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Coronavirus infection and pregnancy

Information for pregnant women and their families

These Q&As were updated on 31 July 2020 and relate to the Coronavirus (COVID-19) infection and pregnancy – guidance for healthcare professionals: Version 11 – 24 July 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 Public Health Scotland.

Read our news stories relating to this guidance. More information on pregnancy and coronavirus, including leaflets you can print, are available from the NHS website.

These videos contain advice from RCOG consultants Dr Jo Mountfield and Dr Christine Ekechi:

The Royal College of Obstetricians and Gynaecologists (RCOG) provides this advice and guidance for your information purposes only. This information is not intended to meet your 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, as appropriate.

 

Coronavirus and pregnancy

Q. What is the main advice for pregnant women?

There is no evidence that pregnant women are more likely to get seriously ill from coronavirus but pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution.

Pregnant women should follow the latest government guidance on staying alert and safe (social distancing) 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.

Key advice for pregnant women during the pandemic:

More information on pregnancy and coronavirus is available on the NHS website.

What should I do if I develop symptoms of coronavirus?

  • The main symptoms of coronavirus are a high temperature, a new, continuous cough or a loss or change to your normal sense of smell or taste (anosmia). Most people with coronavirus have at least 1 of these symptoms.
  • If you think you may have symptoms, use the NHS 111 online service/NHS 24 in Scotland for information and advice, and follow the guidance for households with possible or confirmed coronavirus infection.
  • You should tell your midwife or maternity team that you have symptoms of coronavirus.
  • If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care. You should contact your maternity team, GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.
  • Seek medical advice as early as possible if you have any questions or concerns about you or your baby.

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 symptoms.

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 2020. 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 and regular hand washing from 28 weeks of pregnancy.

The study also found that pregnant women from Black, Asian and minority ethnic 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 and requiring admission to hospital.

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 if you become infected with coronavirus and are pregnant.

Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) might be possible. 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 2020, 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 effect 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. Other maternity surveillance programmes are being funded by the National Institute of Health Research (NIHR). You can also ask your maternity team about any local research that is taking place in your area.

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.

Q. Why are pregnant women in a vulnerable group?

Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution. This is because pregnancy in a small proportion of women can alter how your body handles severe viral infections and some viral infections, such as flu, are worse in pregnant women. This is something that midwives and obstetricians have known for many years and are used to caring for pregnant women in this situation.

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. 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 supporting units to coordinate staff in maternity services, to ensure safe and personalised 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 or doctor are essential and it is important for the wellbeing of you and your baby that you attend these to have routine checks. You will be required to follow guidance about face coverings during visits to healthcare settings.

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies – please check with your maternity unit for their policy on visitors to the antenatal and postnatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland (13 July), Wales and Northern Ireland (6 July) has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable a pregnant woman to invite another person to accompany her to antenatal and postnatal appointments, including pregnancy scans. Some Trusts in England are permitting partners or other supportive people to attend these appointments but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures enabling partners and other supportive people to attend antenatal and postnatal appointments, including scans, with women.

This is an important step not only for the health and wellbeing of pregnant women, but also their partners and families whose mental health has been affected by missing out on these appointments and bonding time with their babies.

If visitor restrictions remain in place on your antenatal/postnatal ward, midwives obstetricians, and other members of the maternity team will be able to support the needs of all women and the practical challenges of caring for newborns after birth.

Q. Should I take Vitamin D supplementation?

Vitamin D supplementation is recommended to all women during pregnancy as it can help reduce the risk of respiratory infections.

There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop coronavirus.

However, there is not enough evidence to show that taking vitamin D prevents coronavirus infection or is an effective treatment.

Most people living in northern hemispheres will have low levels of vitamin D and as such, we advise all pregnant women to consider taking 10 micrograms of vitamin D a day to keep their bones and muscles healthy. Vitamin D supplements are available from most pharmacies, supermarkets and other retailers.

