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Coronavirus infection and pregnancy

Information for pregnant women and their families

These Q&As were updated on 19 July 2021 and relate to Coronavirus (COVID-19) infection in pregnancy – guidance for healthcare professionals 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 COVID-19, including leaflets you can print, are available from the NHS website.

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.

 

COVID-19 and pregnancy

Q. What is the main advice for pregnant women?

Studies from around the world show that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly, two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. But people who are pregnant and unvaccinated or not fully vaccinated are at increased risk of becoming severely unwell if they catch COVID-19, which can lead to them needing intensive care and their baby being born prematurely.

Vaccination is strongly recommended in pregnancy and pregnant women are considered a vulnerable group within the COVID-19 vaccination programme, emphasising the urgency of them receiving COVID-19 vaccination and booster doses. Those who are pregnant, as a minimum, should follow the same guidance on COVID-19 as the general population (for example about vaccination, testing or self-isolation). Follow the latest advice on the .gov website.

Key advice for pregnant women:

  • COVID-19 vaccination is strongly recommended at any stage of pregnancy. Receiving two doses of the vaccine and the booster dose is the safest and most effective way of protecting you and your baby from COVID-19 infection (read our Q&As about COVID-19 vaccines and pregnancy for more information).
  • Pregnant women are a priority group for the booster vaccination.
  • Follow the government guidance on staying safe and preventing the spread of COVID-19.
  • Pregnant women who are unvaccinated or not fully vaccinated may choose to limit close contact with people they don’t usually meet with to reduce the risk of catching or spreading COVID-19, particularly if they are in the third trimester and when COVID-19 disease levels in the general community are high.
  • Keep mobile and hydrated to reduce the risk of blood clots in pregnancy.
  • Stay active with regular exercise, a healthy, balanced diet, and folic acid and vitamin D supplementation to help support a healthy pregnancy.
  • Attend all of your pregnancy scans and antenatal appointments unless you are advised not to.
  • Contact your maternity team if you have concerns about the wellbeing of yourself or your unborn baby.
  • Follow the health guidance for pregnant employees to ensure you are safe in your workplace. It remains a requirement for employers to carry out a risk assessment with pregnant employees to ensure a safe work environment.

More information on pregnancy and COVID-19 is available on the NHS website.

What should I do if I develop symptoms of COVID-19?

  • The main symptoms of COVID-19 are a high temperature, a new, continuous cough, or a loss or change to your normal sense of smell or taste (anosmia).
  • 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 COVID-19 infection.
  • 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 COVID-19 have on pregnant women?

Current evidence from the UK suggests that pregnant women are no more likely to get COVID-19 than other healthy adults, but if they are unvaccinated or not fully vaccinated, they are at increased risk of becoming severely unwell if they catch COVID-19, which can lead to admission to intensive care and premature birth of the baby. . Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms.

Studies have shown that there are higher rates of admission to intensive care units for pregnant women with COVID-19 compared to non-pregnant women with COVID-19. It is important to note that this may be because clinicians are more likely to take a more cautious approach when deciding whether to admit someone to the intensive care unit when a woman is pregnant.

At present, it is unclear whether pregnancy will impact on the proportion of women who experience ‘long COVID’ or a post-COVID-19 condition.

In the UK, information about all pregnant women requiring admission to hospital with COVID-19 is recorded in a registry called the UK Obstetric Surveillance System (UKOSS).

In pregnant women with symptoms of COVID-19, it is twice as likely that their baby will be born early, exposing the baby to the risk of prematurity.  Several international studies have also found that pregnant women who tested positive for COVID-19 at the time of birth were more likely to develop pre-eclampsia, more likely to need an emergency caesarean and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

UKOSS studies and more recent publications have found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for COVID-19. Pregnant women over the age of 35, those who had a BMI of 25 or more, 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. Living in areas or households of increased socioeconomic deprivation is also known to increase risk of developing severe illness.

Q. What effect will COVID-19 have on my baby if I am diagnosed with the infection?

Current evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far.

There is also no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage.

Transmission of COVID-19 from a woman to her baby during pregnancy or childbirth (which is known as vertical transmission) seems to be uncommon. Whether or not a new-born baby gets COVID-19 is not affected by mode of birth (i.e. vaginal birth or caesarean), feeding choice or whether the woman and baby stay together. It is important to emphasise that in most of the reported cases of new-born babies developing COVID-19 very soon after birth, the babies remained well.

