers to seek opportunities for pregnant healthcare workers in their third trimester to work flexibly in a different capacity, to avoid roles where they are working directly with patients.

Whatever gestation of your pregnancy, you should discuss your individual circumstances with your local Occupational Health department.

The evidence base for this new virus is growing rapidly and, as and when new information emerges, the Government and professional bodies will update the guidance. Maternity Action has published maternityaction.org.uk/covidmaternityfaqs around rights and benefits during pregnancy and maternity leave which you may find helpful.

We know that these are worrying times, particularly if you are pregnant. Our members are working around the clock to ensure you continue to get the care and support you and your baby need. In normal circumstances, we strongly believe that women should be given the full range of options to enable you to make an informed choice about where to give birth to your baby. However, the current crisis means that those running maternity services are having to make difficult decisions to ensure your health and safety and that of your baby, as well as the staff caring for you.

Since the beginning of the pandemic, staff shortage rates have doubled, with some services experiencing a current shortage of nearly half of their midwifery staff. In these unprecedented times, service leads must be able to make decisions based on local need and available resources, while always ensuring that the health and safety of women and babies are paramount

Because decisions re being made on a Trust/Board-by-Trust/Board basis, there is likely to be some inconsistency across the country in terms of the services provided. Some services are still able to maintain some level of homebirth provision at this time, while others have made the difficult decision to suspend homebirth services temporarily.

Decisions to suspend home births are not taken lightly, but in the best interests of you and your baby. Services need to ensure that there are enough midwives and other staff to support you, wherever you are giving birth, and, in the case of home births, they also need to ensure that ambulance services are able to provide transfers should an emergency arise during the labour or birth.

If you and your household are symptom free and you are still planning for a home birth, it is important that you and your family follow careful infection control practices. This includes regular cleaning of surfaces and door handles and opening windows in the home to provide good ventilation. You must also ensure that midwives are provided with facilities to wash their hands and follow their own infection control practices.

our maternity services will do all they can to support your birth plan, but resourcing issues may mean that, in some areas, certain services aren’t available. For example, some maternity services are having to restrict home births due to staffing and resource issues during the current crisis. Talk to your midwife about how this may affect your birth plan.

Where home births are still available, a midwife will care for you throughout, with additional support arriving close to the time of birth. Maternity services are working around the clock to honour your choices, however safety is always our priority. You may be asked to come into hospital for care, if it is deemed to be safer for you and your baby.

We are asking you to help the midwives supporting you. If you have been experiencing symptoms or a member of your family has shown symptoms, you must phone the maternity unit when in labour and attend there, even if you have previously planned and hoped for a homebirth. This is based on the current medical advice due to an increased risk of hypoxia for the fetus which will require continuous fetal monitoring, as well as enhanced observations for you and your health.