Pregnancy Related Questions

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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Pregnancy Related Questions

Should intrapartum fever be considered as a possible sign of COVID-19 infection?

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Fever is the most commonly reported sign; most patients with confirmed COVID-19 have developed a fever and/or symptoms of acute respiratory illness (cough, difficulty breathing). Data regarding COVID-19 in pregnancy are limited; according to current information, presenting signs and symptoms are expected to be similar to those for non-pregnant patients, including the presence of fever. Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 infections. As part of the evaluation, clinicians are strongly encouraged to test for other causes of respiratory illness and peripartum fever.

Can nursing mothers with COVID-19 breastfeed their child?

In the limited studies available, COVID-19 has not been found in breast milk. However, babies can get the virus from contact with mothers or other caregivers. The CDC recommends breastfeeding or feeding expressed breast milk to babies while taking precautions to avoid spreading the virus. Breast milk protects babies from getting sick and is the best source of nutrition for most babies. Breastfeeding helps strengthen the baby’s immune system because breast milk contains antibodies and other important components.

If a person sick or experiencing symptoms, they should take all possible precautions to protect the baby, including washing hands before and wearing a facemask prior to touching the baby. Patients may breastfeed directly or express breast milk for a healthy caregiver to feed to the baby.

How many people can be present in the room during births?

The CDC has advised hospitals to limit the number of people allowed in hospitals, including visitors and non-essential staff to reduce exposure of patients and health care workers, to COVID-19. During labor, hospitals have generally made exceptions to allow a support person as long as they are not experiencing symptoms associated with COVID-19.

Patients can talk to their facilities or health care provider about their policies and question if facilities are allowing any exceptions on a case-by-case basis. Primary support persons should be decided in advance and a second person should be identified in case the primary support person is experiencing symptoms of COVID-19. Plans can also be made with providers about connecting with additional support-people through platforms such as FaceTime, Google Hangouts, or Zoom.

Can a baby stay with a COVID-19 infected mother after delivery?

CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room. Temporary separation of the newborn from a mother with suspected or confirmed COVID-19 should be considered to reduce the risk of spreading the virus to the newborn. The risks and benefits of temporary separation of the mother from her newborn should be discussed with the mother by her healthcare team. Decisions about temporary separation should be made with respect to the mother’s wishes. If the mother chooses a temporary separation to reduce the risk of spreading the virus and would like to breastfeed, she should express breast milk and have a healthy caregiver who is not at high-risk for severe illness from COVID-19 bottle feed the newborn the expressed breast milk if possible.

If the mother with suspected or confirmed COVID-19 does not choose temporary separation in the hospital, she should take precautions to avoid spreading the virus to the newborn, including washing her hands and wearing a cloth face covering when within 6 feet of her newborn. The newborn should be kept ≥6 feet away from the mother, as much as possible, including the use of physical barriers (e.g., placing the newborn in an incubator).

Can COVID-19 be transmitted via breastmilk?

The limited studies on breastfeeding women with COVID-19 have not found the virus in breast milk. The main concern is the parent or caregiver infecting the baby through respiratory droplets. Precautions should be taken to keep your baby healthy, including washing hands before touching and feeding your baby and wearing a face mask if you are experiencing symptoms or confirmed positive with COVID-19.

What should mothers do if they have been discharged, but have not med the criteria to discontinue self-isolation?

Mothers may choose to continue to separate from the newborn at home to reduce the risk of spreading the virus if a healthy caregiver is available. If a healthy caregiver is not available, a mother with COVID-19 can still care for her infant if she is well enough while using precautions (for example, hand washing, wearing a cloth face covering).

What precautions can mothers take when directly breastfeeding a child?

As always, before touching the baby the hands should be thoroughly washed with soap and running water for 2o seconds or more. If the mother has tested positive or suspects she has COVID-19, she should wear a face mask and wash hands before each feeding.

What precautions should mothers take when feeding expressed breast milk to a child?

If you are sick or choose to express breast milk to feed your baby, you can do so with hand expression or a breast pump (manual or electric). Be sure to use proper hand washing before touching any pump or bottle parts and before expressing breast milk. Follow recommendations for proper pump cleaning after each use and thoroughly clean all parts that come into contact with breast milk. Clean the pump after each pumping session according to the pump manufacturer’s instructions. If possible, or if you are too sick to feed your baby, have another healthy person feed your expressed milk to your baby. Be sure everyone feeding your baby follows proper hand hygiene and wears a face mask if experiencing symptoms. To establish and keep your milk supply, it is important to express your milk from the breast as often as your baby eats every day, typically 8-12 times a day for newborns or every 1.5 to 3 hours.

Should infants and new-borns wear face shields?

Plastic face shields for newborns and infants are NOT recommended. There are no data supporting the use of infant face shields for protection against COVID-19 or other respiratory illnesses. An infant face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation. Infants, including newborns, move frequently, which could increase the possibility of their nose and mouth becoming blocked by the plastic face shield or foam components. The baby’s movement could also cause the face shield to become displaced, resulting in strangulation from the strap.