Women from Black, Asian and minority ethnic backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D and are advised to take a higher dose of vitamin D. Speak to your midwife or maternity team if you have any questions about vitamin D supplementation.

Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these.

Q. What should I do if I develop a temperature, a new cough, or both, when I am pregnant?

If you develop a temperature or a cough, or both, in pregnancy, use the NHS 111 online service/NHS 24 in Scotland website to obtain advice about self-isolation, which you should follow in line with current regulations. However, please also be alert to the other possible causes of fever/temperature 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 team, who will be able to provide further advice.

Q. What is the international 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 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 the majority of pregnant women who became seriously unwell with coronavirus were in the third trimester. This emphasises the importance of stringently adhering to 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 metres 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 advised of 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.

Shielding guidance is now being relaxed but this is happening differently in the four nations of the UK – advice in England, in Scotland, in Wales, and in Northern Ireland. Practical advice for measures that may be helpful to adopt within a family are now available within this 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 contact 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 women at higher risk of serious illness, including women who are Black, Asian or from other ethnic minorities

Q. What are the shielding measures for pregnant women at high risk of severe illness?

Pregnant women with significant heart disease (congenital or acquired) are classed as clinically extremely vulnerable and have been advised to shield, because they are at very high risk of developing severe illness from coronavirus. Shielding guidance is now being relaxed but this is happening differently in the four nations of the UK – advice in England, in Scotland, in Wales, and in 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 doctor (obstetrician) with any questions you may have.

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 from coronavirus were in their third trimester of pregnancy, emphasising the importance of social distancing and regular hand washing from 28 weeks of pregnancy.

The study also found pregnant women from Black, Asian and minority ethnic (BAME) backgrounds are more likely than other pregnant 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 if you feel your symptoms are worsening or if you are not getting better, you should seek medical help, particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. You should contact your maternity team, your GP, or use the NHS 111 online service/NHS 24 in Scotland online service for further information and advice. In an emergency, call 999.

The increased risk to pregnant women from a BAME background, those who are 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, will mean that your maternity team may offer you additional appointments, or refer you to a doctor or specialist clinic should there be any concerns about your or your baby’s health.

This will be discussed and planned with you by your community midwife or maternity team through a risk assessment, and personalised antenatal and postnatal care plan.

The recommendation to all pregnant women remains that you should seek medical advice as early as possible if you have any questions or concerns about your or your baby’s health. Your maternity team is there for you and you will receive safe, personalised and respectful care.

Q. What is the advice for women from a Black, Asian or minority ethnic background?

Women from Black, Asian and minority ethnic (BAME) backgrounds are at higher risk of becoming seriously unwell and being admitted to hospital so it’s important that if you feel your symptoms are worsening or if you are not getting better, you should seek medical help.

Your maternity team may offer you additional appointments, or refer you to a doctor or specialist clinic if there are any concerns about your or your baby’s health.

If you aren’t already, you should consider taking a vitamin D supplementation, which is recommended to all women during pregnancy. There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop coronavirus. However, there is not enough evidence to show that taking vitamin D prevents coronavirus infection or is an effective treatment.

Women from BAME backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D and are advised to take a higher dose of vitamin D. Speak to your community midwife or maternity team if you have any questions about vitamin D supplementation.

The Royal College of Midwives has developed new guidance for midwives and maternity support workers to ensure that they are aware of the increased risks for BAME women and can pass on relevant advice and support to the women in their care.

The NHS in England has written to all maternity units in the country calling on them to take four specific actions to minimise the additional risk of coronavirus on BAME women and their babies.

 

Early pregnancy

Q. What is the advice if I am in my first trimester/less than 12 weeks’ pregnant?

Even during the pandemic, it is very important that if you have any questions or concerns about yourself or your baby at any time, you contact your GP, midwife or local early pregnancy unit straight away to discuss them. Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage and you should seek urgent medical advice should you experience any of these symptoms.

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 the number of people entering them, 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 including maternity care.

