These Q&As relate to the Coronavirus (COVID-19) infection and pregnancy – guidance for healthcare professionals: Version 6 – 3 April 2020 and Occupational health advice for employers and pregnant women during the COVID-19 pandemic – 30 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, the Obstetric Anaesthetists’ Association, Public Health England and Health Protection Scotland.
Read our news stories relating to this guidance.
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 coronavirus are more at risk of serious complications than any other healthy individuals.
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. At the moment, there’s no evidence that this is the case for coronavirus infection, but the amount of evidence available is still quite limited.
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.
If you are in your third trimester (more than 28 weeks pregnant) you should be particularly attentive to social distancing and minimising any contact with others.
All pregnant women should follow the PHE advice:
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, this includes pregnant women with significant heart disease (congenital or acquired). If you are pregnant and have significant heart disease, it is strongly recommended that you follow these shielding measures to keep yourself save.
Yes. It is really important that you continue to attend your scheduled routine care when you are well.
Maternity care is essential, and has been developed over many years to reduce complications in mothers and babies. There is a potential risk of harm to you and your baby if you don’t attend your appointments, even in the context of coronavirus.
If you are well, you should be able to attend your antenatal care as normal. If you have symptoms of possible coronavirus infection, you should contact your community midwife to postpone routine visits until after the isolation period is over.
At this time, it is particularly important that you help your maternity team take care of you. If you have had an appointment cancelled or delayed, and are not sure of your next contact with your maternity team, please let them know by using the contact numbers given to you at booking.
The following practical advice may be helpful:
Whatever your personal situation please consider the following:
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.
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.
The DOH is making 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 DOH is helping units to plan to have staff obstetrics and gynaecology services, to ensure safe care is provided.
Midwives and obstetricians 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 in person visits 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.
Routine gynaecology operations are being postponed and, in many units, arrangements are being made for gynaecology doctors to work in the maternity unit.
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.
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.
Yes, you should be encouraged to have a birth partner present with you during labour and birth. 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.
If your birth partner has symptoms of coronavirus, they will not be allowed to go into the maternity suite, to safeguard the health of the woman and the maternity staff supporting you
Private hospitals may place restrictions on visitors which might mean that partners 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.
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 Labour Ward) but not if the induction takes place in a bay on a main ward, as it would not be possible to achieve the necessary social distancing measures.
We understand this must be a very worrying and anxious time if you are pregnant and your 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 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. At the point you go into active labour, you will be moved to your own room and your birth partner will be able to join you.
We fully support women having their birth partners with them during labour and the birth, unless they are unwell, when an alternative birth partner can attend. 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.
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 routine circumstances, for safety reasons it is not recommended for the birth partner to be present during the birth.
While the maternity team will do all they can to ensure that your 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 is not possible for your 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 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 partner can see you and your baby as soon as possible after the birth.
If you are pregnant and you have either:
You should stay at home for 7 days. Do not go to a GP surgery, pharmacy or hospital. You do not need to contact your midwife or doctor 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 Covid-19 hotline 0800029999 if:
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.
The process for diagnosing coronavirus infection is changing rapidly. At the current time, only people with severe symptoms who need 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 else, 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 hospital.
You may be advised to self-isolate because:
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 DOH currently recommends people should:
You may wish to consider online fitness routines to keep active, such as pregnancy yoga or Pilates.
You should contact your doctor, 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.
If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged at least two 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.
If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your doctor, 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 the premises, before going into the hospital.
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 your breathing (respiratory condition) 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.
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 usual.
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:
As this is a new virus, there is limited evidence about caring for women with coronavirus infection in women 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.
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.
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.
Yes. There is no evidence showing that the virus can be carried in breastmilk, 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 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:
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.
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 mum’s immune system is 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 the baby if they have symptoms of any illness including the coronavirus.
It is important that the 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 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.
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 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 on 26 March to emphasise that pregnant women of any gestation should be offered the choice of whether to work in direct patient-facing roles during the coronavirus pandemic. Your choices on whether you continue to work in direct patient-facing roles during the coronavirus pandemic should be respected and supported by your employers.
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 FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful: maternityaction.org.uk/covidmaternityfaqs/