Studies have shown that there is a two- to three-times increased risk of giving birth prematurely for pregnant women who become very unwell with COVID-19. In most cases this was because it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover. Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature – the earlier in the pregnancy a baby is born, the more vulnerable they are.

The UK Obstetric Surveillance Study (UKOSS) report from January 2021 describes 1,148 pregnant women with COVID-19 who were admitted to hospital between March and September 2020. Nearly one in five women with symptomatic COVID-19 gave birth prematurely. However, women who tested positive for COVID-19 but had no symptoms were not more likely to give birth prematurely. The babies of women with COVID-19 were more likely to be admitted to the neonatal intensive care unit (NICU), but almost all these babies did well. There was no statistically significant increase in stillbirth rate or infant death for babies born to women who had COVID-19. Not all the babies were tested, but overall, only 1 baby in 50 tested positive for COVID-19, suggesting that transmission of the infection to the baby is low.

Another study from the UK compared 3,500 women who had COVID-19 at the time they gave birth to over 340,000 women who did not have COVID-19 at the time they gave birth. This study found that pregnant women who tested positive for COVID-19 at the time of birth were twice as likely to have a preterm birth, and their risk of stillbirth was twice as high, although the actual number of stillbirths remains low.

Q. What research is being done to monitor the effect of COVID-19 on pregnant women and their babies?

The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for COVID-19 during pregnancy, through well-established systems already used by all maternity units (the UK Obstetric Surveillance System - UKOSS). Any new evidence published from this and other studies will be used to update our guidance.

Imperial College London are also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with COVID-19. 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 COVID-19 pandemic.

 

Domestic abuse

Q. What should I do if I am experiencing domestic abuse?

The COVID-19 pandemic has increased the risk of domestic abuse, including financial, emotional and physical abuse or violence. You can find more information on types of domestic abuse here.

If you are experiencing domestic abuse or violence:

  • Tell a healthcare professional (for example, your GP, health visitor or midwife) who can provide information and support to keep you and your baby safe.
  • You can also seek support and advice from the National Domestic Abuse helpline on 0808 2000 247 or the Women’s Aid COVID-19 resource hub.
  • If you are in immediate danger or it is an emergency, call 999.

 

Antenatal care

Q. How will the COVID-19 pandemic affect my routine antenatal and postnatal appointments?

The NHS is working to ensure that you, your baby and your family are supported and cared for during the pandemic. This means there may be some changes to how, when and where you attend essential routine appointments, and how safe, personalised care and support are offered to you.

For example, your maternity care may include more home visits or some care and support may be provided over the phone or by video. This will 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.

Antenatal and postnatal care is based on years of evidence to keep you and your baby safe through pregnancy, birth and beyond. It is essential that you attend all of your antenatal and postnatal care appointments (whether they have been arranged in-person or via phone/video), while adhering to social distancing measures as far as possible.

Q. Why are changes to antenatal and postnatal care necessary during the COVID-19 pandemic?

These changes help us deliver the best care without overloading our NHS services, which are crucial during the COVID-19 pandemic. This helps us to:

  • Reduce the number of people coming into hospitals where they may come into contact with other people and increase the risk of transmission
  • Ensure staff are not overwhelmed and stretched too far by the extra 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 COVID-19

This allows us to care for you and protect you from COVID-19 while also protecting NHS staff and services. If you have any concerns about you or your baby, you must still make contact with your maternity team.

Q. Who should I contact about my antenatal and postnatal care appointments?

You should contact your local maternity unit (or your GP surgery if you haven’t yet been seen at your local maternity unit) so you can be connected with the right person to discuss any questions or concerns you might have. You can also check on arrangements for all scheduled and future appointments.

If you have been allocated a local health continuity team or a named community midwife, you should continue to contact them by telephone to discuss any questions or concerns you might have.

Q. How many antenatal appointments will I have?

You will have at least six in-person 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 COVID-19 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.

Q. What should happen at my appointments?

You should be asked about your mental health at every maternity appointment, whether in-person or via phone/video.

