[Original publish date: March 20, 2020; Updated: March 24, 2020]
Although pregnant women do not appear to be at greater risk of contracting COVID-19 or suffering severe sickness—based on observations from China—many of those who are expecting understandably have questions and concerns.
For example, what special precautions, if any, should pregnant women take? Can the virus be transmitted to a fetus or newborn? How many people can a woman in labor have with her in the delivery room?
How does the COVID-19 virus spread?
COVID-19 spreads between people in close contact through droplets. When an infected person coughs, sneezes, or talks, they release droplets that can land in an uninfected person’s nose, mouth, or eyes. It also may spread if an uninfected person touches an infected surface and then touches his or her nose, mouth, or eyes. It is advised to avoid touching your face.
Are pregnant women more likely to become infected with COVID-19? Are they at increased risk for severe illness and death with COVID-19?
No, the experience in China does not show that pregnant women are at a greater risk for contracting COVID-19 or at greater risk for severe illness compared to non-pregnant people in the same age group. The influenza virus and some other types of coronaviruses are more likely to infect and cause severe illness in pregnant women, but this does not seem to be the case with COVID-19.
How are COVID-19 symptoms different from other upper respiratory viral illnesses?
COVID-19 infection can be very similar to influenza. People with COVID-19 are more likely to experience fever, cough, fatigue, and shortness of breath because it can reside in the upper airways and lower respiratory tract. A sore throat, headache, body ache, and diarrhea can sometimes be symptoms of COVID-19; a stuffy nose and sneezing are more characteristic of the common cold.
I am pregnant. How can I protect myself from getting COVID-19?
The same general rules apply to both pregnant and non-pregnant adults:
- Avoid people who are sick
- Wash your hands often using soap and water for 20 seconds (best) or alcohol-based hand sanitizer
- Avoid touching your face
- Avoid crowded places and social gatherings; avoid unnecessary person-to-person contact.
- Practice social distancing at work and when out buying food. Try to stay around 6 feet away from other people. The airborne respiratory droplets from coughing are heavy and tend to fall to surfaces within six feet of the person who has coughed.
- Clean and disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
Can I pass COVID-19 to my fetus during pregnancy?
At this point, there is no data on the effects of COVID-19 in early pregnancy, but other coronaviruses have not been transmitted to or caused abnormalities in developing fetuses. This is a very different type of virus from Zika, which can be transmitted to developing fetuses and affect development.
After birth, infants can acquire COVID-19 through respiratory droplet transmission (meaning through the air), just as adults can. At Yale New Haven Hospital (YNHH), it is recommended that mothers who have tested positive for COVID-19 be separated from their newborns to avoid transmitting the disease.
Adults with a possible or confirmed infection who are caring for newborn infants should follow Centers for Disease Control and Prevention (CDC) guidance and discuss this with their pediatrician.
Can COVID-19 be transmitted during breastfeeding?
To date, there is no data to suggest that the virus can be passed to the baby through breast milk. Moreover, breast milk remains the best source of nutrition and protection against many illnesses. However, a mother who tested positive for COVID-19 can transmit the virus through respiratory droplets or during direct contact. As a result, direct skin-to-skin contact is discouraged.
Expressing breast milk with a manual or electric breast pump, then feeding to the infant by a healthy care provider using proper hand hygiene and clean bottles, is the preferred method of feeding the infant breast milk until the COVID-19 infection is resolved.
What should I do if I am pregnant and experience symptoms of a respiratory illness?
If you experience a fever of 100.4 or above and one or more of the following—cough, difficulty breathing, shortness of breath—you should call your OB provider. Additional resources can be found by calling the YNHH COVID hotline at (883) ASK-YNHH (833-275-9644). Anyone with symptoms of viral illness should begin self-isolation to avoid exposing others.
What should I expect during a conversation with my OB provider if I'm pregnant and experiencing COVID-19 symptoms?
