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A message for pregnant women and their families
 

Updated Thursday 6 August 2020

 

Key points

  • Most aspects of this advice have not changed. This update consolidates some new information that has become available.
  • For pregnant women who do become unwell with COVID-19 and require hospital admission, about 1 in 10 will require admission to ICU for help with breathing or other organ support.
  • There have been reports suggesting a small risk that the virus may pass from the mother to the baby (vertical transmission). In cases where babies have been infected there has been no evidence of harm. 
  • All advice must take into consideration the impact of increasing rates of community transmission.


Pregnancy is a time of great joy and expectation for most women and their families. Following the declaration of the COVID-19 (coronavirus) pandemic, we understand that all pregnant women will feel a great sense of anxiety about their own health and that of their unborn or newborn baby. The following information is to inform our patients of the knowledge available to us now regarding risks to pregnant women and their offspring, advice regarding self-care during pregnancy and changes to the way that antenatal and postnatal care will be delivered.

Additionally, helpful resources and up-to-date resources will be available on the College website. RANZCOG is monitoring the evolving situation very carefully and accessing expertise in Australia, New Zealand and around the world e.g. Royal College of Obstetricians and Gynaecologists.

We are cognisant of the fact that it is hard for us to give definitive advice because information what applies in one country, State, or setting, may not be generalisable to another. New Zealand’s experience has been very different to that in Australia, Victoria in particular. What we can do is undertake to keep our information as updated as possible in what is a rapidly evolving situation.


1. Are pregnant women at increased risk of becoming infected with COVID-19?
There is no evidence that pregnant women are at increased risk of becoming infected with COVID-19. However, pregnant women should be considered a vulnerable group as a precaution, and follow government guidance to reduce the risk of becoming infected (social distancing, masks as directed, hand hygiene).

2. Are pregnant women at increased risk of developing severe disease/complications from COVID-19?
At this time, pregnant women do not appear to become more severely unwell if they develop COVID-19 infection than non-pregnant women of the same age. The large majority of pregnant women will experience only mild or moderate symptoms including fever, cough, loss of smell, headaches and fatigue. Most of these women will make a full recovery without need for review in hospital.
 
About 1 in 3 women who develop COVID-19 whilst pregnant will require admission to hospital. For some of these women, this will be to give birth at the end of pregnancy and not because of symptoms from COVID-19. In those women who do become unwell with COVID-19 and require hospital admission, about 1 in 10 will require admission to ICU for help with breathing or other organ support.
 
International experience of COVID-19 in pregnancy has shown that women in the third trimester of pregnancy, women from Black, Asian and minority ethnic groups, those over the age of 35 and those with pre-existing medical problems, may be more at risk of becoming unwell and requiring admission to hospital. These women should be pay particular attention to following advice about social distancing to ensure they reduce the risk of infection where possible.

3. Is there an increased risk of miscarriage with COVID-19?
For women who are trying to conceive, or who are in early pregnancy, there is no evidence to suggest an increased risk of miscarriage with COVID-19.

4. Can I transmit the virus to my baby while I am pregnant?
There have been reports suggesting a small risk that the virus may pass from the mother to the baby (vertical transmission). It is rare for this to happen in the womb or whilst giving birth (2 in 100 pregnancies).  In babies that have been infected with COVID-19, they have largely remained well and not needed any additional care. Woman should remain reassured, that there is currently no evidence that COVID-19 will harm your baby or cause abnormalities during pregnancy.

5. Can I still give birth in a hospital if I am diagnosed with COVID-19 infection?
The safest place to birth your baby is in a hospital, where you have access to highly trained staff and emergency facilities, if they are required. It is important to emphasise that a woman’s experience of labour and vaginal birth, or caesarean section, should not be significantly impacted and women should be encouraged, and supported, to approach this extraordinary time of their lives without fear or apprehension. Medical intervention, other than that specifically related to infection control, should not differ significantly from usual practice. Active mobilisation, use of water immersion in labour, and epidural analgesia are not affected. However, in the setting of increased community transmission of coronavirus (COVID-19), services are advised to suspend the use of water immersion for labour and birth for all women. The protection of our maternity and neonatal health care workforce is essential. PPE is not effective when wet and consequently, the use of water immersion during this period presents an unacceptable risk.

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.

6. Do I need to have a caesarean section or interventional birth to reduce the risk of transmitting the virus to my baby?
There is no evidence that caesarean section or induction of labour is necessary to reduce the risk of vertical transmission. Additional maternal and fetal surveillance may need to be considered during this time.

7. What are the risks to my baby if I am diagnosed with COVID-19 infection?
In some women who become unwell with COVID-19 there is an increased risk of having a baby preterm (before 37 weeks). In the UK, this occurred in 1 in 4 women who were admitted with COVID-19. The majority of these preterm births happened towards the end of pregnancy (between 32 -37 weeks). The risk of going into preterm labour does not appear to be higher than for women without COVID-19. However, for some mothers towards the end of pregnancy it may be safer for either the mother or the baby to be delivered earlier.  Newborn babies and infants do not appear to be at increased risk of complications from the infection, but those born preterm may need to be cared for in the neonatal unit until they are ready to be discharged home.

8. Can I still go for my routine antenatal check ups and tests, and receive antenatal vaccinations if I am diagnosed with COVID-19 infection?
Routine antenatal investigations, ultrasounds, maternal and fetal assessments should continue as before, allowing for the modifications suggested below. If you are diagnosed with COVID-19 infection your healthcare provider may arrange for you to have some extra scans to monitor your baby’s growth and development as a precaution.

While it will not influence response to COVID-19 infection, routine whooping cough and influenza vaccination should continue to be administered in pregnancy.