In the third trimester, you should be asked about your baby’s movements at every maternity appointment, whether in-person or via phone/video.

All pregnant women should be provided with information about Group B streptococcus (GBS) in pregnancy and new-born 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 if a physical examination or test is not required. This will enable partners and other family or household members to join you for support and allow social distancing to protect you and your baby from COVID-19.

Q. Will I need to wear a facemask when I attend hospital for antenatal appointments, or to have my baby?

All NHS staff, visitors and outpatients, including pregnant women attending antenatal appointments or scans, must wear face coverings at all times (unless subject to an exemption) to protect other pregnant women, patients and staff from COVID-19. You should be told about this in any appointment letters. You will also find up-to-date information on local Trust websites and social media.

During birth/labour

Hospital inpatients, including women giving birth, are not required to wear masks. If you are having a planned caesarean, you may be asked to wear a face covering when you enter the hospital, until you get changed to go to theatre.

Birth partners will need to wear a mask whenever requested.

 

Pregnancy scans

Q. Will I be able to bring someone with me to scans?

Most maternity services in England, Scotland, Wales and Northern Ireland are now allowing one support partner to attend scan appointments, as long as they are not showing any COVID-19 symptoms. However, guidance on this varies between hospitals and Trusts. Please check with your maternity unit for their policy on visitors at scans.

It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular hand washing.

There is a possibility that visitor restrictions may be reintroduced in response to an increase in the local or national transmission risk.

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. If you choose to attend a private clinic for additional scans, you should still attend your NHS scans as advised by your maternity team.

 

Childbirth choices

Q. Will my childbirth choices be affected by the COVID-19 pandemic?

Like all areas of NHS care, maternity services have been affected by the pandemic. Maternity units have been working to manage additional pressures and facilitate women’s choices. They 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. It’s important to note that staffing levels may still necessitate closure of midwifery led units.

 

Birth partners

Q. Will I be able to have my birth partner with me during labour and birth?

Yes, you are able to have one birth partner present with you during labour and birth. Your birth partner must wear a mask in hospital.

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

If a birth partner has symptoms of COVID-19, has recently tested positive for COVID-19 or is required to self-isolate for other reasons, they should follow government advice and self-isolate at home, to safeguard the health of you, other women and babies and the maternity staff supporting you.

To prepare for this, women and their current birth partner are encouraged to choose a ‘back-up’ birth partner, if required.

In some hospitals and maternity units, restrictions on visiting remain in place. This 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, your birth partner will be able to be there during your labour and the birth, unless they are unwell with COVID-19 symptoms or have tested positive for COVID-19.

Q. Will I be able to have my birth partner with me if I am being induced?

A birth partner without symptoms of COVID-19 should be able to attend your induction of labour, particularly if that is in a single room (e.g. on the maternity suite or labour ward). If the induction takes place in a bay on a main ward, whether your birth partner can be there will be dependent on the local NHS Trust/Board’s assessment of safety, including whether it is possible to maintain the necessary social distancing measures.

Please be assured that if your birth partner is unable to be with you on a ward during your induction, this will not impact on your birth partner’s presence during labour and the birth, unless they are unwell with symptoms of COVID-19 or have tested positive for COVID-19. 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.

Local guidance

Visiting in hospitals is still 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.

It is possible that visitor restrictions may be reintroduced in response to an increase in the local or national transmission risk.

Q. Will my birth partner be able to stay with me if I have a caesarean or instrumental birth that occurs in an operating theatre?

We fully support women having a birth partner with them during labour and birth.

Around one in four women in the UK has a caesarean birth. Around one in five women in the UK has an instrumental (assisted) birth (ventouse or forceps). Some instrumental births may also occur in an operating theatre so that the maternity team can 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 COVID-19 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.

General anaesthetic and emergency caesareans

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 COVID-19 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 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 to be present. This is because, during an emergency, operating theatres are more high-risk environments for the potential spread of COVID-19 to anyone who is present.

If your birth partner cannot 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 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?

This depends on your hospital or local health Trust’s policy on visiting, so please check with your maternity unit.

Where visitors are allowed, it is important that they follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

There is a possibility that visitor restrictions may be reintroduced in response to an increase in the local or national transmission risk. 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 any restrictions in place are there to reduce the risk of transmission of COVID-19 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 new-born babies after birth.

