Coronavirus: 13 important facts for pregnant women

Whether you're concerned about your newborn catching the virus or worrying about breastfeeding if you're unwell yourself, we've studied guidance from the Royal College of Obstetricians and Gynaecologists (RCOG) to address some common concerns about COVID-19 and how it might affect you.

Page last updated 19/08/20.

Things to know if you're pregnant during lockdown.

1. You are not more likely to get coronavirus if you're pregnant

There is currently no evidence to suggest that pregnant women are more likely to catch coronavirus than the non-pregnant population, nor are you more likely to get seriously ill if you do catch it.

In most cases pregnant women are expected to experience only mild or moderate cold or flu-like symptoms, or possibly a cough, fever and shortness of breath.

Also, on the whole, pregnant women who develop it don't appear to become more severely unwell or more at risk of serious complications than other healthy adults.

A large UK study on the outcomes of 427 pregnant women and their babies during the coronavirus pandemic in the UK published on 11 May 2020 showed that between 1 March and 14 April 2020, 4.9 pregnant women per 1000 were admitted to UK hospitals with coronavirus and of these, around one in 10 received intensive care.

This supports the RCOG and RCM (Royal College of Midwives) clinical guidance that pregnant women are at no greater risk of severe illness than the non-pregnant population.

However, the UK Obstetric Surveillance System (UKOSS) study found that pregnant women from black or other minority ethnic (BAME) backgrounds were more likely to be admitted to hospital with COVID-19, as were older pregnant women (those over the age of 35), those who are overweight or obese, and those with pre-existing conditions such as high blood pressure and diabetes.

The spokesperson says: 'The majority of women who did become severely ill were in their third trimester of pregnancy [more than 28 weeks pregnant], emphasising the importance of social distancing for this group.'

The RCOG says that in total, five pregnant women with coronavirus died during this period, but it is unclear at this stage if coronavirus was the cause of death.

• If you think you may have symptoms of COVID-19, you should use the NHS 111 online service for information or contact your maternity care team, including if you develop more severe symptoms.
• The same applies if you develop a fever, temperature or both, although there may be other possible causes of fever including urine infections (cystitis) or your waters breaking.
• If you have any burning or discomfort when passing urine, unusual vaginal discharge or have any concerns about your baby's movements, contact your maternity provider.
• It's important to keep mobile and hydrated to reduce the risk of blood clots in pregnancy.
• If you're planning a pregnancy, the RCOG says that it's a 'matter of personal choice', while the Faculty of Sexual and Reproductive Healthcare suggests you take into consideration the risks of coronavirus transmission associated with routine contacts with healthcare professionals, especially if your pregnancy turns out to be complicated.

2. Pregnant women are deemed 'clinically vulnerable' as a precaution

The RCOG says pregnant women have been included in the list of people at 'moderate risk' (clinically vulnerable) as a precaution because pregnancy in a small proportion of women can alter how their body handles severe viral infections, especially from 28 weeks pregnant and beyond.

However, the RCOG says this is something midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and are used to caring for pregnant women in this situation.

Also, evidence so far suggests that pregnant women with coronavirus are at no greater risk of serious complications than other healthy individuals.

Additional 'shielding' measures were previously in place for people defined on medical backgrounds to be at very high risk of severe illness for coronavirus, including pregnant women with significant heart disease (congenital or acquired).

However, the advice to shield is now paused in all four UK nations although in areas with lockdown the advice to shield may be reintroduced.

It may be useful to read more about the Government's guidance on social distancing for everyone in the UK.

Reduce your risk of catching coronavirus when pregnant

• Regularly wash your hands, use disposable tissues when coughing or sneezing and wear a face covering if you go out
• Avoid contact with those showing symptoms such a high temperature and/or new continuous cough
• Stay at home as much as possible, avoiding non-essential use of public transport and working from home where possible
• Adhere to the Government's social distancing guidelines, especially past 28 weeks of pregnancy
• Use telephone or online services to contact your GP and other essential services
• Stay healthy with regular exercise, a healthy diet with plenty of water, plus folic acid and vitamin D supplementation (10 micrograms per day) to help support your pregnancy

If you are less than 12 weeks pregnant, the RCOG says that even in a pandemic it's important that you contact your GP, midwife or local early pregnancy unit immediately if you have any concerns about yourself or your pregnancy.