9. Can I still breastfeed if I am diagnosed with COVID-19 infection?
Women who wish to breastfeed their babies should be encouraged and supported to do so. The well-recognised benefits of breastfeeding outweigh any potential risks of transmission of COVID-19 through breastmilk. If the mother has COVID-19 infection she should not be automatically separated from her baby but additional hygiene measures should be implemented.

However the baby is fed (breastfeeding, expressed milk, formula) the following precautions are recommended:

  • Handwashing prior to touching the baby, breast pump or bottles.
  • Wear a mask whilst feeding and holding the baby
  • Follow guidelines for cleaning/sterilisation of bottles and breast pump


10. How can I prevent getting COVID-19 infection?
Unfortunately, no vaccination is currently available for COVID-19. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) advises the following preventative measures:  

  • Hand washing regularly and frequently with an alcohol-based hand rub or soap and water 
  • Avoidance of anyone who is coughing and sneezing
  • Avoid touching eyes, nose and mouth
  • Social-distancing and reducing general community exposure
  • Early reporting and investigation of symptoms
  • Prompt access to appropriate treatment and supportive measures for infection or concerns about the pregnancy
  • Limit support person to one
  • If your partner has COVID-19, or is symptomatic, they should not accompany you to the hospital

11. Is it safe to still travel and go outdoors?
Pregnant women are advised to avoid all non-essential travel. Generally speaking, it is safest to stay at home and to avoid public spaces. Reduce your use of public transport and work from home, if possible.

Whist at home women are encouraged to remain active, well hydrated and eat a healthy balanced diet.

12. What are hospitals and medical clinics doing to minimise the risk of COVID-19?
RANZCOG has recently outlined some of the specific risks posed to pregnant patients and health care workers due to the COVID-19 pandemic. As such, RANZCOG has encouraged public and private hospitals and private practitioners to proactively implement strategies to reduce the risk of exposure for both patients and medical staff. It is essential that Australia and New Zealand continue to maintain a high-quality obstetric service in the setting of the unprecedented COVID-19 pandemic.

In order to keep health care workers and patients safe, staff will be wearing appropriate Personal Protective Equipment (PPE).

RANZCOG continues to support excellence in provision of antenatal, birth and postnatal care but changes to the way routine pregnancy care is delivered may be required. These may, include:
  • Reducing, postponing and/or increasing the interval between antenatal visits
  • Limiting time of all antenatal visits to less than 15 minutes
  • Using telehealth consultations in Australia or New Zealand as a replacement, or in addition to, routine visits
  • Cancelling face to face antenatal classes
  • Limiting visitors (partner only) while in hospital
  • Considering early discharge from hospital
  • Minimise risk of neonatal complications by avoiding early planned birth unless clearly clinically indicated
  • Preadmission COVID-19 testing


13. What should I do if I become unwell?
If you develop cold/flu symptoms (fever, cough, sore throat, nausea, vomiting, diarrhoea, fatigue, difficulty breathing) please follow local guidance to arrange COVID-19 testing (fever clinic, GP practice, Emergency Department). If you have any of these symptoms, or are required to self-isolate, or are diagnosed with COVID-19, you should notify your healthcare provider to reschedule or delay your appointment, and ensure appropriate medical care during this period. This will enable you to continue to receive antenatal or postnatal care and reduce the risk to other pregnant patients or health workers.

If you are concerned about your health or the wellbeing of your baby, you should contact your healthcare provider to determine if you need to attend the hospital or require additional care at home.
 
14. I feel anxious about COVID-19
There has necessarily, and appropriately, been an emphasis on the physical implications of the COVID-19 infection on the health of the community. However, we must remain aware that pregnancy and parenting are associated with anxiety and depression and that the current environment will only exacerbate this risk for women, their partners and families. Screening, diagnosis and management of perinatal anxiety and depression, substance misuse and domestic violence must continue and services must be supported. Seek advice and help from your health professional if you are concerned.

Your doctors, midwives and other health workers care about you and your baby. We understand that you will feel worried. Take the opportunity to rest, eat well and maintain your interests and hobbies, where possible. Your baby has the best protection it will ever have i.e. you, so caring for yourself, your emotional and physical health, is what is most important. We want to reassure you that the risk to you, and your baby, is extremely small. The medical system and dedicated staff are well-trained, world-class, committed and equipped to care for you.

The College, all of our members and staff, are thinking of you and caring for you. Pregnancy, birth and parenting should be a happy time for mothers, fathers and their families. We wish you every happiness during your pregnancy and with the arrival of your baby.

 

Additional Information

Information and advice to the general public applies equally to pregnant women. The College recommends the following websites as reliable sources of information:

 

Disclaimer

Disclaimer

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) is the lead body for women’s health in Australia and New Zealand and carries the responsibility for advice, dissemination of information and support of our members, our patients and the community during the Covid-19 pandemic.

The College respects the role of government, health departments and health administrators in coordinating a national response. Our public statements are made following consultation with officials, and medical experts, and with the understanding that the impacts of the pandemic are evolving, multifactorial and that action in one area will have intended, and unintended, effects on other areas.

RANZCOG will continue to provide information and advice that is the best available, to our knowledge. Given the recency of Covid-19 and the paucity of data, particularly in pregnancy, the accuracy of any advice may be rapidly superseded. We will endeavour to regularly update our communication as new information becomes available. Furthermore, RANZCOG will not comment on areas beyond our remit.

RANZCOG commentary on COVID-19 should be considered advisory, and not proscriptive, and all health workers, and the general public, should heed the advice of government and health authorities.
 

 



 

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