Q. What is the advice for birth partners during the COVID-19 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 COVID-19 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. 
  • Every woman should be able to have a birth partner stay with her through labour and birth, unless the birth occurs under a general anaesthetic.
  • To help prevent spread of COVID-19 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 COVID-19 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 are being encouraged to choose a ‘back-up’ birth partner, if required. This person does not need to be from the same household as you.
  • If you are supporting a woman during labour and birth, please be aware of the strict infection control procedures in place to prevent the spread of COVID-19 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 or touch any theatre equipment/’furniture’, 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

 

COVID-19 testing

Q. Will I be tested for COVID-19?

Appointments

To minimise the spread of COVID-19 in hospitals, you may be asked to have a test before you attend a scan or appointment, regardless of whether you have COVID-19 symptoms or not. You can order free rapid (lateral flow) tests online.

Planned caesarean and induction of labour

If you are coming to hospital for a planned caesarean birth or induction of labour, it is recommended that you are offered testing before being admitted.

This may be in the form of a PCR test and a period of self-isolation, or a lateral flow test on the day of the procedure (provided you are fully vaccinated, asymptomatic and have not had contact with anyone with suspected or confirmed COVID-19 within the last 10 days).

Homebirths

You may also be asked to self-isolate and offered a test before a home birth.

Testing problems or coming in at short notice

If you have difficulties with home testing or need to come in at short notice, your hospital will be able to help.

For all of the above, your maternity team will be able to advise you on their local testing protocol and what is suitable for you.

Q. How does the COVID-19 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 or just your nose.

If you have symptoms of COVID-19 and you are awaiting test results while in hospital, you may be treated as potentially infectious until the result is returned.

If you have symptoms of COVID-19 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. If you need to stay in hospital for a few days, you may be offered repeat testing during your stay, even if you do not have any symptoms of COVID-19.

Q. What is an antibody test – will I have this?

An antibody test is a blood test. If it is positive it can tell you it’s likely you’ve had COVID-19 before, or that your body has created antibodies from the vaccine.

However, some people who have had the virus and/or the vaccine do not have antibodies, so the test does not tell you if you are immune to COVID-19 or whether you can spread the virus to other people.

Who can have antibody testing?

At the moment, an antibody test is not available to everyone. You may be offered a free antibody test if you have taken a PCR test for COVID-19 and it is positive. It may also be offered to you as part of a research trial. It is also available for people working in some healthcare and educational settings. If you are not eligible for a free antibody test, you can opt to pay for one at a private clinic.

Currently, we do not routinely use antibody testing when caring for women in their pregnancy but hope that the research being carried out will help us to learn more about how our immune systems respond to COVID-19 infection.

Q. Will my birth partner be tested for COVID-19?

It is possible that your birth partner may also be offered testing for COVID-19 when you attend a scan or appointment, or are admitted to hospital. Your maternity team will be able to advise you further.

Q. What if I decline testing for COVID-19?

If you decline testing for COVID-19 before 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 of COVID-19 your care will be the same as for any woman who potentially has COVID-19.

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 COVID-19.

 

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 getting COVID-19 or of becoming seriously unwell if you are fully vaccinated. If you have not been vaccinated before or during pregnancy, or have only had one dose of the vaccine, it is strongly recommended that you get vaccinated as soon as possible after giving birth.

If you have been pregnant recently, your immune system is regarded as normal unless you have other underlying medical problems or infection. It is important, however, to remain nourished with a balanced diet, and to take gentle exercise.

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

Staying safe

Follow the latest government guidance to stay safe and help prevent the spread of COVID-19. Close observation of hygiene, including washing hands regularly, is important among all members of your household, and they should be careful when holding your baby if they have symptoms of any illness.

Getting help

It is important that your baby is feeding well and gaining weight. If you have any concerns, please contact your midwife. 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 COVID-19 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.

Your first postnatal visit should be within 36 hours of coming home from the maternity unit or after a home birth. Ideally the visit should be face-to-face at your home, but this will depend on individual circumstances and preferences.

If you and your baby are well, you will usually be seen on day 5 and 10, and then discharged from the midwifery team. After this, you will be looked after by the health visiting team who will normally arrange to see you between 7-14 days later. You may have already met your health visitor or a member of their team before you had your baby.