It says: 'Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage so you should seek urgent medical advice.'

3. Your coronavirus won't harm your unborn baby

The UK Obstetric Surveillance System (UKOSS) study, published on 11 May, found that outcomes for babies born mothers with COVID-19 were mostly good.

Although almost one in five were born prematurely and were admitted to a neonatal unit, fewer than 20 babies were born very prematurely (less than 32 weeks gestation).

One in 20 babies born had a positive test for COVID-19, but only half of these babies had tested positive immediately after birth, suggesting that transmission of infection from mother to baby (vertical transmission) is low.

In its most recent guidance for pregnant women and their families, the RCOG says, 'Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) might be possible.

'It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well,' the report says.

Although this is a very new virus, there is currently no evidence to suggest it increases the risk of miscarriage or that it causes problems with a baby's development.

What is being done to monitor coronavirus and pregnancy?

The UK is conducting near-real-time surveillance (observation) of all women who develop COVID-19 during pregnancy and their newborn babies through well-established systems already used by all maternity units - this is the UK Obstetric Surveillance System (UKOSS).

Imperial College London is also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with coronavirus.

The COVID-19 Symptom Study app has been developed by King's College London and health science company ZOE. The RCOG says members of the public, including pregnant women, can use this to report their health during the pandemic.

4. You'll continue to have antenatal appointments

Routine antenatal care is essential for detecting common complications of pregnancy such as pre-eclampsia, gestational diabetes and urine infections that don't present symptoms.

During the pandemic, you will have at least six face-to-face antenatal appointments in total and where possible these will be offered within a single appointment, such as your initial 'booking in' appointment being merged with your 12-week (dating) scan.

At every appointment - whether in person or via phone or video - you'll be asked about your mental health and given information about group B streptococcus (GBS) in pregnancy, and in your third trimester, you should be asked about your baby's movements at every appointment.

It may be that you need additional antenatal appointments and medical care, depending on your medical needs - for example, appointments with a specialist doctor, support for your mental health or discussions about your birth plan.

In these instances, provided you don't need a test or physical examination, these appointments may happen over the phone or via video, allowing partners and other family/household members to join you for support.

The lifting of the NHS's blanket suspension of hospital visiting means that visiting is now subject to local discretion by trusts and other NHS bodies so check with your maternity team and sonography unit for their policy on antenatal appointments, including scans.

It is important to know that if you are concerned about your mental health or your baby's wellbeing, including the baby's movements, it is critically important that you seek advice and care from maternity services without delay.

If you are well and are due a routine scan or visit in the coming days, you should attend your antenatal care as normal but contact your maternity unit for advice and a plan.

If you have confirmed coronavirus or symptoms suggestive of coronavirus, you should stay home for seven days and self-isolate, and other people you live with should stay at home for at least 14 days.

Antenatal appointments and coronavirus

• A partner or other supportive person should be able to attend antenatal appointments with you, including scans, but check locally as it will vary locally.
• If you've been allocated a named community midwife or continuity team, contact them to check on arrangements for all antenatal appointments and if you have concerns.
• If you haven't been allocated either of these, contact your GP or local maternity order if you have any concerns and to check on arrangements for all appointments.
• If you are attending more regularly in your pregnancy, your maternity team will be in touch with plans.
• If you miss an appointment and haven't heard from your maternity team, contact them.
• If you have an urgent problem related to your pregnancy but not related to coronavirus, use the emergency contact details you were given at your booking appointment.

NCT v NHS antenatal classes: what's the difference?

