The RCM has been working closely throughout this pandemic with colleagues from the RCOG and other colleges. These Q&As are based on questions sent into the RCM and RCOG during the pandemic. The RCM hosted two Twitter Q&As for women and families in April 2020 in which many of these questions were addressed. The responses have been developed by the RCM’s Expert Clinical Advisory Group and the RCOG team and have been updated to reflect current evidence and Government guidance.
The Joint RCM/RCOG Coronavirus (COVID-19) infection and pregnancy - guidance for healthcare professionals is now being updated on a monthly or bimonthly basis. The most recent version (12) was updated on 14 October 2020.
You may also find the guidance documents on antenatal and postnatal services during the pandemic and midwife led settings of interest.
The below Q&As also refer to the Occupational health advice for employers and pregnant women during the COVID-19 pandemic: Version 3.4 – 10 August 2020 published by the Royal College of Midwives ,Royal College of Obstetricians and Gynaecologists, and Faculty of Occupational Medicine.
More information on pregnancy and coronavirus, including leaflets are available from the NHS website.
We have developed a poster that summarises some key issues for women during the pandemic.
Topic: Coronavirus & pregnancy
These question and answers were all reviewed on 14 September and will be reviewed again at the end of October 2020.
Current research evidence suggests that healthy pregnant women are no more likely than others to contract COVID-19. However, pregnant women have been designated as at moderate risk (clinically vulnerable). Some research indicates that some pregnant women may be at greater risk of becoming seriously unwell if they contract COVID-19. These include women with underlying medical conditions including diabetes or high blood pressure; women with a high BMI; women aged over 35 and women from a BAME background.
Although the initial acute phase of the pandemic in the UK is easing, with easing of lockdown restrictions across all four countries of the UK, the virus is still present and it still poses a risk to health. There is still no effective vaccine and the ability to effectively test and trace across the whole population is not yet universal.
Since lockdown restrictions began to ease, there have been differences between the four UK countries in regulations and guidance. Pregnant women should follow the latest government guidance in their country.
In England, the advice is to stay alert and safe (social distancing) and avoid anyone who has symptoms suggestive of coronavirus. If you are in your third trimester (more than 28 weeks’ pregnant) you should be particularly attentive to social distancing.
In Scotland you can find the current guidance on physical distancing for pregnant women as a ‘higher risk group’ here
In Wales, the social distancing guidance can be found here
In Northern Ireland, you can find the latest COVID-19 advice for vulnerable people here
• Reduce your risk of contracting the virus through following advice on social (physical) distancing; infection prevention and control measures (regular thorough handwashing and use of hand sanitisers, use of face coverings in enclosed public spaces and cough and sneeze hygiene). Hand hygiene guidance is available here and here
• Keep mobile and hydrated to reduce the risk of blood clots in pregnancy
• Stay active with regular exercise, a healthy balanced diet, and folic acid and vitamin D supplementation to help support a healthy pregnancy
• It is really important to continue to have regular antenatal care during your pregnancy. Attend all of your pregnancy scans and antenatal appointments. If you have symptoms of Coronavirus or someone in your home has symptoms, call your maternity team for advice before you attend.
• Contact your midwife, midwifery team or maternity unit on the number provided if you have concerns about the wellbeing of yourself or your baby
We have developed a poster for women that summarises some of these key messages
More information on pregnancy and coronavirus is available on the NHS website.
• The main symptoms of coronavirus are a high temperature, a new, continuous cough or a loss or change to your sense of smell or taste. Most people with coronavirus have at least 1 of these symptoms
• If you think you may have symptoms, use the NHS 111 online service/NHS 24 in Scotland for information and advice, and follow the guidance for households with possible or confirmed coronavirus infection.
• The offer of testing is now open to anyone in the UK (including pregnant women), with coronavirus symptoms. You should visit the NHS 111 online service/NHS 24 in Scotland or call 119 to arrange testing. Do not go to a GP surgery, pharmacy or hospital without contacting them on the telephone first.
• You should tell your midwife or maternity team that you have symptoms of coronavirus or if you have had a positive test result.
• If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more significant infection that requires specialised care. You should contact your maternity team, GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.