You will also be offered the new-born heel-prick test.

This useful infographic is designed to help you prepare for a home visit from your midwife.

 

Postnatal contraception

Q. Why is it important to think about contraception during pregnancy and immediately after my baby is born?

Your fertility can return rapidly after birth, even if you choose to breastfeed. This can be as early as 21 days after your baby is born. Starting contraception soon after birth allows you to make family planning choices.

Planning the timing of a further pregnancy is important. Research shows that a short time between pregnancies (less than 12 months) can increase the chance of a complication in the next pregnancy, including having a small baby or an early birth (preterm birth). It could also have a serious impact on your mental health if you become pregnant unexpectedly.

During the pandemic, access to contraception in sexual health services (‘family planning clinics’) and in GP practices has been significantly reduced. Your midwife or doctor should discuss your contraceptive choices for the postnatal period during both your pregnancy and following the birth of your baby.

Q. What methods of contraception are suitable after my baby is born?

Most methods of contraception, except combined hormonal contraception, can be started safely by most women immediately after birth, whether you choose to breastfeed or not. Your midwife or doctor will discuss options with you and help you make an informed choice about what would be suitable for you.

Long-lasting contraception

There are several forms of contraception that are very effective and last for several years, without you having to take a tablet each day – these are known as long-acting reversible contraception or LARC methods. These include:

  • An IUD (intrauterine device) or IUS (intrauterine system) - devices that are placed in your womb, also known as the ‘coil’
  • A contraceptive implant (a rod that is placed under the skin in your upper arm).

Hormonal pills and other options

Other methods include a pill that contains the hormone progestogen (taken every day), an injection that is given every 3 months, and condoms. Your midwife or doctor can give you more information about each of these contraceptive methods.

If you are very keen to use the combined hormonal contraceptive pill (‘the pill’) your midwife or doctor will discuss the benefits and risks and make sure this is a safe method for you, and when it is safe to start after having your baby.

Q. Can I get a device inserted in to my womb before I go home after my baby is born?

In many hospitals there are doctors and midwives who are trained to insert a contraceptive device (IUD) during a caesarean birth, after a vaginal birth or any time up to 48 hours after the birth of your baby. Not all maternity staff are trained in these techniques and in some maternity units these devices are not currently available. Your midwife or doctor should discuss your contraceptive choices for the postnatal period both during your pregnancy and following the birth of your baby and explain what methods are available in your maternity unit.

If it is not possible to fit an IUD within 48hrs of the birth of your baby, they should be able to provide information on who to contact to arrange an appointment. This may mean you have to wait 4 weeks from the birth of your baby to have it fitted and a different type of contraception may be offered until you are able to have this appointment.

If you have had an IUD fitted before going home, your medical team will provide advice on when to arrange to get your threads checked and what to do if you are worried that the device has fallen out.

Q. Can I get an implant inserted in to my arm before I go home after my baby is born?

In many hospitals there are doctors and midwives who are trained to insert contraceptive implants immediately after you have given birth and before you go home. If the implant is inserted in the first 3 weeks after your baby is born, this should provide you with effective contraception.

Not all maternity staff are trained in these techniques and in some maternity units the contraceptive implant is not currently available. Your midwife or doctor should discuss your contraceptive choices for the postnatal period both during your pregnancy and following the birth of your baby and explain what methods are available in your maternity unit.

They should be able to give you information on local clinics to arrange fitting if they are unable to provide this service.

Q. Can I take emergency contraception if I have had unprotected sex after having my baby?

If you have had unprotected sex and your baby is less than 21 days old, you do not need to take emergency contraception.

If you have had unprotected sex 21 days or longer after childbirth, then emergency contraception is advised.

Breastfeeding and fertility

Some women use the lactational amenorrhoea method (LAM) as a form of contraception. This is a natural form of contraception that is related to exclusive breastfeeding. Women can be reassured that LAM is a highly effective method of contraception but should be aware that the criteria for this method includes: fully breastfeeding, free from periods and less than 6 months since childbirth. The risk of pregnancy increases if the frequency of breastfeeding decreases e.g. stopping night feeds, if your periods return or more than 6 months after your baby is born. If you are unsure if you need emergency contraception, please speak to your doctor or health care professional for advice.

