COVID-19: Protection of midwives and doctors in the birth unit

30 March 2020

Updated on 27 August 2021

Key points
  • Droplets are particles that are heavier, travel a short distance, and are contained/deflected by a surgical mask. Aerosol refers to smaller particles that can disseminate throughout a room and can pass through a surgical mask
  • Labour and birth are primarily associated with surface and droplet exposure but they are potentially aerosol-generating behaviours (AGB).
  • Caesarean section under general anaesthetic should be considered an aerosol-generating procedure (AGP). A caesarean section planned under a regional anaesthetic could be converted to a general anaesthetic
  • Updated advice is that N95 masks are required for healthcare workers caring for women with suspected or proven COVID-19 infection in labour, birth and caesarean section
  • The College recognises concerns regarding PPE supplies and recommends that information available to Government and Health Departments is shared in a transparent manner with healthcare workers
  •  Medical personnel should observe their local health organisation’s protocols, engage with their Infection Control Practitioner (if available).
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) acknowledges the risk posed to the community, health 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 governments, Ministry, health departments and health administrators in coordinating national responses. We continue to communicate regularly with the Chief Medical Officer and other authorities in both Australia and Aotearoa New Zealand. The purpose of this communiqué is to address the issue of protection of midwives and doctors in the birth unit. Availability and use of healthcare resources, the welfare of healthcare workers and patients and local hospital protocols are all considerations.
Midwives, doctors and other personnel caring for pregnant women, have a right to be fully informed about potential risks, and to have access to protective equipment. Health services should accept that all healthcare workers will feel vulnerable at this time, and ensure that appropriate supports are in place. RANZCOG accepts that guidance regarding PPE is not consistent across all jurisdictions and clinicians should follow the advice and protocols of their local authority.

RANZCOG is a bi-national College and it is important to note that advice may differ between Australia and Aotearoa New Zealand. The guidance from the New Zealand MoH is reproduced, with permission, in the chart below. The chart can also be found here.

* Please note: this statement continues after this chart

Currently, women are screened for exposure, symptoms or diagnosis prior to admission to the birth unit.  The current definition for suspected cases is available for Australia from the Communicable Diseases Network Australia COVID 19 Series of National Guidelines and for Aotearoa New Zealand from the Ministry of Health. At the start of the pandemic, the rate of community exposure was low and the relative risk of a screen-negative pregnant woman being an asymptomatic carrier was considered low.
However, the situation in some Australian States and areas of Aotearoa New Zealand has now changed, with an increasing rate of infection and community transmission.
Aerosol generating behaviour (AGB)= screaming, shouting, crying out, vomiting
Aerosol-generating procedures (AGP). Examples include: bronchoscopy, tracheal intubation, non-invasive ventilation (e.g. BiPAP, CPAP), high flow nasal oxygen therapy, manual ventilation before intubation, intubation, cardiopulmonary resuscitation, suctioning, sputum induction, nebuliser use
View the chart on the Victorian Department of Health and Human Services (DHHS)

Download the updated Guide to the conventional use of PPE (Word) from the Victorian Department of Health and Human Services (DHHS) website. It is also below.

Updated guidance from the Victorian Department of Health and Human Services (DHHS) is here

* Please note: this statement continues after this chart





General recommendations
  • Usual hygiene protocols should be followed, particularly hand washing and social distancing
  • All multi-use medical equipment and surfaces should be cleaned between patients, including antenatal assessment e.g. ultrasound or CTG 
  • Restrict support persons to one
  • Healthcare workers should minimise time in the room, allowing for provision of usual care, including CTG and abdominal palpation
  • Mobilisation and epidural anaesthesia may be used in the usual manner. Active mobilisation, use of water immersion in labour, and epidural analgesia are not affected.
  • RANZCOG recognises that there is limited information regarding the use of nitrous oxide in labour. Concerns relate to cleaning, filtering, and potential aerosolisation in the setting of Covid-19.  Given these considerations, RANZCOG advises a cautious approach i.e. that nitrous oxide should not be routinely provided to women who are defined as suspected, probable or confirmed for Covid-19 infection. If nitrous oxide is used in this setting then all exposed staff should wear appropriate PPE, as determined by the local health jurisdiction. Nitrous oxide may still be offered to women at low risk of Covid-19, as deemed appropriate by the midwife.
  • Consideration should be given to early epidural in labour as an option for analgesia e.g. as an alternative to nitrous oxide
  • Particularly during the pushing phase, the woman’s expulsive exhalation presents an increased risk of contact, faecal contamination, aerosol and droplet exposure to the doctor and midwife in the room.
  • All healthcare workers should wear protective apparel, fluid-repellant surgical mask and eye protection during the pushing phase, for all patients and N95 for suspected or proven COVID-19 patients
  • The patient who has proven or is suspected to be at high-risk for COVID-19 infection should be encouraged to wear an appropriate mask, recognizing that this may not be tolerable.
  • During the third stage, retain protective equipment and follow usual practice, including, where appropriate delayed cord clamping, controlled cord traction, skin to skin contact and initiation of breastfeeding




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