Within this blog you will find answers to everything from falling pregnant during the pandemic, to antenatal and post natal appointments, birthing and birthing partners, if you think you may have the virus and also how to protect your mental wellbeing
*information updated from 26th June 2020*
Q. What effect does coronavirus have on pregnant women? All available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus. The large majority of pregnant women experience only mild or moderate cold/flu-like symptoms. Cough, fever, shortness of breath, headache and loss or change to your sense of smell or taste are other relevant symptoms. If you think you may have symptoms of coronavirus you should use the NHS 111 online service for information, or NHS 24 if in Scotland. 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 specialised care. If you feel your symptoms are worsening or if you are not getting better, you should contact your maternity care team, your GP, or use the NHS 111 online service / NHS 24 for further information and advice. In an emergency, call 999. While pregnant women are at no greater risk of becoming seriously unwell than other healthy adults, a small proportion of pregnant women with coronavirus have required admission to hospital for treatment. In the UK, information about all pregnant women requiring admission to hospital with coronavirus is recorded in a registry called the UK Obstetric Surveillance System (UKOSS). The first report from this study included information about the outcomes of 427 pregnant women admitted to hospital with coronavirus and their babies during the pandemic, and was published on 11 May. While most women in the study required only ward treatment and were discharged home well, around one in ten women required intensive care, and sadly five women with coronavirus died, although it is currently unclear if coronavirus was the cause of their death. The study found that the majority of women who did become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing from 28 weeks of pregnancy. The study also found that pregnant women from black, Asian and minority ethnic (BAME) backgrounds were more likely than other women to be admitted to hospital for coronavirus. Pregnant women over the age of 35, those who were overweight or obese, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness.
Q. What effect will coronavirus have on my baby if I am diagnosed with the infection? 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. Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) is probable. It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well. Given current evidence, it is considered unlikely that if you have the virus it would cause problems with your baby’s development, and none have been observed currently. Across the world, emerging reports suggest some babies have been born prematurely to women who were very unwell with coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover. In the recent UK study of 427 pregnant women with coronavirus published on 11 May, the data reported outcomes for babies who were born to women with coronavirus severe enough that the woman required hospital admission. Although almost one in five were born prematurely and were admitted to a neonatal unit, fewer than 20 babies were born very prematurely (when the women were less than 32 weeks’ pregnant). One in 20 babies born (12 babies in total) had a positive test for coronavirus, but only half of these babies – 6 babies - had a positive test immediately after birth, suggesting that transmission of the coronavirus infection from a woman to her baby is low. The number of babies born at term (37 weeks or later) to women who had tested positive for coronavirus that required neonatal care was similar to the number of babies born to women without the virus – about 1 in 10.
Q. What research is being done to monitor the impact of coronavirus on pregnant women and their babies? The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for coronavirus during pregnancy, through well-established systems already used by all maternity units – this is the UK Obstetric Surveillance System (UKOSS). Imperial College London are also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with coronavirus. The COVID-19 Symptom Study app has been developed by King’s College London and health science company ZOE. Members of the public, including pregnant women, can use this app to report on their health during the coronavirus pandemic. We will update our information if and as soon as there is any change in the evidence.
Q. What can I do to reduce my risk of catching coronavirus? The most important thing to do is to follow government guidance. For pregnant women and the rest of their households, this includes:
Wash your hands regularly
Use a tissue when you or anyone in your family coughs or sneezes, discard it and wash your hands
Avoid contact with someone who is displaying symptoms of coronavirus (these symptoms include high temperature and/or new and continuous cough)
Avoid non-essential use of public transport when possible
Work from home, when possible
Avoid large and small gatherings in public spaces, noting that pubs, restaurants, leisure centres and similar venues are currently shut as infections spread easily in closed spaces where people gather together
Avoid gatherings with friends and family; keep in touch using remote technology such as phone, internet and social media
Use telephone or online services to contact your GP or other essential services
Q. Why are pregnant women in a vulnerable group? Pregnant women were placed in a vulnerable group by the Chief Medical Officer on 16 March. This means you have been advised to reduce social contact through social distancing measures. 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. What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution. We know that some viral infections are worse in pregnant women; however, all available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus.
Q. Are some pregnant women more at risk of becoming seriously unwell from coronavirus than others? Data from the UKOSS study of 427 pregnant women in May 2020 found the majority of women who have become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing from 28 weeks of pregnancy. The study also found pregnant women from black, Asian and minority ethnic (BAME) backgrounds are more likely than other women to be admitted to hospital for coronavirus. Pregnant women over the age of 35, those who are overweight or obese, and those women who have pre-existing medical problems, such as high blood pressure and diabetes, also appear to be at higher risk of developing severe illness. All pregnant women are advised to follow government guidance on staying alert and safe (social distancing). If you develop coronavirus you are still most likely to have no symptoms or a mild illness from which you will make a full recovery. It is important that all pregnant women who develop more severe symptoms or whose recovery is delayed should seek help, particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. Healthcare professionals are also being advised that women known to be at higher risk should be told at each contact that they may be at risk of complications of coronavirus, and advised to seek help early if they become concerned about their health or that of their baby. The increased risk to pregnant women from a BAME background will mean that your maternity team may book you additional appointments, or refer you to a doctor or specialist clinic should there be any concerns about your health or your baby’s. Q. I am pregnant – what do I need to do? As a precaution, you should follow government advice about social distancing, stay away from public places and avoid anyone who has symptoms suggestive of coronavirus. It is still considered necessary for pregnant women to go out for essentials, such as food shopping, exercise and to attend antenatal appointments. If you are in your third trimester (more than 28 weeks’ pregnant) you should be particularly attentive to social distancing and minimise any contact with others. All pregnant women should follow the Public Health England advice:
Guidance on social distancing for all vulnerable people including pregnant women
Keeping mobile and hydrated is important to reduce the risk of blood clots in pregnancy. Find out more about exercise in pregnancy.