• Please also be alert to the other possible causes of fever/temperature in pregnancy. In particular, these include urine infections (cystitis) and waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge, or have any concerns about your baby’s movements, contact your maternity team, who will be able to provide further advice.
• If you are infected with coronavirus you are still most likely to have no symptoms or a mild illness from which you will make a full recovery.
• This advice is important for all pregnant women, but particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. This includes women who are in their third trimester, from a Black, Asian or minority ethnic background, over the age of 35, overweight or obese, or have a pre-existing medical problem, such as high blood pressure or diabetes.
• If you have concerns about the wellbeing of yourself or your unborn baby during your illness, contact your midwife or, if out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.
If you test positive for coronavirus outside of a hospital setting, you should contact your midwife or maternity team to make them aware of your diagnosis. If you have no symptoms or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you might be treated in hospital.
Pregnant women who have been advised to self-isolate should stay indoors and avoid contact with others for 10 days. If you live with other people, they should all stay at home for at least 14 days, to avoid spreading the infection.
Follow the NHS guidance on when and how to self-isolate.
You may wish to consider online fitness routines to keep active, such as pregnancy yoga or Pilates. Keeping mobile and hydrated, even if you are self-isolating, is important to reduce the risk of blood clots in pregnancy. Find out more about exercise in pregnancy.
All pregnant women are recommended to take 10 micrograms of vitamin D supplementation daily. This is especially important if you are self-isolating as you may not be getting enough vitamin D from sunlight.
You should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for suspected/confirmed coronavirus and ask for advice on going to any antenatal appointments.
It is likely that routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect others.
If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact your midwife or, if out-of-hours, your maternity unit. They will provide further advice, including whether you need to attend hospital.
If you are advised to go to the maternity unit or hospital, you will be asked to travel by private transport, or arranged hospital transport and to alert the maternity unit reception once on site before going into the hospital. You will be required to wear a mask or face covering.
All available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus. The large majority of pregnant women experience only mild or moderate symptoms.
In the UK, information about all pregnant women requiring admission to hospital with coronavirus is recorded in a registry called the UK Obstetric Surveillance System (UKOSS).
The first report from this study included information about the outcomes of 427 pregnant women admitted to hospital with coronavirus and their babies during the pandemic, and was published on 11 May 2020. While most women in the study required only ward treatment and were discharged home well, around one in ten women required intensive care, and sadly five women with coronavirus died, although it is currently unclear if coronavirus was the cause of their death. The study found that the majority of women who did become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing and regular hand washing from 28 weeks of pregnancy.
The study also found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for coronavirus.
Pregnant women over the age of 35, those who were overweight or obese, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital.
• The RCM and RCOG do not recommend that women with symptoms of COVID-19 should labour and give birth at home
• If you have been experiencing symptoms or a member of your family has shown symptoms, please call the maternity unit or your midwife when you think you are in early labour. It is recommended that anyone who needs to self isolate (that is, if you have had symptoms or someone in your home has symptoms) comes into the maternity unit to be cared for during labour and birth.
• There are two key reasons why it is recommended that women with suspected or confirmed Covid-19 have their labour and birth in the maternity unit rather than at home.
• Firstly, this is to be as safe as possible for you and your baby. If you have a high temperature, or if you are ill as a result of any infection including Covid-19, your baby is more likely to show signs of distress in labour and for this reason we recommend that your baby is monitored continuously during labour and that your health is closely monitored during labour. Both of these need you to be in the hospital to have this additional monitoring.
• Secondly, this is to keep midwives safe and at lower risk of contracting the virus, so that they are able to continue to care for women during this time. The current evidence is that people with symptoms have a high likelihood of passing the virus to others around them, particularly if that person is in close contact with them for some hours, as happens during a labour and birth. We know that the virus can stay alive on household surfaces for hours and even days. In labour rooms in hospitals, there is a greater ability to ensure that every surface is deep cleaned before each admission and midwives have access to the full range of protective equipment and to other members of the team to relieve them when they are wearing this equipment.
Topic: Being pregnant in the time of coronavirus
- Vitamin D supplementation is recommended to all women during pregnancy as it can help reduce the risk of respiratory infections.