5. You'll do antenatal classes remotely

If you're expecting to do NHS antenatal classes, they will still be happening during the coronavirus pandemic but they'll be conducted remotely because of social distancing guidelines for all pregnant women.

An RCOG spokesperson says: 'We suggest you contact your local maternity service to find out how they will support you.'

'Many teams are looking at setting up virtual antenatal support networks, so you can meet other new parents online.'

If you're doing NCT (National Childbirth Trust) classes, they will be in a virtual format for the foreseeable future.

The new courses will be interactive and engaging, and will be local, meaning parents-to-be attending them will have the chance to build a community support network of other parents having a baby at the same time as them.

6. Where you give birth might change from how you planned

The RCOG says, 'Maternity units everywhere are working around the clock right now to manage additional pressures and facilitate women's choices.'

Although, like all areas of the NHS, maternity services are being affected by the pandemic, it says maternity units are working to ensure services are provided in a way that is safe, with the necessary staffing levels and the ability to provide emergency care where necessary.

In some areas of the UK, Trusts and Boards had to pause their home birth service or close their midwife-led unit but most of these services have now been reinstated. You will be told if this is not the case.

Pregnant women with suspected or confirmed coronavirus are being advised to give birth in a hospital obstetric unit for the safety of both mum and baby, even if they had been planning delivery at home or in a midwife-led centre.

This is so that the baby can be monitored using continuous electronic foetal monitoring and your oxygen levels, temperature and respiratory rate can be monitored, too.

This kind of monitoring can only take place in an obstetric unit where both doctors and midwives are present.

Everything you need to get your birth plan ready.

7. How you get to hospital might change

If you go into labour, call your maternity team for advice.

If you have suspected or confirmed coronavirus, let them know. If you have mild symptoms you'll be encouraged to remain self-isolating at home.

When the time has come to go to hospital, you are advised to get there by private transport where possible.

When you arrive you should notify them of your attendance when on the hospital premises but before entering the hospital.

You will then be met at the maternity unit entrance and provided with a surgical face mask, which you'll need to wear until you're isolated in a suitable room.

You'll also be tested for coronavirus. This currently involves swabs being taken from your mouth and nose and you may also be asked to cough up sputum (a mixture of saliva and mucus).

Understanding the signs and stages of labour

8. How you give birth might change

As it stands, if you have suspected or confirmed coronavirus infection, there is currently no evidence to suggest you can't give birth vaginally or must have a caesarean.

However, there may be times when medical intervention might be necessary, such as if your respiratory condition indicates that your baby should be urgently delivered.

Having suspected or confirmed coronavirus might also mean your maternity team delays your elective caesarean until your condition improves.

Your team will discuss these situations with you, taking your preferences into consideration where possible.

The RCOG and the RCM suggest that for those with suspected or confirmed coronavirus, birthing pools in hospitals should be avoided.

However, in other cases, NHS England says hospital birthing pools should be made available. Decisions are being made locally throughout the UK so check with your team.

Inductions and interventions in labour

9. You can still have a birth partner with you

The RCOG says, 'Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth.'

It adds that during the coronavirus pandemic, every woman should be able to have at least one birth partner stay with her throughout active labour and birth, unless the birth takes place under a general anaesthetic.

Restrictions are being eased but what's allowed is still at the discretion of Trusts and other NHS bodies so check locally.

Guidelines for birth partners:

• Induction: At least one birth partner should be able to attend your labour induction if you're in a single room but potentially not if it's in a bay on a main ward. When you go into active labour, you'll be moved to your own room and at least one well birth partner can join you.
• Elective caesarean or instrumental birth in an operating theatre: If you're having one of these, everything will be done by clinical staff to keep your birth partner with you. They will be allocated a staff member to support them during the procedure.
• Caesarean under general anaesthetic (such as an urgent delivery): For safety reasons it's not recommended for your birth partner to be present during the birth.
• Wear a face covering: Birth partners must wear a face covering when entering the hospital. Those with coronavirus symptoms won't be allowed into the maternity suite during labour and birth and should self-isolate for 7 days. Consider potential alternative birth partners, should the need arise.
• Rules on the labour ward: On the labour ward, partners are asked not to walk around unaccompanied but to use the call bell if they require assistance.
• Wait for post-birth information from staff: If your partner can't be with you during the birth, your maternity team will explain why and do everything they can to ensure they can see you and your baby as soon as possible after the birth.