Staying active with regular exercise, a healthy balanced diet, and folic acid and vitamin D supplementation will help support a healthy pregnancy.
Vitamin D There have been some reports that people with low levels of vitamin D are at an increased risk of serious complications if they become infected with COVID-19. Also, because we are indoors a lot due to the pandemic, we might not be getting enough vitamin D from sunshine. Vitamin D supplementation is recommended to all women during pregnancy. Pregnant women should consider taking a vitamin D supplement which is available from most pharmacies, supermarkets and other retailers. You just need 10 micrograms a day - this applies to adults, including pregnant women, and children. Do not take more than 100 micrograms of vitamin D a day as it could be harmful. Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these. Shielding measures for those at high risk of severe illness On 24 March, additional shielding measures were announced for people defined on medical grounds to be at very high risk of severe illness from coronavirus, including pregnant women with significant heart disease (congenital or acquired). The shieldingguidance was updated on 31 May. Shielding guidance is now being relaxed but this is happening differently in the four nations of the UK. Please look for advice here for England, here for Scotland, here for Wales, and here for Northern Ireland. If you are pregnant and have significant heart disease, you should continue to take the precautions outlined in this updated guidance, and speak to your midwife or obstetrician with any questions you may have.
Q. What is the advice if I am in my first trimester/less than 12 weeks’ pregnant? Even during the pandemic, it’s very important that if you have any concerns about yourself or your pregnancy at any time, you contact your GP, midwife or local early pregnancy unitstraight away to discuss them. Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage so you should seek urgent medical advice. A telephone appointment will be arranged for you as soon as possible with your local early pregnancy unit to check your symptoms. They will be able to advise whether a visit to the hospital during the coronavirus pandemic is necessary, and ensure you receive the care that you need. Whilst hospitals are trying to minimise people entering in order to reduce the spread of the coronavirus and to limit the impact on services, they are organised in such a way that they are able to provide all acute services. Find out more information on the changes to early pregnancy care and what to expect during the coronavirus pandemic.
Q. How can I protect my mental wellbeing during the pandemic? We understand that the coronavirus pandemic will inevitably result in an increased amount of anxiety in the general population, and this is likely to be even more so for pregnant women as pregnancy represents an additional period of uncertainty. Specifically, these anxieties are likely to revolve around:
The virus itself
The impact of social isolation resulting in reduced support from wider family and friends
The potential of reduced household finances
Major changes in antenatal and other NHS care, including appointments being changed from face-to- face to telephone contact
Isolation, bereavement, financial difficulties, insecurity and inability to access support systems are all widely recognised risk factors for mental ill-health. The coronavirus epidemic also increases the risk of domestic abuse or violence. You should be asked about your mental health at every contact with a health professional. By acknowledging these difficulties, healthcare professionals can help to contain some of these anxieties. If you require support, you should be signposted to resources which can be remotely provided, where possible. If you are experiencing domestic violence, please disclose this to a health professional who can provide information and support to keep you safe. Where necessary, women in England can self-refer to local IAPT (Improving Access to Psychological Therapies) services. In Scotland, advice is available from Parentclub and NHS Inform. Further information is available from the following organisations:
Public Health England – COVID-19: guidance for the public on mental health and wellbeing
NHS – Every Mind Matters
Q. What is the travel advice if I am pregnant? 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.
Q. What is the advice for pregnant women with older children attending school/nursery/external childcare? Pregnant women were placed in the vulnerable category by the Chief Medical Officer on 16 March as a precaution during the coronavirus pandemic. The government‘s guidance on schools and early years settings advises that: children and young people who live with someone who is pregnant (vulnerable) can attend school and early years settings. See the next question for information about pregnant women who are classed as extremely vulnerable. All pregnant women are advised to follow government guidance on staying alert and safe (social distancing). Pregnant women are at no greater risk of contracting coronavirus or becoming seriously unwell than other healthy adults. However, there are additional concerns for pregnant women in the third trimester. This is based on the challenges in caring for women who are heavily pregnant, and the risk of the baby needing to be born early for the woman’s wellbeing. A recent report from a UK study showed that so far all pregnant women who became seriously unwell with coronavirus were in the third trimester. This emphasises the importance of more stringently practicing social distancing from 28 weeks of pregnancy. If you choose to take your children to school/nursery/external childcare, you should ensure you practice social distancing – stay two meters away from teachers/carers and other parents and do not go inside the building. If this is difficult, then consider staggering your child’s drop off and pick up times. Remember to wash your hands when you return home and ensure that your children wash their hands when they leave the childcare setting. Alcohol gel can be used if they cannot wash their hands with soap and water. If you are concerned about the choice of returning to school or other childcare settings based on the risk to children attending, helpful information is available from the RCPCH.