If you need emergency contraception, you will be able to discuss which method is best and safe for you. You may be offered a pill (even if you are breastfeeding) or fitting of a copper intrauterine device (Cu-IUD).

Your doctor can also discuss your ongoing contraception needs and advise if any sexual health screening is advised.

 

Advice for pregnant women with suspected or confirmed COVID-19 infection

Q. What should I do if I think I may have COVID-19?

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 get tested for COVID-19, and self-isolate until you have a received a negative test result. If you are unwell, 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.

Anyone in the UK (including pregnant women) can get tested if they have symptoms of COVID-19. Find more information on getting a COVID-19 test here. If you suspect COVID-19 infection, do not go to a GP surgery, pharmacy or hospital without contacting them by phone first, unless it is an emergency. In an emergency you should inform the healthcare team immediately that you suspect you may have COVID-19.

Free rapid (lateral flow) testing is available to all, and can be carried out if you do not have any symptoms of COVID-19 every 3-4 days. You can have these tests sent to your house for free. This is because many people with COVID-19 do not have any symptoms but could still spread the virus. If you take a lateral flow test and the result is positive, even if you feel well, you should self-isolate and arrange a PCR test to confirm the result as soon as possible. You should continue to self-isolate until the result is back.

Other causes of fever in pregnancy

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.

Q. What should I do if I think I have been exposed to COVID-19?

COVID-19 is spread through close contact with people who have the virus. People with the virus can spread it even if they do not have symptoms. When someone with the virus breathes, speaks, coughs or sneezes, they release small droplets containing the virus. You can catch COVID-19 if you breathe in these droplets or touch surfaces covered with droplets.

If someone in your household tests positive for COVID-19, even if you have no symptoms you should get a PCR test to confirm whether you are also infected.

You may not need to self-isolate if a member of your household is positive, provided you have had a negative PCR and any of the following apply:

  • you're fully vaccinated – this means 14 days have passed since your second dose of a COVID-19 vaccine given by the NHS
  • you're under 18 years, 6 months old
  • you're taking part or have taken part in a COVID-19 vaccine trial
  • you're not able to get vaccinated for medical reasons

Even if you don’t have symptoms, you should still follow advice on how to avoid catching and spreading COVID-19 and consider limiting contact with people who are at higher risk from COVID-19

If you have been contacted by NHS Test and Trace or the NHS COVID-19 app because you've been in contact with someone with coronavirus (COVID-19) and told to stay at home (self-isolate) it is a legal requirement to do so. You could be fined if you do not do this. You will not need to self-isolate if you fulfil any of the criteria mentioned in the bullet points above, but may be asked to get a PCR test to confirm you are not infected with COVID-19.

Q. What should I do if I test positive for COVID-19?

If you test positive for COVID-19 outside of a hospital setting, you should contact your midwife or maternity team to make them aware of your diagnosis. This is so they can rearrange appointments during your self-isolation period or arrange an alternative method of consultation e.g. telephone/video consultation, if it is appropriate to do so.

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.

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. 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 COVID-19, 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 COVID-19 and you’ve been advised to recover at home
  • You have a planned caesarean birth or induction of labour 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
  • You have been informed by NHS Test and Trace to self-isolate

Q. What if I’m asked to self-isolate because I have symptoms or confirmed COVID-19?

Self-isolation is when you do not leave your home because you have or might have COVID-19. This helps stop the virus spreading to other people.

Self-isolate straight away and get a PCR test (a test that is sent to a lab) as soon as possible if you have any of these 3 symptoms of COVID-19, even if they are mild:

  • a high temperature
  • a new, continuous cough
  • a loss or change to your sense of smell or taste

If this test is positive you should stay at home for 10 days (you may be able to stop self-isolating 7 days after a positive PCR if you meet specific conditions) and avoid contact with others in your household as much as possible. Find out about help and financial support while you're self-isolating.

You must not go to school/work/public places – work from home if you can. Do not go on public transport or use taxis. Do not go out to get food and medicine – order it online or by phone, or ask someone to bring it to your home. Do not have visitors in your home, including friends and family – except for people providing essential care. Do not go out to exercise – exercise at home or in your garden, if you have one.

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

Staying active

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.