What is the role of a birth partner?

10. You can still have pain relief

You can still have an epidural or spinal analgesia or anaesthesia (a spinal block) if you have suspected or confirmed coronavirus.

In fact, the RCOG says an epidural should be recommended before or in early labour to these women to minimise the need for a general anaesthetic if urgent delivery is needed.

Entonox is still an option, too. It had previously been suggested that the use of Entonox might increase aerosolisation and spread the virus but this has now been disproven and it can be used.

In line with standard procedure throughout UK maternity units, the Entonox will be used with a single-patient microbiological filter.

What pain relief options are available during labour?

11. Your newborn baby might be tested for coronavirus

If you have suspected or confirmed coronavirus when your baby is born, neonatal doctors will examine your baby and advise you about their care, including whether they need testing.

A small number of babies have been diagnosed with coronavirus shortly after birth but it isn't clear whether transmission was prior to or soon after birth.

Your maternity team will maintain strict infection control measures at the time of your birth and closely monitor your baby.

Once you go home, it is, as always, important to closely observe hygiene and anyone entering the house should wash their hands and be careful about handling the baby if they have symptoms of any illness including coronavirus.

Don't put off seeking medical advice if you have concerns about your baby's health during the pandemic. Seek medical advice if your baby has fever, lethargy, irritability, poor feeding or any other symptoms that concern you.

Although you might want to celebrate the birth with close friends and family, the RCOG cautions against large gatherings until more is known about the spread of the virus in the community.

12. You can still stay with your baby and give skin-to-skin

If that is what you want then provided your baby is well and doesn't need care in the neonatal unit, you'll be able to stay together after the birth.

There are some reports from China suggesting that women with confirmed coronavirus have been advised to separate from their baby for 14 days.

However, this may have potential negative effects on feeding and bonding and the doctors caring for you and your baby will discuss the risks and benefits with you.

The RCOG says this guidance may change as knowledge evolves.

Why choosing where to give birth matters.

13. You can still breastfeed

Although guidance may change as our knowledge evolves, there is currently no evidence to show that coronavirus can be carried in breast milk to your baby.

Also, the benefits of breastfeeding are well recognised and outweigh any potential risks of transmission of coronavirus through breast milk.

The RCOG says the main risk of breastfeeding is close contact between you and your baby as it could be that you share infective airborne droplets, leading to infection of your baby after birth.

Your maternity team will discuss the risks and benefits of breastfeeding with you.

When it comes to your own risk of contracting coronavirus or becoming seriously unwell from it after you've given birth, the RCOG says that a recently pregnant woman's immune system is considered normal unless she has other forms of infection or underlying illness.

When breastfeeding, the following precautions are recommended:

• Wash your hands before touching your baby, breast pump or bottles
• Try to avoid coughing or sneezing on your baby while feeding at the breast
• Consider wearing a face mask or face covering while breastfeeding, if available
• Follow recommendations for pump cleaning after each use
• Consider asking someone who is well to feed your expressed breast milk to your baby.
• If you are feeding your baby with formula or expressed milk, you should follow strict sterilisation guidelines.
• If you are expressing breast milk in hospital, you should use a dedicated breast pump.

In early June, the NHS provided guidance to all maternity teams that your first postnatal appointment should be a face-to-face visit at home following birth.

This will be day one if you gave birth at home or the first day following discharge from the maternity unit and is an important visit to check that you and your baby are well and to support you in these first few days.

Where to buy face masks and how to make your own.

You can keep up to date on our latest coverage over on our coronavirus advice hub.

Please check outRoyal College of Obstetricians and Gynaecologists for any more recent updates.