Q. What is the advice for pregnant women who are classed as extremely vulnerable or who are shielding on older children attending school/nursery/external childcare? Some pregnant women with pre-existing severe medical illnesses have been classed as extremely vulnerable and have been advised to shield. You will have been told this by your maternity team. The government advice is that children and young people who live in a household with someone who is pregnant and shielding (extremely vulnerable) should only attend school/nursery/external childcare if stringent social distancing, and hand hygiene, can be adhered to – and the child or young person is able to understand and follow those instructions. Practical advice for measures that may be helpful to adopt within a family are now available within the shielding guidance.
Q. Should I plan a pregnancy during the coronavirus pandemic? Becoming pregnant during the coronavirus pandemic is a matter of personal choice. The Faculty of Sexual and Reproductive Healthcare (FSRH) recommend that when considering a pregnancy, women and their partners consider the risks of coronavirus transmission associated with routine contacts with healthcare professionals during pregnancy, particularly if pregnancy complications may necessitate frequent hospital attendance. For more information, see the FSRH clinical statement: Information to support management of individuals requesting to discontinue contraception to plan a pregnancy during the Covid-19 outbreak.
Advice for all pregnant women on attending antenatal and postnatal care during the coronavirus pandemic
Q. How will the coronavirus pandemic affect my routine antenatal and postnatal appointments? We understand that it could be a stressful and anxious time if you are pregnant or have recently given birth during the coronavirus pandemic. The NHS is working to ensure that you, your baby and your family are supported and cared for during these uncertain times. This means that there may be some changes to how, when and where you attend essential routine appointments and how safe care and support are given to you. You will be told about any changes by your local maternity service. Antenatal and postnatal care is based on years of evidence to keep you and your baby safe in pregnancy and birth, and beyond. Antenatal and postnatal care should therefore be regarded as essential and you should be encouraged to attend, despite being advised to engage with social distancing measures. Your local maternity team may reduce routine appointments, provide more home visits or deliver some care and support over the phone or by video to reduce the number of times you need to travel and attend hospital/clinics. You will be informed of any changes to your care in advance.
Q. Why are changes to antenatal and postnatal care necessary during the coronavirus pandemic? These changes are a way of ensuring we deliver the best care without overloading our NHS services, which are crucial during the coronavirus pandemic. This helps us to:
Reduce the number of people coming into hospitals where they may come into contact with other people and spread the virus
Ensure staff are not overwhelmed and stretched too far by the additional strain on services, which could be due to staff sickness and self-isolation as well as the higher numbers of patients needing care and overnight hospital stays due to coronavirus
This allows us to care for you and protect you from coronavirus while also ensuring we protect our NHS staff and services.
Q. Who should I contact about my antenatal and postnatal care appointments? If you have been allocated a local health continuity team or a named community midwife You should continue to contact your continuity team or community midwife by telephone to discuss any questions or concerns you might have and to check on arrangements for all scheduled and future appointments. If you have not been allocated a local health continuity team or a named community midwife You should contact your GP surgery or local maternity unit in order to be connected to an appropriate continuity team or named community midwife so you can discuss any questions or concerns you might have and to check on arrangements for all scheduled and future appointments. If you are unsure when your next appointment is you should make contact as above to help us care for you.
Q. Can I still attend my antenatal/postnatal care appointments? Your antenatal and postnatal appointments remain an important part of your maternity care to provide checks and screening on your health and your baby’s health. A member of the maternity team looking after you may call you before your appointment, or carry out an assessment at entrance of the clinic/hospital, or both, to check whether you have any symptoms that are suggestive of coronavirus, or if you meet the current ‘stay at home’ guidance. If you are advised to attend an appointment by your local maternity team, this is because the need for the appointment to help reduce the risk of complications for you and your baby is greater than your risk of being exposed to coronavirus. If you are well, you should be able to attend your appointments. You may be asked to attend alone to protect your household from the risk of coronavirus. You will be told about this by your local maternity service. If you are asked to attend your antenatal appointments alone, you should be advised where possible to have a discussion with your partner, or other supportive companion, about any questions they would like you to ask your maternity team on their behalf. If you are currently self-isolating with suspected or confirmed symptoms of coronavirus, and you have an appointment scheduled in the coming days, you should telephone your continuity team or community midwife, or local maternity unit, to inform them. Your upcoming appointment will be reviewed by the maternity team looking after you and your baby. You will then be advised whether your appointment is urgent and a home appointment is required, or whether your appointment can be safely delayed for a period of 7 or 14 days until you are well.