Your providers will ask you questions about your symptoms and your background health that can help determine if you are at higher risk of getting a severe disease. If your OB provider does not identify risk factors, your symptoms appear to be mild, and there is no pregnancy-related reason for you to be seen in the hospital, you may be asked to stay at home and self-isolate. You may also be referred to an ambulatory COVID-19 test site to be tested for COVID-19 infection if you meet specific criteria.
If your provider is concerned about your symptoms or if you have additional risk factors for severe disease, your provider may instruct you to come to the office or to the hospital for evaluation.
My OB provider has suggested less frequent prenatal visits, or visits over the phone or via video. Is this safe?
Generally speaking, most elements of prenatal care can be performed remotely. Knowing your baby is doing OK can be determined by doing fetal kick counts. Another important part of prenatal care is checking your blood pressure. If you are low risk, this can be done less frequently. Also, if you have access to a blood pressure cuff this may also be done at home and discussed with your doctor. Checking in on how you are feeling and talking about your plans for delivery can easily be done over the phone, too. Avoiding unnecessary person-to-person contact is an important part of reducing the transmission of the virus for you and your family.
For Telehealth visits, you will need the MyChart app on your phone. The office team can help you get that set up.
What should I do if I am pregnant, experience COVID-19 symptoms and have pregnancy-related concerns (contractions, fluid leakage, decreased fetal movement, vaginal bleeding, etc.)?
If you have any pregnancy-related questions, call your OB provider. If your pregnancy-related issues need evaluation, you will be asked to come in. After speaking with your provider, you will be asked to call the Labor and Birth floor at (203) 688-2309 as you arrive at the Children’s Hospital at Yale New Haven Hospital or (203) 789-3461 at the Vidone Birthing Center at the St. Raphael Campus of YNHH. You will be asked to stay in your car until you are greeted by a nurse who will provide you with a surgical mask and escort you into the hospital. Only one support person will be allowed to come with you for the duration of your delivery hospitalization in order to reduce transmission of the COVID-19 virus.
Part of your initial evaluation may be done via video port. During your stay, your providers will be wearing personal protective equipment. If you get admitted and meet specific criteria, COVID-19 confirmatory testing will be performed.
Is it safe for me to come to the hospital to give birth?
We believe that delivery at a hospital is safe for you and your baby. Extensive precautions are taken with every patient to prevent the spread of infection. Rooms and equipment are deeply disinfected after each patient. Our staff is trained on how best to prevent infection, as well as to be able to provide the labor support and guidance you need during your birth. In addition, we are prepared to respond to any complications that may occur during labor and birth for both healthy women and those that have higher-risk pregnancies.
Are there visitor restrictions at the hospital?
Yes, the entire hospital has moved to not allow visitors, except for maternal special care, labor and birth, postpartum, and pediatrics, where you may choose one visitor. The visitor will be screened for coronavirus symptoms and will not be able to be with you if they screen positive. You should plan ahead and identify a backup support person if this occurs. There is no swapping out of visitors.
By limiting visitors and care providers, we hope to limit the spread of the virus and protect mothers, newborns, as well as providers and visitors from becoming ill. Being with a person during labor and birth is a long duration of person-to-person contact, and each additional person in the labor room can increase exposure risk for mothers, babies, and staff.
I had been planning to work with a doula. What do I do?
Doulas and their clients have been getting very creative about working together remotely via FaceTime or Zoom. In addition, many doulas have been working with their clients prior to labor to help them prepare for the birth process.
What will happen if I give birth and I have COVID-19?
During your labor process, some things may seem a little different. You will have a dedicated nurse and provider and will have fewer staff coming in and out of your room; some communications may even be done over the phone instead of face-to-face. You may or may not need to wear a mask, but those taking care of you will have facemasks, eye shields, and be wearing gloves.
After the baby is born, obstetricians, midwives, and pediatricians strongly recommend immediate separation from your baby and discourage direct skin-to-skin contact. We encourage breastfeeding, but this is to be done through manual or pump expression and feeding to the baby through a bottle or cup. Your baby’s pediatrician will help you decide how to care for your baby when you are discharged from the hospital.