- There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop coronavirus.
- However, there is not enough evidence to show that taking vitamin D prevents coronavirus infection or is an effective treatment.
- Most people living in northern hemispheres will have low levels of vitamin D and as such, we advise all pregnant women to consider taking 10 micrograms of vitamin D a day to keep your bones and muscles healthy. Vitamin D supplements are available from most pharmacies, supermarkets and other retailers.
- Women from Black, Asian and minority ethnic backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D and are advised to take a higher dose of vitamin D. Speak to your midwife or maternity team if you have any questions about vitamin D supplementation.
- Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these.
• Even during the pandemic, it is very important that if you have any questions or concerns about yourself or your baby at any time, you contact your GP, midwife or local early pregnancy unit straight away to discuss them. Some symptoms, such as pelvic pain, cramping and/or bleeding during early pregnancy, are linked to ectopic pregnancy and miscarriage and you should seek urgent medical advice should you experience any of these symptoms.
• A telephone appointment will be arranged for you as soon as possible with your local early pregnancy unit to check your symptoms. They will be able to advise whether a visit to the hospital during the coronavirus pandemic is necessary, and ensure you receive the care that you need.
• Whilst hospitals are trying to minimise the number of people entering them, in order to reduce the spread of the coronavirus and to limit the impact on services, they are organised in such a way that they are able to provide all acute services including maternity care.
• Find out more in the RCOG guidance and information on the changes to early pregnancy care and what to expect during the coronavirus pandemic.
Topic: Coronavirus after the baby’s birth
As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage if you become infected with coronavirus and are pregnant.
Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) is probable. It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well.
Given current evidence, it is considered unlikely that if you have the virus it would cause problems with your baby’s development, and none have been observed currently.
Across the world, emerging reports suggest some babies have been born prematurely to women who were very unwell with coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover.
In the recent UK study of 427 pregnant women with coronavirus published on 11 May 2020, the data reported outcomes for babies who were born to women with coronavirus severe enough that the woman required hospital admission. Although almost one in five were born prematurely and were admitted to a neonatal unit, fewer than 20 babies were born very prematurely (when the women were less than 32 weeks’ pregnant). One in 20 babies born (12 babies in total) had a positive test for coronavirus, but only half of these babies – 6 babies - had a positive test immediately after birth, suggesting that transmission of the coronavirus infection from a woman to her baby is low. The number of babies born at term (37 weeks or later) to women who had tested positive for coronavirus that required neonatal care was similar to the number of babies born to women without the virus – about 1 in 10.
• There is no evidence that women who have recently had a baby and are otherwise well are at increased risk of contracting coronavirus or of becoming seriously unwell.
• A recently pregnant woman’s immune system is regarded as normal unless she has other forms of infection or underlying illness. You should however remain well-nourished with a balanced diet, take mild exercise and ensure social distancing guidance is followed.
• Children, including newborn babies, do not appear to be at high risk of becoming seriously unwell with the virus.
• However, close observation of hygiene, including washing hands regularly, is important amongst all members of your household and they should be careful when holding your baby if they have symptoms suggestive of any illness.
• Anyone from outside your household who enters your home should pay stringent attention to hygiene precautions and follow social distancing guidance.
• The government has also published guidance on meeting people outside your household.
• It is important that your baby is feeding well and gaining weight and if you have any concerns, please contact your midwife. Once restrictions are lifted, we would caution against large family gatherings to celebrate your baby’s arrival until more is known about the spread of the virus in the community.
• Do not put off seeking medical advice if you have concerns about your baby’s health during the pandemic. Seek medical advice if your baby has a fever, lethargy, irritability, poor feeding or any other symptoms you may have concerns about.
• The NHS has produced a leaflet on coronavirus and information for newborn babies.
- Your postnatal care will be individualised to meet your needs and those of your baby. You should have at least three postnatal appointments with your local continuity team or community midwife and some or all of these should be in person in your home or at a local postnatal clinic. These will take place once you have been discharged from the maternity unit or the day of your homebirth: on your first full day at home, then on day 5 and day 10.
- These appointments may be a mixture of in person care at home or in a clinic, and telephone consultations where this is appropriate. After your postnatal appointment on day 10, your care will be transferred to your local health visiting team. You will be given information about this.