Q. How many antenatal appointments will I have? You will have at least six face-to-face antenatal appointments in total. Where possible, essential scans/tests and routine antenatal care will be offered within a single appointment. This is to prevent multiple journeys and visits to clinics/hospital, and will involve contact with as few staff as possible to prevent the spread of coronavirus to you, your family and other patients. This may mean that your initial ‘booking in’ appointment will take place at the same time as your 12-week (dating) scan. You should be asked about your mental health at every appointment, whether in person or via phone/video. In the third trimester, you should be asked about your baby’s movements at every appointment, whether in person or via phone/video. All pregnant women should be provided with information about group B streptococcus (GBS) in pregnancy and newborn babies. Sometimes, you may need additional antenatal appointments and medical care. This will depend on your individual medical needs. These appointments may be carried out over the phone or via video, provided a physical examination or test is not required. This will enable partners and other family/household members to join you for support and allow social distancing to protect you and your baby from coronavirus. This may include:
Appointments with a specialist doctor
Extra blood tests
Support for your mental health
Discussion of plans for birth
Local provision of antenatal/parent education classes, infant feeding support and information on safe sleeping, pelvic floor exercises and birth choices
Q. How many postnatal appointments will I have? Your postnatal care will be individualised to meet your needs and those of your baby. You should have at least three postnatal appointments with your local continuity team or community midwife. These will take place once you have been discharged from hospital: on your first full day at home, then on day 5 and day 10. These appointments may be a mixture of face-to-face care at home or in a clinic, and telephone consultations, where this is appropriate. After your postnatal appointment on day 10, your care will be transferred to your local health visiting team. You will be given information about this. In early June, the NHS provided guidance to all maternity teams that your first post-natal appointment should be a face-to-face visit at home following birth. This will be day 1 if you gave birth to your baby at home or the first day following discharge from the maternity unit if you gave birth to your baby away from home in hospital or a midwifery led unit. This is an important visit to check that you and your baby are well, and support you in these first few days. The RCM have produced a useful infographic on preparing for a home visit from your midwife.
Q. Will I be able to bring someone with me to scans? In some hospitals and maternity units, there are restrictions on visitors which might mean that birth partners or other supportive people are not able to attend routine antenatal appointments, including scans, with you. On 5 June, the NHS’s suspension of hospital visiting was lifted. This means that visiting is now subject to local discretion by trusts and other NHS bodies – please check with your maternity team and sonography unit for their policy on visitors attending antenatal appointments, including scans. It is important that any visitors and outpatients follow guidance in hospitals about wearing a face covering and handwashing. If you are unable to bring someone with you to your scan, we encourage units to allow women to share the ultrasound scan experience with their partner (or other family members and friends) by saving a short 10–30-second video clip of the baby at the end of the dating scan and/or anomaly scan. In the current pandemic situation, when women attend alone, virtual attendance by partners or companions with online video calls, or the filming of the dating scan and/or anomaly scan, is not recommended. While we understand this may be disappointing, virtual attendance can be distracting to the sonographer and prevent them from doing their job effectively. We understand it may be upsetting if you are asked to come alone to a scan, but this measure has been put in place to protect maternity staff, other women and babies, and you and your family from the risk of infection. Scans are an essential part of pregnancy care and it is important that you continue to attend them for your and your baby’s wellbeing.
Q. What should I do if I develop a fever or temperature, or both, when I am pregnant? If you develop a temperature or a cough, or both, in pregnancy, you can use the NHS 111 or NHS 24 website to obtain advice about isolation, which you should follow in line with current regulations. However, please also be alert to the other possible causes of fever in pregnancy. In particular, these include urine infections (cystitis) and waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge, or have any concerns about your baby’s movements, contact your maternity provider, who will be able to provide further advice.
Information for all pregnant women about childbirth choices and birth partners during the coronavirus pandemic
Q. What impact will coronavirus have on my pregnancy? The NHS has made arrangements to ensure that women are supported and cared for safely through pregnancy, birth and the period afterwards during this pandemic when there will be extra pressures on healthcare services. Maternity services are absolutely essential and the RCOG is helping units to coordinate staff in maternity services, to ensure safe care is provided. This includes reducing staff commitments outside maternity units, reducing any non-essential work within Trusts and re-organising staffing.. Maternity units are increasingly providing consultations on the phone or by video link, when this is appropriate, so you do not have to travel unnecessarily to the hospital. However, some visits in person with a midwife are essential and it is important for the wellbeing of you and your baby that you attend these to have routine checks. On 5 June, the NHS’s suspension of hospital visiting was lifted. This means that visiting is now subject to local discretion by trusts and other NHS bodies – please check with your maternity team for their policy on visitors to the antenatal and postnatal wards. It is important that any visitors follow guidance in hospitals about wearing a face covering and handwashing. If visitor restrictions remain in place on your postnatal ward, midwifery, obstetric and support staff will be able to support the needs of all women and the practical challenges of caring for newborns after birth.