Find out more in the RCOG guidance and information on the changes to early pregnancy care and what to expect during the coronavirus pandemic.

 

Mental health

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 and their families as pregnancy presents 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 virtual contact

Isolation, bereavement, financial difficulties, insecurity and inability to access support systems are all widely recognised risk factors for mental ill-health. The coronavirus pandemic 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 provided remotely, where possible. If you are experiencing domestic abuse or violence, please disclose this to a healthcare 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. More information about mental health and pregnancy, including the signs of perinatal depression, is available from the NHS website.

Further information is also available from the following organisations:

 

Antenatal care

 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, personalised care and support are given to you. Any changes implemented by your local maternity service should be discussed with you.

Antenatal and postnatal care is based on years of evidence to keep you and your baby safe through pregnancy, birth and beyond. Antenatal and postnatal care should therefore be regarded as essential and you should be encouraged to attend, while adhering to social distancing measures as far as possible.

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. Any changes to your care will be discussed with you 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 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, and/or carry out an assessment at the entrance of the clinic/hospital to check whether you have any symptoms that are suggestive of coronavirus.

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. Your local maternity team will discuss this with you in advance. 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, 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 10 to 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/staff.

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.

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 has announced that from 15 June 2020, 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 pregnant 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.

 

Pregnancy scans

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 partners and other supportive people are not able to attend routine antenatal appointments, including scans, with you.

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies – please check with your maternity unit for their policy on visitors to the antenatal and postnatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland (13 July), Wales and Northern Ireland (6 July) has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable a pregnant woman to invite another person to accompany her to antenatal and postnatal appointments, including pregnancy scans. Some Trusts in England are permitting partners or other supportive people to attend these appointments but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures enabling partners and other supportive people to attend antenatal and postnatal appointments, including scans, with women.

This is an important step not only for the health and wellbeing of pregnant women, but also their partners and families whose mental health has been affected by missing out on these appointments and bonding time with their babies.

If you are still 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.

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.

 

Childbirth choices

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 have been working to manage additional pressures and facilitate women’s choices.

Like all areas of NHS care, maternity services have been 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.

In some areas of the UK, some Trusts and Boards have had to pause their home birth service or close their midwife-led unit. Most of these services have now been reinstated.

 

Birth partners

Q. Will I be able to have my birth partner(s) 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(s) must wear a mask in hospital.

Having at least one trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth.

If a birth partner has symptoms of coronavirus or has recently tested positive for coronavirus, we do not recommend they 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, restrictions on visiting remain in place which might mean that birth partners or other supportive companions 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(s) 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(s) with me if I am being induced?

At least one 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 maintain the necessary social distancing measures.

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies – please check with your maternity unit for their policy on visitors to the antenatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland, Wales and Northern Ireland has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable at least one birth partner to be present throughout induction of labour. Some Trusts in England are permitting birth partners to attend these appointments but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures birth partners to stay with women during their induction of labour.

We understand this must be a very worrying and anxious time if you are pregnant and your birth partner(s) cannot be with you while you are being induced. However, hospitals still need to limit the number of visitors during this time.

This guidance is in place to protect other pregnant women and babies and birth partners themselves, as well as maternity staff.

Please be assured that if your birth partner(s) 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 at least one well birth partner will be able to join you.

Q. Will my birth partner(s) 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 at least one birth partner with them during labour and birth, unless they are unwell or have tested positive for coronavirus.

Around one in four women in the UK has a caesarean birth. A caesarean birth 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 instrumental births 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 caesarean 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, doctors (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 is very important your birth partner(s) follows the instructions from the maternity team carefully and quickly.

Occasionally, a general anaesthetic (where you are put to sleep) may be used, particularly if your baby needs to be born urgently. During this type of caesarean birth, even under usual circumstances (before the coronavirus pandemic), for safety reasons it is not possible for birth partners to be present during the birth.