Vitamin D

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. Vitamin D supplements are available from most pharmacies and supermarkets, and for eligible families through the NHS Healthy Start scheme

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 in self-isolation for suspected/confirmed COVID-19 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, they will make arrangements 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 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. Let them know that you are self-isolating. 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 COVID-19 affect where I give birth?

If you have tested positive for COVID-19 in the last 10 days without any symptoms, are otherwise low risk and wish to give birth in a midwifery led unit or at home, you should discuss this with your doctor or midwife.

If you have mild symptoms of COVID-19 and show signs of early (latent phase) labour, you can remain at home, which is the routine care we offer, provided there are no other concerns about you or your baby’s health.

As a precautionary approach, if you suspect you have COVID-19 due to symptoms or have confirmed COVID-19 with symptoms, we advise that you labour and deliver in an obstetric unit where the baby can be monitored using continuous electronic fetal monitoring and your oxygen levels can be monitored hourly.

Continuous fetal monitoring is a technique used to check how your baby is coping with labour. It records baby’s heart beat and your contractions through your abdomen (tummy), and the midwife and doctors looking after you can use this to check for signs that your baby is well. 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.

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 COVID-19, 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 COVID-19 or are experiencing symptoms of COVID-19, 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.

Q. If I have suspected or confirmed COVID-19, will this affect my choice of pain relief in labour?

There is no evidence that women with suspected or confirmed COVID-19 cannot have an epidural or a spinal block, unless there are other reasons why this may not be suitable for you.

Initially, we were unsure if using gas and air (Entonox) may increase the spread of the virus if you are positive for COVID-19. However, a review of the evidence suggests that Entonox is not an aerosol-prone procedure, so there is no reason you cannot use this in labour.

The use of tablets/injections for pain relief in labour is individualised for every patient. If you are experiencing mild symptoms of COVID-19 and you and your baby are well, it is likely that you will be able to take the routine medication offered to women in labour.

A good time to discuss your preferences and the choices available for pain relief in labour is at your appointment with your midwife to discuss your birth plan, but it can be brought up at any appointment if you have questions or concerns.

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 COVID-19 infection.

Women who have tested positive for COVID-19 in the last 10 days with no symptoms, are otherwise low risk and want to deliver in a midwifery led unit or at home should have a discussion with their doctor/midwife to decide on the most appropriate place to have their baby. Ideally this should happen before the onset of labour, so please contact your midwife if you think you have or have tested positive for COVID-19.

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/if 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

As a precautionary approach, if you suspect you have COVID-19 due to symptoms or have confirmed COVID-19 with symptoms, we advise that you labour and deliver in an obstetric unit where the baby can be monitored using continuous electronic fetal monitoring and your oxygen levels can be monitored hourly.

Continuous fetal monitoring is a technique used to check how your baby is coping with labour. It records baby’s heart beat and your contractions through your abdomen (tummy), and the midwife and doctors looking after you can use this to check for signs that your baby is well. 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.

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 COVID-19, 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 COVID-19 or are experiencing symptoms of COVID-19, 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.

Q. Could I pass COVID-19 to my baby?

Current evidence suggests that if transmission from a woman to her baby during pregnancy or birth (vertical transmission) does occur, it is uncommon.

If your baby develops COVID-19 infection, it is not affected by the mode of birth, feeding choice or whether mother and baby stay together. In most reported cases of new-born babies with COVID-19, the babies did not suffer severe infection.

A small number of babies have been diagnosed with COVID-19 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 COVID-19?

If you have confirmed or suspected COVID-19 when the baby is born, doctors who specialise in the care of new-born 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 COVID-19?

Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth.

If your baby is in the neonatal unit, the nurses and doctors there will give you guidance as to when it is safe for you to have skin-to-skin contact with your baby.

In some other countries, women with confirmed COVID-19 have been advised to separate from their baby for 14 days. However, this may have 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 to individualise care for your baby.

Q. How can I feed my baby if I have suspected or confirmed COVID-19?

If you have suspected or confirmed COVID-19, a discussion about the benefits and risks of infant feeding, including breastfeeding should take place between you, your family and your maternity team.

There is no strong evidence to show 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 COVID-19 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 started and supported if you choose.