Q. Will my childbirth choices be affected by the coronavirus pandemic? We understand this must be a stressful and anxious time if you are pregnant and due to give birth in the coming months. Maternity units everywhere are working around the clock right now to manage additional pressures and facilitate women’s choices. Like all areas of NHS care, maternity services will be affected by the pandemic but units are working to ensure services are provided in a way that is safe, with the levels of staff that are needed and the ability to provide emergency care where necessary. If you have chosen to give birth at home or in a midwife-led unit that is not co-located with an obstetric unit, it is worth noting that these services rely on the availability of ambulance services to allow for rapid transfer to hospital, and the right number of staff to keep you safe. If these are not in place, it is possible that your Trust or Board may not be able to provide these services.
Q. Will I need to wear a facemask when I attend hospital for antenatal appointments, or to have my baby? To reduce transmission of coronavirus in hospitals, the government have announced that from 15 June, face masks and coverings must be worn by all NHS hospital staff and visitors in England. All visitors and outpatients, including pregnant women attending antenatal appointments or scans, must wear face coverings at all times to protect other women and patients, and staff from coronavirus. This should be communicated with you through your appointment letter, local Trust websites and social media outlets. At present hospital inpatients, including women giving birth, are not required to wear masks.
Q. Will I be able to have my birth partner with me during labour and birth? Yes, you should be encouraged to have at least one well birth partner present with you during labour and birth. Your birth partner must wear a mask in hospital. Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth. If your birth partner has symptoms of coronavirus or has recently tested positive for coronavirus, they will not be allowed to go into the maternity suite, to safeguard the health of you, other women and babies, and the maternity staff supporting you. In some hospitals and maternity units, there are now restrictions on visitors which might mean that birth partners or other supportive people are not able to attend routine antenatal appointments, or stay with women on antenatal or postnatal wards. However, this should not impact on your birth partner’s presence during your labour and the birth, unless they are unwell with coronavirus symptoms or have tested positive for coronavirus. We know that for some women, their chosen birth partner may be from a different household due to their individual circumstances. You should be supported to have them with you, unless they are unwell with coronavirus symptoms or have tested positive for coronavirus.
Q. Will I be able to have my birth partner with me if I am being induced? A birth partner without symptoms should be able to attend your induction of labour where that is in a single room (e.g. on the maternity suite) but potentially not if the induction takes place in a bay on a main ward, as it may not be possible to achieve the necessary social distancing measures. On 5 June, the NHS’s suspension of hospital visiting was lifted. This means that visiting is now subject to local discretion by trusts and other NHS bodies – please check with your maternity team for their policy on visitors to the antenatal ward. It is important that any visitors follow guidance in hospitals about wearing a face covering and handwashing. We understand this must be a very worrying and anxious time if you are pregnant and your birth partner can’t be with you while you are being induced; however, it is essential that we limit the number of visitors to hospitals during this time. This guidance is in place to protect other pregnant women and babies, and birth partners themselves. Please be assured that if your birth partner is unable to be with you on a ward during your induction, this will not impact on your birth partner’s presence during labour and the birth, unless they are unwell with symptoms of coronavirus or have tested positive for coronavirus. At the point you go into active labour, you will be moved to your own room and a well birth partner will be able to join you.
Q. Will my birth partner be able to stay with me if I have a caesarean or instrumental birth that occurs in an operating theatre? We fully support women having their birth partners with them during labour and birth, unless they are unwell or have tested positive for coronavirus, when an alternative well birth partner can attend. Around one in four women in the UK has a caesarean birth. A caesarean may be recommended as a planned (elective) procedure for medical reasons or as an emergency – for example, if doctors and midwives are concerned that your baby is not coping with labour and needs to be born immediately. Furthermore, around one in five women in the UK has an instrumental birth (ventouse or forceps). Some of these types of birth may also be recommended to occur in an operating theatre in order to allow the maternity team to modify plans and undertake a caesarean birth if necessary. Most caesareans and instrumental births in theatre are carried out under spinal or epidural anaesthetic, which means you’ll be awake, but the lower part of your body is numb and you cannot feel any pain. In this situation, everything will be done by the clinical staff – midwives, obstetricians and anaesthetists – to keep your birth partner with you. Due to the coronavirus pandemic, staff in the operating theatre will be wearing enhanced personal protective equipment (PPE) to prevent the spread of infection, which will make it more difficult for them to communicate. To enable the clinicians to assist in the birth of your baby safely, it’s really important your birth partner follows the instructions from the maternity team carefully and quickly. Occasionally, a general anaesthetic (where you’re put to sleep) may be used, particularly if your baby needs to be born urgently. During this type of caesarean birth, even under more usual circumstances, for safety reasons it is not possible for the birth partner to be present during the birth. While the maternity team will do all they can to ensure that your birth partner is present for the birth, there will be some occasions when there is a need for an urgent emergency birth with epidural or spinal anaesthetic, and it will not be possible for your birth partner to be present. This is because, during an emergency, operating theatres are more high-risk environments in terms of potential spread of coronavirus to everyone who is present. If it is the case that your birth partner will not be able to be present during the birth, your maternity team will explain this to you and will do everything they can to ensure that your birth partner can see you and your baby as soon as possible after the birth.