I am pregnant and a health care worker. Should I avoid caring for patients who may have COVID-19?
Currently, there is no recommendation from the CDC or the American College of Obstetricians and Gynecologists (ACOG) to specifically prohibit pregnant employees from caring for patients with suspected or confirmed COVID-19. However, pregnant health care personnel should follow best hand hygiene practices, standard precautions, and be aware of all updated infection control guidelines for their health care facilities to keep themselves and others safe in the health care environment. If feasible, pregnant health care personnel may want to consider limiting their exposure to patients with confirmed or suspected COVID-19 during higher risk aerosol-generating procedures.
I am pregnant and I work outside the home. Should I stop working?
Most places of employment are moving work to home settings, if possible, to help contain the spread of COVID-19 in the community. If your job requires you to be at your work setting, then it is important to follow the best practices described above to limit the spread of COVID-19 to yourself and others.
I am pregnant and planning to travel this spring/summer. Should I cancel my trips?
The impact of COVID-19 in the U.S. and around the globe is evolving quickly. All patients should avoid international travel. Pregnant women should consider avoiding all non-essential domestic travel as well. Patients should be aware that they may be subject to travel restrictions, disruptions, and limitations in movement affecting their return home should exposure to COVID-19 occur.
Pregnant women at particularly higher risk, such as those with pulmonary and cardiovascular co-morbidities or immuno-suppression, should avoid all travel. Always review the latest information and CDC advisories before embarking on any trip.
How can I get tested for COVID-19?
At this time, there is no “universal” testing for COVID-19. COVID-19 tests are currently only recommended for patients who meet specific criteria. Testing in the outpatient drive-through sites is done by appointment and per physician’s order only.
Testing guidance is likely to evolve rapidly and indications for testing are likely to expand in the next two weeks.
I was on crowded public transportation and near a person who was coughing. Should I be tested for coronavirus?
No, testing is not recommended in this case. You should wash your hands and avoid touching your face. A person will not test positive until they become ill with the virus. If you develop fever and shortness of breath/coughing, you should call your provider as noted above.
Can I bring a guest to my prenatal appointments or ultrasounds?
No. We are trying to limit the number of people in the office space in order to decrease the potential spread of the virus. During ultrasounds, you may ask for pictures to take home to show your family.
I have other kids—what do I do about them when I am in the hospital?
It is important to make safe childcare plans for your children, as well as backup plans in case the person you had planned to watch your children gets sick. Ideally, you should choose someone who does not have any high-risk conditions for coronavirus, including those with lung problems, heart problems, or who are older than 70 years of age.
I wanted to see if I qualify for Women, Infant, and Children’s (WIC) benefits for food and, if needed, formula, but their physical offices are closed—what should I do?
They are operating remotely but can verify your eligibility over the phone and get WIC paperwork from your providers via fax or by verifying information over the phone. They will mail you an EBT card and then reload it electronically. Choose the office you want to work with (below) and give them a call.
- Chapel Street YNHH Saint Raphael’s Campus—(203) 789-3563
- Hill Health Center—(203) 503-3080
- YNHH York Street Campus Howard Avenue—(203) 688-5150
- Fair Haven Community Health Care—(203) 773-5007
Can I leave the hospital early to minimize my time there?
Yes, you can leave as early as 24 hours after the birth. There are some essential newborn tests that occur at 24 hours of age and we want to make sure those get done to minimize the need for frequent pediatric office visits.
What else may have changed for my inpatient stay?
Unfortunately, to keep everyone safe, inhaled nitrous oxide will not be available at this time, and walking outside of your room and unit is limited. Please don’t forget to bring music that you enjoy and other things that help your relax. We have birthing balls, rocking chairs, and our rooms are bright and spacious. We continue to have the availability of narcotic and epidural analgesia for mothers who desire it.