- In early June 2020, the NHS provided guidance to all maternity teams that your first postnatal appointment should be a in person visit at home following birth. This will be day 1 (if you gave birth to your baby at home) or the first day following discharge from the maternity unit (if you gave birth to your baby away from home in hospital or a midwifery led unit). This is an important visit to check that you and your baby are well and support you in these first few days. The Royal College of Midwives has produced a useful infographic on preparing for a home visit from your midwife.
If you have confirmed or suspected coronavirus when the baby is born, doctors who specialise in the care of newborn babies (neonatologists) will examine your baby and advise you about their care, including whether your baby needs to be tested.
Yes. Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth. It is really important for both you and your baby and your developing relationship to stay together as much as possible.
There is no evidence showing that the virus can be carried or passed on in breastmilk. The well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of the transmission of coronavirus through breastmilk. Provided your baby is well and does not require care in the neonatal unit, you will stay together after you have given birth, so skin-to-skin contact and breastfeeding can be initiated and supported if you choose.
The main risk of breastfeeding is close contact between you and your baby, as if you cough or sneeze, this could contain droplets which are infected with the virus, leading to infection of the baby after birth.
If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines.
However you feed your baby, 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 or from a bottle
• Consider wearing a mask or face covering while feeding
• Follow recommendations for pump/bottle cleaning after each use
• Consider asking someone who is well to feed your expressed breast milk or formula milk to your baby
If you are expressing breast milk in hospital, a dedicated breast pump should be used. Further information on infant feeding during the coronavirus pandemic is available from Unicef.
Topic: Understanding more about COVID-19 , pregnancy and maternity care
• The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for coronavirus during pregnancy, through well-established systems already used by all maternity units – this is the UK Obstetric Surveillance System (UKOSS).
• Imperial College London are also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with coronavirus. Other maternity surveillance programmes are being funded by the National Institute of Health Research (NIHR). You can also ask your maternity team about any local research that is taking place in your area.
• The COVID-19 Symptom Study app has been developed by King’s College London and health science company ZOE. Members of the public, including pregnant women, can use this app to report on their health during the coronavirus pandemic.
• A national survey study, ‘Babies Born Better’, is currently underway. The survey is inviting all women who have given birth in the UK over the last 3 years, including during the COVID-19 pandemic, to understand more about their experiences. The study aims to look at what works best in maternity care, both usually, and during COVID-19. Information about the study that the survey is part of is here. The link to the survey is here.
- Pregnant woman were placed in a vulnerable group by the Chief Medical Officer on 16th March. This means you have been advised to reduce social contact through social distancing measures.
- Based on the evidence we have so far, pregnant women are still no more likely to contract coronavirus than the general population. What we do know is that pregnancy in a small proportion of women can alter how your body handles severe viral infections. This is something that midwives and obstetricians have known for many years and are used to dealing with. As yet, there is no evidence that pregnant women who get coronavirus are more at risk of serious complications than any other healthy individuals.
- What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution. We know that some viral infections are worse in pregnant women. At the moment, there’s no evidence that this is the case for coronavirus infection, but the amount of evidence available is still quite limited.
- However, changes to the immune system in pregnancy can be associated with more severe symptoms, particularly towards the end of pregnancy. This is why women after 28 weeks have been advised to be especially careful in following social distancing measures.
- Some pregnant women, with serious underlying medical conditions have been defined as ‘extremely vulnerable’ and have been asked to adher to ‘shielding measures’ – As lockdown measures are eased over the summer months of 2020, guidance for those shielding are also changing Keep abreast of the current guidance in your own country. See the latest updates for shielding here and here for Scotland.
Another key change to how your pregnancy will look and feel is that you and your partner will be asked to wear a face covering or mask when you attend a hospital for appointments in England and Scotland. To reduce transmission of coronavirus in hospitals, the government announced that from 15 June, face masks and coverings must be worn by all NHS hospital staff and visitors in England. In Scotland this guidance was also given for visitors to hospitals on 24 June.