If you are too unwell to care for your baby, or if direct breastfeeding is not possible, you should be offered support to express your breastmilk by hand or using a breast pump, and/or be offered access to donor breast milk. A dedicated breast pump for you should be used while you are in hospital.

Formula feeding is entirely acceptable if this is your choice.

Taking care when feeding

The main risk of feeding is close contact between you and your baby, as if you cough or sneeze, this could contain droplets that are infected with the virus, leading to infection of the baby after birth.

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

However you choose to 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 breastmilk or formula milk to your baby
  • Babies should not wear face masks as this risks suffocation.

Further information on infant feeding during the COVID-19 pandemic is available from UNICEF.

 

Occupational health guidance for pregnant women who work in a public-facing role

Q. What is the advice for pregnant employees?

The UK government has published COVID-19 advice for pregnant employees, including pregnant healthcare professionals. The guidance will help you discuss with your line manager and occupational health team how best to ensure health and safety in the workplace. The RCOG and RCM has provided clinical advice to the government and the Health and Safety Executive (HSE) on this guidance. If you have concerns about your risk assessment and the resulting recommendations, you should speak to your employer in the first instance. If you are still not satisfied, consider contacting your trade union representative or, if you do not have a trade union representative, Maternity Action has published lots of helpful information. Maternity Action has also published FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful.

Q. Why does the RCOG not provide detailed occupational health advice?

Earlier in the pandemic, the RCOG provided occupational health advice. This has now been archived.

The government has now published Coronavirus (COVID-19): advice for pregnant employees. This guidance notes that information contained in the RCOG/RCM guidance on COVID-19 in pregnancy should be used as the basis for a risk assessment.

Evaluating safety at work for an individual requires knowledge of both the individual’s health and their job. Therefore, while the clinical information we have published still stands, the risk assessments and the resulting conclusions in relation to safety at work will differ by country, region and between employment sectors. A single recommendation is no longer appropriate and therefore, it has been necessary to archive our occupational health guidance for pregnant women.

Q. What is the advice for pregnant women about going to work following changes to shielding guidance?

The government made changes to their shielding advice on 15 September 2021. In England, people considered to be clinically extremely vulnerable, including pregnant women with significant congenital or acquired heart disease, would not be advised to shield again and no further names will be added to the Shielded Patient List in England. This is a new update following the government’s initial pausing of the shielding programme on 1 April 2021.

The requirement to undertake a risk assessment for pregnant women has not changed as a result of the updated shielding advice.

Information for women in Scotland who are pregnant with significant congenital or acquired heart disease can be found on the Scottish Government website. Women with these conditions will continue to be on the Scottish Government’s Highest Risk List but can follow the same measures and guidance as the rest of the population, including going into the workplace.

Please visit Public Health Wales for any separate arrangements.

We have information for healthcare professionals and pregnant women about COVID-19 vaccination, including a decision aid. The guidance set out in section 2 of RCOG/RCM guidance on COVID-19 in pregnancy is also dedicated to COVID-19 vaccination in pregnancy.

Pregnant women are a priority group for booster vaccinations, which are offered to all adults in the UK 3 months after their second vaccine. It is particularly important for women with underlying health conditions and those who work in health and social care to get their COVID-19 booster.

Q. What is the advice on going to work if I am pregnant and have not been vaccinated? Or if I have not yet had my second dose?

This section relates to women who are pregnant and are either unvaccinated or are still awaiting their second dose (to become fully vaccinated). If this is the case, you should take a more precautionary approach.

This is because you have an increased risk of becoming severely ill and of pre-term birth if you contract COVID-19. Therefore, you should seriously consider getting the COVID-19 vaccine and completing your vaccination schedule of 2 doses to protect yourself and your baby. The RCOG/RCM guidance on COVID-19 in pregnancy contains information on vaccine safety and effectiveness, while this information for healthcare professionals and pregnant women about COVID-19 vaccination includes a decision aid and Q&As on pregnancy, fertility and breastfeeding.

All employers should undertake a workplace risk assessment, and where appropriate consider both how to redeploy these staff and how to maximise the potential for homeworking, wherever possible.

Where adjustments to the work environment and role are not possible (for example, in manufacturing or retail industries) and alternative work cannot be found, you should be suspended on paid leave. Advice on suspension and pay can be found in HSE guidance.