Pregnancy

COVID-19 in pregnancy, childbirth and breastfeeding: frequently asked questions and answers

Women must be guaranteed the presence of a person of their choice for the entire duration of labour, delivery and during hospitalisation.

In this difficult period, many expectant mothers are faced with many doubts and questions about pregnancy , childbirth and breastfeeding .

What consequences can the Covid-19 infection have on pregnancy and my baby’s health? If I test positive for the swab, will my partner be able to enter the delivery room? And after the birth, will I be able to breastfeed my child and keep him with me for the entire hospital stay?

These are not only legitimate questions, but very important ones in view of the birth event, which unfortunately will take place in the pandemic era.

Naturally, as with any other doubt or concern, the advice is always to contact your gynecologist , your trusted midwife and the staff of the facility chosen to give birth .

Although there are national guidelines on the management of pregnancy, childbirth and postpartum, the indications are not always updated, because the pandemic situation evolves very rapidly. Additionally, the application of the guidelines may vary by region or specific birthplace .

In this article, we have tried to summarize for you all the most frequently asked questions about Covid-19 in pregnancy, childbirth and breastfeeding , and to answer them on the basis of the most up-to-date evidence on the subject.

Covid-19 in pregnancy: what are the risks for mother and child?

At present, however, there is no evidence that pregnant women with COVID-19 have an increased risk of miscarriage and fetal abnormalities or malformations .

However, unvaccinated expectant mothers have a higher risk of developing severe Covid-19 disease . In particular, studies have shown a more than doubled risk of admission to intensive care for pregnant women with Covid-19 compared to infected non-pregnant women of childbearing age.

In addition, COVID-19 in pregnancy appears to increase the risk of complications such as preeclampsia , premature birth and low birth weight.

In light of these considerations, vaccination against Covid-19 in pregnancy is strongly recommended by all major scientific societies . 

Can the mother transmit the SARS-COV-2 virus to the fetus or newborn?

Vertical transmission (  i.e. from mother to child) of the new coronavirus is possible, but is currently considered a rare event .

In case of positivity, is it necessary to interrupt obstetric checks?

Even in the event of suspected or confirmed infection, it is important to continue to undergo the scheduled checks, which for the entire duration of the pregnancy must include at least 6 face-to-face appointments . Where the visit is urgent and cannot be postponed, future mothers positive for Covid-19 will have dedicated paths , in order to reduce contact with other patients and other healthcare professionals.

Can the future dad enter the delivery room?

According to the recommendations of Italian and international health institutions, pregnant women  must be guaranteed the presence of a person of their choice for the entire duration of labour , at the time of delivery (except in the case of general anesthesia) and during their stay in hospital .

The accompanying person must not have had any suspicious signs and symptoms of COVID-19 in the previous 14 days (including fever, persistent cough, nasal congestion and discharge, difficulty breathing, sore throat, wheezing or sneezing). Furthermore, you must not be in self-isolation and must not have had a fever in the last 48 hours. Otherwise, the chosen person will not be able to access, but the woman will have the possibility of requesting another trusted companion.

Can Covid-19 positive women have an epidural?

Epidural analgesia is not contraindicated in case of SARS-CoV-2 infection and should be recommended in case of urgent or emergency caesarean section, to reduce the need for general anesthesia.

In case of positivity, is it necessary to give birth by caesarean section?

Pregnant women positive for COVID-19 do not have to perform a caesarean section.

Furthermore, the induced labor , the acceleration of the delivery , the episiotomy and the instrumental or manual interventions to facilitate the expulsion phase (such as the use of the suction cup) must be clinically justified and performed according to the conditions of the mother and/or the fetus, and NOT for COVID-19 positivity .

More generally, it is important that the choice of delivery method be discussed with the woman, taking into account her preferences and possible obstetric and anesthesiological indications. Even the position to be taken during labor and delivery  is not related to the COVID-19 emergency and must take into account the woman’s choices .

Is water birth always contraindicated?

In the presence of symptoms (such as cough, fever or general malaise), labor and birth in water are not recommended, due to the potential risk of transmission through the faeces.

On the contrary, in women without symptoms and presumed or confirmed negative, water birth is not contraindicated .

Is it possible to cut the umbilical cord after birth?

Due to the health benefits of the newborn,  late clamping of the cord  (1 to 3 minutes) is recommended.

Should Covid-19 positive mothers be separated from the baby at birth?

In the absence of serious maternal or neonatal complications, mother and baby should be able to remain together and practice skin-to-skin contact and  rooming-in both day and night .

Skin-to-skin contact is also recommended in the event of a premature birth , because its health benefits for the newborn outweigh the possible risks of transmitting infection and disease related to COVID-19.

In the event that the mother is unable to take care of the child, another caregiver should be considered , such as the father or another family member .

If the newborn requires hospitalization in the neonatal intensive care unit (NICU) , it will be necessary to guarantee the mother and father free access to a dedicated and separate area , using the prevention measures.

Can Covid-19 positive mothers breastfeed?

By itself, infection with the SARS-CoV-2 virus is not a contraindication to breastfeeding . Consequently, if health conditions permit, the mother must be able to breastfeed as often and for as long as she wishes .

It should also be remembered that, following the coronavirus infection or the Covid vaccine during pregnancy , women are able to transmit specific antibodies against the virus to the newborn through their mother’s milk . 

During skin-to-skin contact and the first feed, the preventive measures envisaged for cases of COVID-19 positivity are still recommended, i.e. mask and thorough hand washing . On the other hand, the use of masks or other forms of face covering for the newborn is absolutely forbidden, due to the possible risk of suffocation.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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