Q. Will I be able to have my birth partner with me on the postnatal ward? On 5 June, the NHS’s suspension of hospital visiting was lifted. This means that visiting is now subject to local discretion by trusts and other NHS bodies – please check with your maternity team for their policy on visitors to the postnatal wards. Restrictions on visitors to postnatal wards may remain in place to ensure compliance with social distancing measures and prevent the spread of coronavirus. We understand it may be upsetting not having your birth partner with you on the postnatal ward after you have given birth, but these restrictions are in place to reduce the risk of transmission of coronavirus to you, your baby, the maternity staff and birth partners themselves. Please be reassured that during this time, midwifery, obstetric and support staff will do their best to support the needs for all women and the practical challenges of caring for newborns after birth. If visitors are permitted, it is important that they follow guidance in hospitals about wearing a face covering and handwashing.
Q. Is there any advice for birth partners during the coronavirus pandemic? We are asking you to follow the guidance below to keep yourself, your family, other families and NHS staff as safe as possible during the pandemic:
During the coronavirus pandemic, all hospitals have been restricting visitors, but there are exceptions for a birthing partner during active labour and birth.
Birth partners will be required to wear a mask or face covering when entering a hospital under new NHS guidance.
Every woman should be able to have one birth partner stay with her through labour and birth, unless the birth occurs under a general anaesthetic.
To help prevent spread of coronavirus to other women, their babies and key front-line healthcare staff, it is very important that you do not attend the maternity unit if you have any symptoms of coronavirus or have had any in the previous 7 days.
If you are unwell, protect your family and NHS staff, and stay at home. To prepare for this, women and their current birth partner are being encouraged to think about an alternative birth partner, if required. This person does not need to be from the same household as you.
If you are supporting a woman during labour and birth, please be aware of the strict infection control procedures in place to prevent the spread of coronavirus to other pregnant women and their babies, as well as other people within the hospital and the maternity staff.
Please wash your hands regularly with soap and water and use hand sanitiser gel in clinical areas as available.
If you cough or sneeze, please cover your mouth with a tissue and dispose of it in a bin immediately.
Stay in the labour room with the woman you are supporting. Do not move (/walk) around the maternity unit unaccompanied – use the call bell if you require assistance.
If you are asked to a wear a mask or any personal protective equipment (PPE) during the labour or birth, it is very important. Please follow the instructions carefully, and take it off before you leave the clinical area.
If you are accompanying a woman to her birth in an operating theatre, please be aware that operating theatre staff will be wearing PPE and it may be more difficult for them to communicate with you:
A staff member will be allocated to support you; please carefully follow their instructions and approach them if you have any questions.
To enable the clinical staff to do their job, it is very important that you do not move around the operating theatre as you risk de-sterilising sterile areas and spreading the virus.
The maternity team will do everything they can to enable you to be present for the birth. However, if there is a particular safety concern, they may ask that you are not present in the operating theatre. If this is the case, the team should discuss this with you and explain their reasons unless it is an emergency.
We understand this is a stressful and anxious time for pregnant women and their families and we thank you for your cooperation during this time.
Please be assured that the maternity team will do all it can to provide information, guidance and support to you and the woman giving birth.
Q. Who should care for my other children when I go into hospital for labour and birth, or a check-up during pregnancy? Government guidelines recommend that guidelines on social distancing should be followed by everybody in the UK wherever possible. It is reasonable to leave your home when you need to do so for a medical reason (i.e. attending a routine clinic appointment, to check on the wellbeing of you or your baby or attending the maternity unit to give birth to your baby). However, your other children must not go with you into the maternity unit. If this means that there is nobody available at home to care for your other children, then it is necessary for the children to be cared for by another close family member or friend. Please discuss this with the chosen person in advance so they can make any necessary arrangements. When choosing another person to care for your children in this situation, please do not ask somebody who is vulnerable to the severe effects of coronavirus (e.g. people over the age of 70, other pregnant women or individuals with significant medical problems). Also, please make a back-up plan, in the case the person you had planned to ask is self-isolating because either they, or someone else in their home, are unwell with coronavirus when you need them. Q. Will I be tested for coronavirus? The process for diagnosing coronavirus infection is changing rapidly. Testing is now open to anyone in the UK, including pregnant women, with coronavirus symptoms. You should visit the NHS website to book your test, or call 119 to arrange testing. The list of symptoms has also been expanded to include loss of or change in someone’s normal sense of smell or taste. To minimise the spread of coronavirus in hospitals, the offer of testing is being expanded to include all patients admitted to hospital, regardless of whether they have coronavirus symptoms or not. This includes offering tests to all women who attend hospitals for urgent or emergency maternity care, including attendance for spontaneous labour and birth. New national guidance from NHS England recommends that individuals admitted for elective procedures should be offered testing prior to admission, following a period of self-isolation. For maternity units, there are particular practical concerns and the RCOG has developed more detailed informationabout this. If you have an elective caesarean birth or induction of labour planned, you may be asked to follow a period of self-isolation and offered a test for coronavirus prior to admission. Your maternity team will discuss this with you. The ability for widespread testing in a hospital trust will depend upon the availability of testing kits, testing capacity in the local laboratory and available staff to take the tests. This is likely to vary across the UK and local adaptations will be required, adapted according to local capacity and disease prevalence.