While the maternity team will do all they can to ensure that your birth partner(s) 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 in which it will not be possible for your birth partner(s) to be present. This is because, during an emergency, operating theatres are more high-risk environments for the potential spread of coronavirus to anyone who is present.

If it is the case that your birth partner(s) will not be able to be present during the birth, your maternity team will discuss this with you and will do everything they can to ensure that your birth partner(s) can see you and your baby as soon as possible after the birth.

Q. Will I be able to have a birth partner with me on the postnatal ward?

On 5 June 2020, the suspension of hospital visiting in England of inpatients and those who accompany women and other patients to outpatient appointments was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies – please check with your maternity unit for their policy on visitors to the postnatal wards. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Restrictions around visiting inpatients and accompanying outpatients are now being eased but this happening differently in the four nations of the UK - advice in Scotland, Wales and Northern Ireland has been updated recently. The RCOG welcomes the range of measures re-introduced in the devolved nations which will enable birth partners to remain with women on the postnatal ward. Some Trusts in England are permitting birth partners to the postnatal wards but there is not a consistent approach.

However, we are aware the NHS in England and other organisations are working with your local Trust so they can safely begin to reintroduce measures birth partners to stay with women on the postnatal ward.

We understand that not having a birth partner with you on the postnatal ward after you have given birth may be upsetting for you both 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 of all women and the practical challenges of caring for newborn babies after birth. If visitors are permitted, it is important that they follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Q. What is the 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 has always been an exception for a well 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 at least 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 10 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(s) are being encouraged to think about an alternative birth partner(s), 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.
  • If you are asked to wear any additional personal protective equipment (PPE) in addition to a mask or face covering during the labour or birth, 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.
    • 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, birth partners and their families and we thank you for your cooperation during this time.
  • Please be assured that the maternity team will do all they can to provide information, guidance and support to you and the woman giving birth.

 

Coronavirus testing 

Q. Will I be tested for coronavirus?

The process for diagnosing coronavirus infection is changing rapidly. The offer of testing is now open to anyone in the UK (including pregnant women) with coronavirus symptoms. You should visit the NHS website 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 information about 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. You may also be asked to self-isolate and offered a test prior to a home birth. 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 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 have symptoms suggestive of coronavirus and 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. Therefore, we do not currently recommend that results from antibody tests are offered when caring for pregnant women.

Q. Will my birth partner(s) be tested for coronavirus?

It is possible that your birth partner(s) 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.

If you have symptoms suggestive of coronavirus you will be treated as potentially having coronavirus.

If you do not have symptoms you will be treated as other asymptomatic women who do not yet have a test result. For most units, this will mean that you are presumed to not have coronavirus.

 

Postnatal care

Q. After my baby’s 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 and ensure social distancing guidance is followed.

Children, including newborn babies, do not appear to be at high risk of becoming seriously unwell with the virus.

However, close observation of hygiene, including washing hands regularly, is important amongst all members of your household and they should be careful when holding your baby if they have symptoms suggestive of any illness.

Anyone from outside your household who enters your home should pay stringent attention to hygiene precautions and follow social distancing guidance.

The government has also published guidance on meeting people outside your household.

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.

The NHS has produced a leaflet on coronavirus and information for newborn babies.

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 the maternity unit or the day of your homebirth: 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 2020, the NHS provided guidance to all maternity teams that your first postnatal 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 Royal College of Midwives has produced a useful infographic on preparing for a home visit from your midwife.

 

Advice for pregnant women with suspected or confirmed coronavirus infection

Q. What should I do if I think I may have coronavirus or have been exposed to it?

If you are pregnant and you have 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 10 days.

The offer of testing is now open to anyone in the UK (including pregnant women), with coronavirus symptoms. You should visit the NHS 111 online service/NHS 24 in Scotland or call 119 to arrange testing. Do not go to a GP surgery, pharmacy or hospital without contacting them on the telephone first.

You should contact your maternity unit to inform them that you have symptoms suggestive of coronavirus, particularly if you have any appointments in the next 10 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 care provider as early as possible, 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 feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care.

