According to latest government advice pregnant women are being urged to to limit their social contact but still attend antenatal appointments as normal. The Royal College of Midwives agreed, saying the appointments were “essential to ensure the wellbeing of pregnant women and their babies”.
Gill Walton, chief executive of the Royal College of Midwives, said that despite this, antenatal and postnatal care continue to be important.
“We would urge all pregnant women who are well to attend their care as normal. If you are pregnant and have symptoms of possible coronavirus infection, you should call to defer routine visits until after the isolation period is over,” she said.
Addressing concerns from some pregnant women about contracting the virus in hospitals or clinics, Dr Gaurav Gupta told the BBC that hospitals “can actually be a place of safety”.
“We shouldn’t think of hospitals as a place to avoid at all costs,” he said.
The guidance, issued on Monday, asks pregnant women to minimise social contact for up to 12 weeks from this weekend.
What is the government’s advice for pregnant women?
The government has issued five points that people in at-risk groups such as the over-70s, those with underlying conditions, and pregnant women should follow “as much as you can”:
- 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, varying your travel times to avoid rush hour, when possible; Work from home, where possible. Your employer should support you to do this
- Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars, clubs
- 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
Your pregnancy questions answered
These Q&As relate to the Coronavirus (COVID-19) infection and pregnancy – guidance for healthcare professionals: Version 2 – 13 March 2020 published by the Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and Royal College of Paediatrics and Child Health, with input from the Royal College of Anaesthetists, Public Health England and Health Protection Scotland.
Q1. What effect does coronavirus have on pregnant women?
Pregnant women do not appear to be more severely unwell if they develop coronavirus than the general population. 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. There are no reported deaths of pregnant women from coronavirus at the moment.
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.
Q2. 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. There is also no evidence that the virus can pass to your developing baby while you are pregnant (this is called vertical transmission). It is therefore considered unlikely that if you have the virus it will cause abnormalities in your baby.
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.
Q3. What can I do to reduce my risk of catching coronavirus?
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.
Q4. 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.
Q5. 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
- 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 should contact the maternity unit looking after your pregnancy 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 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 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.
Q6. How will I be tested for coronavirus?
The process for diagnosing coronavirus infection is changing rapidly. At the current time, only people with severe symptoms who require 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 mucous.
Q7. What should I do if I test positive for coronavirus?
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.
Q8. Why would I be asked to self-isolate?
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
Q9. 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. 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.
Q10. 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 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.
Q11.How will my care be managed after I have recovered from coronavirus?
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 in recovery 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.
Q12. What do I do if I feel unwell or I’m worried about my baby during self-isolation?
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.
Q13. 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 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.
We will keep this advice continually updated as new evidence emerges.
Q14. Will being in self-isolation for suspected or confirmed coronavirus affect how I give birth?
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) suggested that urgent delivery would be needed, a caesarean birth may be recommended.
There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. However, the use of Entonox (gas and air) may increase aerosolisation and spread of the virus, so your maternity team will discuss all the options with you in early labour to ensure you are aware of the pain relief options available to you.
Q15. What happens if I go into labour during my self-isolation period?
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 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
Q16. Could I pass coronavirus to my baby?
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 reports of women diagnosed with coronavirus during the third trimester of pregnancy having passed the virus to their babies while in the womb.
Q17. Will my baby be tested for coronavirus?
Yes, if you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus.
Q18. 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 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.
Q19. Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?
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 and 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 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.
Q20. What is the advice if I am a healthcare worker and pregnant?
We understand that it must be an anxious time if you work in healthcare and you are pregnant. To the best of our knowledge, pregnant healthcare professionals are no more personally susceptible to the virus or its complications than their non-pregnant colleagues.
However, infection with coronavirus may pose some risks to your unborn baby. There is a possible risk of fetal growth restriction, or of premature birth if you become seriously unwell.
You should discuss your individual circumstances with your local Occupational Health department.
References: BBC news and Royal College of Obstetricians and Gynaecologists
March 18, 2020
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