Q. How does the coronavirus test work? Pregnant women are tested in the same way as anyone else. Currently, the test involves swabs being taken from your mouth and nose. You may also be asked to cough up sputum, which is a mixture of saliva and mucus. The most effective tests currently take 24–48 hours for the result to be available. This means that if you are awaiting test results whilst in hospital you may be treated as potentially infectious until the result is returned. If you have symptoms of coronavirus but have recently received a negative test result, your maternity team may still use caution when caring for you. Sometimes, the virus doesn’t show on the test results if you have been tested not long after you have become infected. You may be offered another test in a few days.
Q. What is an antibody test – will I have this? You may also have heard about antibody testing for coronavirus. This is a blood test that can show whether you have previously come into contact with the virus or not. It does this by detecting antibodies, which your body produces if you have had coronavirus. This is called an immune response. At present, this type of test is only being offered to NHS staff and some individuals across the UK. It is hoped the results of these tests will help us to understand how immunity to coronavirus works as we do not yet know how the antibodies develop and how long immunity lasts for. Therefore, we do not currently recommend that results from antibody tests are used when caring for pregnant women.
Q. Will my birth partner be tested for coronavirus? It is possible that your birth partner may also be offered testing for coronavirus when you are admitted to hospital. Your maternity team will be able to advise you further.
Q. What if I decline testing for coronavirus? If you decline testing for coronavirus prior to attending hospital for urgent or planned maternity care (including labour and birth), your care will be the same as any woman who is admitted to hospital and who does not yet have a test result.
Advice for pregnant women with suspected or confirmed coronavirus infection
Q. What should I do if I think I may have coronavirus or been exposed? If you are pregnant and you have either:
a high temperature or
a new, continuous cough or
a loss or change to your sense of smell or taste
you should stay at home for 7 days. Do not go to a GP surgery, pharmacy or hospital without contacting them on the telephone first. 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. Please also be alert to the other possible causes of fever in pregnancy. In particular, these include urine infections (cystitis) and waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge, or have any concerns about your baby’s movements, contact your maternity provider, who will be able to provide further advice. If you are infected with coronavirus you are still most likely to have no symptoms or a mild illness from which you will make a full recovery. 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. If you feel your symptoms are worsening or if you are not getting better, you are recommended to contact the NHS on 111 (or a local alternative), your maternity unit or, in an emergency 999, straightaway for further information and advice. This advice is important for all pregnant women, but particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital – if you are in your third trimester, from a black or minority ethnic background, are over the age of 35, are overweight or obese, or have a pre-existing medical problem, such as high blood pressure or diabetes. 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.
Q. What should I do if I test positive for coronavirus? If you test positive for coronavirus outside of a hospital setting, 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 hospital.
Q. Why would I be asked to self-isolate (as opposed to reducing social contact)? You may be advised to self-isolate because:
You have symptoms of coronavirus, such as a high temperature or new, continuous cough, or loss or change in your sense of smell or taste
You have tested positive for coronavirus and you’ve been advised to recover at home
You have an elective caesarean birth or induction of labour planned and you have been asked to self-isolate prior to your admission to hospital
Q. What should I do if I’m asked to self-isolate? 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
Open windows to ventilate rooms
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. Keeping mobile and hydrated, even if you are self-isolating, is important to reduce the risk of blood clots in pregnancy. Find out more about exercise in pregnancy.
Q. Can I still attend my antenatal appointments if I am in self-isolation? You should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for possible/confirmed coronavirus and ask for advice on going to 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 others.
Q. How will I be cared for after I have recovered from coronavirus? If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged at least 2 weeks after your recovery, to check that your baby is well. 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. Visitor numbers may be restricted to promote recommended social distancing but your birth partner will be able to be with you, provided they are not unwell.
Q. What do I do if I feel unwell or I’m worried about my baby during self-isolation? Pregnant women who are self-isolating are advised not to attend maternity 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 you are advised to go to the maternity unit or hospital, pregnant women are asked to travel by private transport, or arrange hospital transport, and alert the maternity unit reception once on site, before going into the hospital.
Q. Will being in self-isolation for suspected or confirmed coronavirus affect where I give birth? As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour are being advised to go to 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 there would not be doctor present and where this monitoring would not be possible. We will keep this advice continually updated as new evidence emerges. Maternity units everywhere are working around the clock right now to manage additional pressures and facilitate women’s choices to the best of their abilities. 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 choices should be respected and followed as closely as possible based on your wishes. However, if you are unwell and your team feel that this suggests that your baby needs to be born urgently, 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 confirmed coronavirus, as the virus can sometimes be found in faeces. This means it could contaminate the water, causing infection to pass to the baby. 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.
