The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) acknowledges the risk posed to the community, healthcare workers and all patients due to the COVID-19 pandemic. RANZCOG also recognises our responsibility to respond to this situation as a large organisation and also as a medical college and health leader.
 
The College respects the role of government, health departments and health administrators in coordinating a national response. The College has already issued general advice for healthcare workers and pregnant patients. The purpose of this communiqué is to address the issue of health and safety for pregnant health care workers and other at-risk workers.
 
The risk to pregnant healthcare workers is quite specifically impacted by the nature of their professional activities and exposure. While not directly applicable, the following advice can be extrapolated to other professions with a relatively high risk of exposure. This includes, but is not limited to teachers, child-care workers, aged-care workers and service providers with high volume contact.
 
Evidence has emerged over the course of the pandemic that pregnant women are at increased risk of becoming severely unwell if they develop COVID-19 infection in comparison to the general population. It is expected that the large majority of pregnant women will experience only mild or moderate cold/flu-like symptoms. However, infected pregnant women, especially those who are not fully vaccinated, have increased risks of hospitalisation, admission to intensive care, mechanical ventilation and death.
 
There is no current evidence of an increased risk of miscarriage or teratogenicity. The incidence of premature birth is increased and there is a slightly higher risk of stillbirth.

The risk of severe disease in pregnant women, as in non-pregnant people, differs according to the variant of the virus. Recent data show that infections with the Delta variant are significantly more likely to result in severe disease than those with the Omicron variant. Vaccination status remains the strongest predictor of disease severity regardless of the viral strain. The risk of severe disease in a fully vaccinated woman, without additional comorbidities, infected with the Omicron variant appears to be around 1% or less. Pregnant women can be reassured that the vast majority will have asymptomatic or mild disease but that they should seek medical advice early if they develop severe symptoms.
 

All health care workers in direct patient contact will potentially have increased exposure to COVID-19. This risk applies particularly, but is not limited to, those in nursing and midwifery, or those providing medical, or ancillary care, to known infected patients. This will increase their risk of contracting the disease. This applies to pregnant health care workers.
 
RANZCOG recommends that pregnant health care workers discuss their occupational duties with the employers. Where possible, consideration should be given to pregnant health care workers being allocated to patients, and duties, that have reduced exposure to patients with, or suspected to have, COVID-19 infection. This applies particularly to those workers with comorbidities or who are not fully vaccinated. All personnel should observe strict hygiene protocols and have full access to Personal Protective Equipment (PPE).
 
The College also urges employers to be sensitive to the fact that pregnant women are, appropriately, often anxious about their own health and protective of their unborn baby. Consideration should be given to reallocation to lower-risk duties, working from home or leave of absence.
 
The current circumstances are unprecedented. The community will rely on the medical system to function at the highest level and near 100 percent participation of the medical, nursing and midwifery workforce. Specialist practitioners may need to re-allocate to other areas of the medical system. The College expresses our deep and sincere gratitude to our members, all doctors, nurses, midwives and other health care workers, the administrative staff and management of our hospitals and health services for their dedication, professionalism and compassion.
 
RANZCOG recognises that decisions around resource allocation are complex, and multifactorial, and defers to local jurisdictions in this regard.