You should contact your maternity care team, your GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.

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. This includes women who are in their third trimester, from a Black, Asian or minority ethnic background, over the age of 35, 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 illness, contact your midwife or, if 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 maternity 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
  • You have a home birth planned and have been asked to self-isolate prior to your due date

Q. What should I do if I’m asked to self-isolate because I have symptoms or confirmed coronavirus?

Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 10 days. If you live with other people, they should all stay at home for at least 14 days, to avoid spreading the infection..

Follow the NHS guidance on when and how to self-isolate.

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.

All pregnant women are recommended to take 10 micrograms of vitamin D supplementation daily. This is especially important if you are self-isolating as you may not be getting enough vitamin D from sunlight.

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 suspected/confirmed coronavirus and ask for advice on going to any 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. What do I do if I feel unwell or I am worried about my baby during self-isolation?

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

If you are advised to go to the maternity unit or hospital, you will be asked to travel by private transport, or arranged hospital transport and to alert the maternity unit reception once on site before going into the hospital. You will be required to wear a mask or face covering.

Q. Will being in self-isolation for suspected or confirmed coronavirus affect where I give birth?

As a precautionary approach, when pregnant women with suspected or confirmed coronavirus go into labour, they are being advised to go to an obstetric unit for birth where the baby can be monitored using continuous electronic fetal monitoring and their 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 a 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 to manage additional pressures and facilitate women’s choices to the best of their abilities.

There is currently no evidence to suggest that 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.

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.

If you have confirmed coronavirus or are experiencing symptoms of coronavirus (a cough, fever, or feeling unwell), labour and birth in a birthing pool is not recommended as the monitoring of vital signs and administration of therapy is more challenging in water.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. In an early 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 and high quality care, facilitating and respecting your birth choices as closely as possible.

When you and your maternity team decide that 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 may be provided with a face mask, which you will need to wear until you are isolated in a suitable room

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 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 (neonatologists) will examine your baby and advise you about their care, including whether your baby needs to be tested.

Q. Will I be able to stay with my baby/give skin-to-skin contact 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.

Q. How can I feed my baby if I have suspected or confirmed coronavirus?

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 the transmission of coronavirus through breastmilk. Provided your baby is well and does not require care in the neonatal unit, you will stay together after you have given birth, so skin-to-skin contact 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 if you have suspected or confirmed coronavirus.

If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines.

However you feed 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 or from a bottle
  • Consider wearing a mask or face covering while feeding
  • Follow recommendations for pump/bottle cleaning after each use
  • Consider asking someone who is well to feed your expressed breast milk or formula milk to your baby

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.

 

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?

We understand that it must be an anxious time if you are pregnant and you work in a public-facing role.

Despite the easing of restrictions from 4 July 2020, the advice remains that pregnant women who can work from home should continue to do so. If you can’t work from home, you can work in a public-facing role if this can be modified appropriately to minimise your exposure. This should be considered and discussed with your occupational health team and/or employer. If you are advised that it is safe to go to work, you should be especially careful and be diligent about social distancing and hand hygiene.

The RCOG, RCM and FOM joint Occupational Health document version 3.3, updated on 31 July 2020 is still available to provide you and your employer with clinical advice on the risk and potential implications of being severely affected by COVID-19, particularly if you are 28 weeks’ pregnant or more. This clinical advice still stands, however, how and where you can safely work should be advised by your employer, after they conduct a risk assessment of your workplace and your individual situation.

We recommend that employers use the clinical advice in our occupational health document, along with other sector-specific advice published on the UK government, and NHS Employers websites. We can assure you that the RCOG, RCM and Faculty of Occupational Medicine continue to act as clinical advisors on these documents published by government agencies.

Maternity Action has published FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful.

Q. What is the advice if I am 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 in. Some useful advice for healthcare workers on general precautions to prevent infection is available in the article here.