Q. What happens if I go into labour during my self-isolation period? If you go into labour during self-isolation, 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 usual practice. Your maternity team have been advised on ways to ensure that you and your baby receive safe, quality care, respecting your birth choices 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
Advice for women with suspected or confirmed coronavirus infection who have recently given birth
Q. Could I pass coronavirus to my baby? As this is a new virus, there is limited evidence about caring for women with coronavirus infection when they have just given birth. A small number of babies have been diagnosed with coronavirus shortly after birth, so there is a chance that infection may have occurred in the womb, but it is not certain whether transmission was before or soon after birth. Your maternity team will maintain strict infection control measures at the time of your birth and closely monitor your baby.
Q. Will my baby be tested for coronavirus? If you have confirmed or suspected coronavirus when the baby is born, doctors who specialise in the care of newborn babies (neonatal doctors) will examine your baby and advise you about their care, including whether they need testing.
Q. Will I be able to stay with my baby/give skin-to-skin if I have suspected or confirmed coronavirus? Yes, if that is your choice. Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth. In some other countries, 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.
Q. Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus? Yes. There is no evidence showing that the virus can be carried or passed on in breastmilk. The well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of transmission of coronavirus through breastmilk. Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth so skin-to-skin and breastfeeding can be initiated and supported if you choose. The main risk of breastfeeding is close contact between you and your baby, as if you cough or sneeze, this could contain droplets which are infected with the virus, 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. When you or anyone else feeds 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. Further information on infant feeding during the coronavirus pandemic is available from Unicef.
Q. After the birth, is there any increased risk to me or my baby? There is no evidence that women who have recently had a baby and are otherwise well are at increased risk of contracting coronavirus or of becoming seriously unwell. A recently pregnant woman’s immune system is regarded as normal unless she has other forms of infection or underlying illness. You should however remain well-nourished with a balanced diet, take mild exercise as you feel fit and ensure social distancing guidance is followed. Children, including newborns, do not appear to be at high risk of becoming seriously unwell with the virus. However, close observation of hygiene, as always, is important and particularly with family members resident in the house. Anyone who enters the home should take standard hygiene precautions, including washing their hands, and be careful about handling your baby if they have symptoms of any illness including the coronavirus. It is important that your baby is feeding well and gaining weight, and if you have any concerns, please contact your midwife. Once restrictions are lifted, we would caution against large family gatherings to celebrate your baby’s arrival until more is known about the spread of the virus in the community. Do not put off seeking medical advice if you have concerns about your baby’s health during the pandemic. Seek medical advice if your baby has a fever, lethargy, irritability, poor feeding or any other symptoms you may have concerns about.
Occupational health guidance for pregnant women who work in a public-facing role
Q. Can I still go to work? What if I work in a public-facing role? Following the Chief Medical Officer’s advice on 16 March 2020 that all pregnant women are classed as a precaution in a vulnerable group, we understand that it must be an anxious time if you are pregnant and you work in a public-facing role. Pregnant women who can work from home should do so. If you can’t work from home, but your work in a public-facing role can be modified appropriately to minimise your exposure, this should be considered and discussed with your occupational health team or employer. More detailed occupational health advice for pregnant women, including those who cannot work from home was published on 21 March 2020, and updated on 26 March. It recommends that 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 public-facing role, provided the necessary precautions are taken - these include the use of personal protective equipment (PPE) and risk assessment. If you are in your third trimester (more than 28 weeks’ pregnant), or have an underlying health condition – such as heart or lung disease – you should work from home where possible, avoid contact with anyone with symptoms of coronavirus, and significantly reduce unnecessary social contact. Read the government guidance on social distancing. The guidance was updated again on 21 April (Version 3) in response to feedback from individuals and charities supporting pregnant women, to clarify that responsibility for risk assessment in the workplace lies with the employer. The guidance clearly places the emphasis on employers undertaking a risk assessment and involving occupational health, to determine whether women who are under 28 weeks’ pregnant can continue working in public-facing roles. Pregnant women can only continue working where the risk assessment supports this. The evidence underpinning this guidance and the fundamentals agreed with the UK Chief Medical Officers remains unchanged.
Q. What is the advice for pregnant healthcare workers before 28 weeks’ gestation? If you are in your first or second trimester (less than 28 weeks’ pregnant), with no underlying health conditions, 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. Pregnant women can only continue working where the risk assessment supports this. 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.
Q. What is the advice for pregnant healthcare workers after 28 weeks’ gestation, or with an underlying health condition? 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. Data from the UKOSS study of 427 pregnant women in May 2020 found the majority of women who have become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing from 28 weeks of pregnancy. 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.
Q. What is the advice if I’m pregnant and my partner is a key worker working in a public-facing role? The government has published guidelines for people living with a vulnerable person, which includes pregnant women as a precaution. Particular sensible advice includes frequent hand-washing, showering when you re-enter the house and washing the clothes you travelled with.
This blog has been written upon advice and guidance provided by The Royal College of Obstetricians and Gynaecologists (RCOG) and is for information purposes only. This information is not intended to meet specific individual healthcare requirements and this information is not a clinical diagnostic service. If you are concerned about your health or healthcare requirements we strongly recommend that you speak to your clinician or other healthcare professional.