To the community, this is such a difficult time where in order to prevent the spread of the virus, there has been a limitation on who may accompany a birthing mother during labor. There have been certain circumstances where even the partner was not allowed. Things are changing literally moment to moment. In most hospitals, at least one person can accompany the birthing mom, You can advocate for your doula or birth support person to be there with you, because according to AWHONN recommendations, doulas are an essential member of the care team:
“Doulas are not visitors and should not be blocked from caring for patients in the antepartum, intrapartum and postpartum period. Most doulas have been contracted by patients weeks to months ahead of time and have established provider relationships. They are recognized by AWHONN and ACOG as essential personnel and part of the maternity care team.”
We also have to understand that we are in a time where we can be asymptomatic and still carry the virus and personal protective equipment is not in abundance. So, we have to understand that these policies are in place to protect you and your baby. The good thing is all providers are able to provide tele-health services.
El Camino Los Gatos/El Camino Mountain View: 1 Support person and no switching out with another person.
Kaiser: 1 visitor who cannot change throughout the duration of the birth and postpartum. NO visitors younger than 14.
Stanford: 1 support person with birthing mother
Sequoia: 1 support person with birthing mother, can switch out one other unique support person.
Valley Care (Pleasanton): As of 3/14: 1 partner, 1 unique visitor total. One person in the room at a time.
Alta Bates: 2 Visitors who cannot change throughout the duration of the birth and postpartum.
CPMC: 1 Visitor who cannot change throughout the duration of the birth and postpartum.
Sutter Health: 1 Support person.
UCSF: 1 Support person.
For most hospitals, some kind of screening procedure will be done.
The following information is from Evidence Based Birth®:
- According to the World Health Organization’s (WHO) most recent situation report here, there are now over 153,000 confirmed cases and 5,735 deaths globally
- The WHO published interim guidance on March 13, 2020, here.
- There is little research on the clinical presentation of COVID-19 in pregnant women and children
- There have been a few cases of infants with COVID-19 and they experienced mild illness
- So far, there is no evidence of mother-to-baby transmission, and when researchers tested women who were infected, the samples of amniotic fluid, cord blood, vaginal discharge, newborn throat swabs, and breast milk have all been negative.
- Some reports of PROM (premature rupture of membranes), fetal distress, and preterm birth have been reported when mothers became infected in the third trimester
- The mode of birth should be individualized and Cesarean used only when it is medically justified
- Standard infant feeding guidelines should be followed with appropriate precautions for infection prevention and control. These standard guidelines include initiating breastfeeding within 1 hour of birth and continuing to exclusively breastfeed for 6 months, continuing breastfeeding up to 2 years or beyond. Infected mothers who are breastfeeding or practicing skin-to-skin should wear a medical mask, perform careful hand hygiene, and clean and disinfect all surfaces. Infected mothers should still be provided with breastfeeding support. If complications prevent the infected parent from breastfeeding, they should be encouraged and supported to express milk for the infant for someone else to feed to the baby or to maintain milk supply. There should be no promotion of breastmilk substitutes (formula) or pacifiers.
- The WHO states, “Mothers and infants should be enabled to remain together and practice skin-to-skin contact, kangaroo mother care and to remain together and to practice rooming-in throughout the day and night, especially immediately after birth during establishment of breastfeeding, whether they or their infants have suspected, probable, or confirmed COVID-19.”
- The Centers for Disease Control and Prevention (CDC) in the Unites States (U.S.) publishes situation summaries here
- The CDC has a pregnancy/breastfeeding and COVID-19 page here
- ACOG Practice Guidelines: The American Congress of Obstetricians and Gynecologists published a practice advisory on March 13, 2020.
- ACOG has worked with the Society for Maternal Fetal Medicine to develop an algorithm that can be used to assess and manage pregnant women with suspected COVID-19.
- They encourage care providers to read and familiarize themselves with the complete list of recommendations from the CDC about inpatient obstetric facilities (see below).
- ACOG refers to the CDC guidance on breastfeeding and COVID-19 infection. They state, “Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets during the period of breastfeeding.”
- CDC Interim Guidance on Inpatient Obstetric Healthcare
- The CDC has released interim guidance on caring for pregnant women with suspected or confirmed COVID-19 in the inpatient hospital setting.
- In contrast to the WHO, the CDC recommends separation of a newborn from a mother with confirmed or suspected COVID-19: “To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother’s transmission-based precautions are discontinued.”
- The guidance goes on to say, “If colocation (sometimes referred to as “rooming in”) of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother’s wishes or is unavoidable due to facility limitations, facilities should consider implementing measures to reduce exposure of the newborn to the virus that causes COVID-19.”
- UpToDate® guidance for clinicians here
- There is very little info regarding COVID-19 during pregnancy
- Mother-to-baby transmission during pregnancy or birth has not been identified
- There have been at least two newborn cases documented
- Pregnant people are more susceptible to infectious diseases due to immune suppression during pregnancy
- Other respiratory infections—(SARS)-CoV, (MERS)-CoV, and influenza—have been shown to develop into more severe disease in pregnant people
- Out of 18 pregnant women with confirmed or suspected infection, there was no laboratory evidence of transmitting the virus to the newborn
- New research on PubMed: A retrospective study reviewed the clinical and CT imaging features of 59 people in China with COVID-19. This group included 14 non-pregnant adults with lab-confirmed infection, 16 pregnant women with lab-confirmed infection, 25 pregnant women with clinically diagnosed infection, and 4 children with lab-confirmed infection (Liu et al.)
- All of the pregnant women had mild illness. None were admitted to ICU and none of the babies had abnormalities or evidence of mother-to-baby transmission.
- Compared with the non-pregnant adults, the pregnant women (both lab-confirmed and clinically diagnosed) had atypical clinical features, making early detection difficult. It was more common for pregnant people to have an initial normal temperature—only 36% to 44% had a fever. This means that fever may not be as useful of a screening tool with pregnant people.
- It was also more common for the pregnant people with infection to have leukocytosis (increase in white blood cells) and elevated neutrophil ratio (a marker of inflammation) compared to the non-pregnant people with infection.
For other research updates that we sent out last week, view our COVID-19 resource page here.