All visitors and outpatients, including pregnant women attending antenatal appointments or scans, must wear face coverings at all times to protect other women, patients, and staff from coronavirus. This should be communicated with you through your appointment letter, local Trust websites and social media outlets.
At present hospital inpatients, including women giving birth, are not required to wear masks. The RCM has developed guidance about the wearing of masks in labour
If you live in Wales or Northern Ireland, ask your midwife about the local guidance about face coverings and check on the local Trust or Board websites, as well as Government/Assembly websites.
Topic: The impact of the Pandemic on maternity services
If you think you may have symptoms of coronavirus you should use the NHS 111 online service for information, or NHS 24 if in Scotland.
Anyone with symptoms in the UK can now ask for a test to confirm if they have the virus.
If you suspect you have the virus or have tested positive, you need to follow the Stay at home guidance: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance
If you don’t have Coronavirus, the pandemic and its effects will clearly still change your experience of pregnancy, some of these are explored in the questions below.
We know that these are worrying times, particularly if you are pregnant. Midwives have been working around the clock to ensure you continue to get the care and support you and your baby need. In normal circumstances, we strongly believe that women should be given the full range of options to enable you to make an informed choice about where to give birth to your baby. However, the current crisis means that those running maternity services have had to make difficult decisions to ensure your health and safety and that of your baby, as well as the staff caring for you.
During the early weeks of the pandemic, staff shortage rates doubled, with some services experiencing a shortage of nearly half of their midwifery staff. In these unprecedented times, service leads needed to make decisions based on local need and available resources, while always ensuring that the health and safety of women and babies are paramount.
As we emerge from the first acute phase of the pandemic, many services are now able to look at restoring the full range of their maternity services, including the provision of midwife led units and homebirths.
Because decisions re being made at a local level basis, there is likely to be some inconsistency across the UK in terms of the services provided.
Do get in touch with your midwife to discuss the option available to you and get involved with your local Maternity Voice Partnerships (MVPs) or Maternity Services Liaison Committees (MSLCs) to be involved in discussions regarding changes in your area.
Ask your midwife about your current services or look on your local Trust or Health Board website.
We have produced guidance for you about getting ready for home visits from midwives during the pandemic.
The RCM and RCOG has produced shared guidance about providing midwife led care settings during the pandemic, including developing clear plans for restoration of full services.
We understand that it could be a stressful and anxious time if you are pregnant or have recently given birth during the coronavirus pandemic. The NHS is working to ensure that you, your baby and your family are supported and cared for during these uncertain times. This means that there may be some changes to how, when and where you attend essential routine appointments and how safe, personalised care and support are given to you. Any changes implemented by your local maternity service should be discussed with you.
Antenatal and postnatal care is based on years of evidence to keep you and your baby safe through pregnancy, birth and beyond. Antenatal and postnatal care should therefore be regarded as essential and you should be encouraged to attend, while adhering to social distancing measures as far as possible.
Your local maternity team is likely to have reduced routine appointments, home visits and delivered some care and support over the phone or by video at the height of the pandemic. While the virus remains in the community, it is still sensible to reduce the number of times you need to travel and attend hospital/clinics and so some of these changes will remain.
From summer 2020, many in person home, hospital and clinic based appointments are being restored. However, this may be affected if there are any local outbreaks and decisions are made about a local temporary return to lockdown. Stay in touch with what is happening in your local area through your Trust or Health Board website.
In order to ensure that social distancing measures are in place, some services continue to be provided, but in a different form: many antenatal education classes have currently moved online and some breastfeeding support services after the birth might also be provided through virtual technology such as video calls. In person group antenatal classes will gradually be re-established over the coming weeks and months.
Another change to services during the first months of the pandemic was that partners were asked not to attend appointments, ultrasound scans or to visit on antenatal and postnatal wards. Visiting restrictions are beginning to be lifted again in most areas, so check out your local service for updates.
On 5 June, NHS England’s suspension of hospital visiting was lifted. This means that visiting is now subject to local discretion by trusts and other NHS bodies in England – please check with your maternity team for their policy on visitors to the antenatal and postnatal wards. It is important that any visitors follow guidance in hospitals about wearing a face covering and handwashing and maintaining a safe social distance from others. If visitor restrictions remain in place on your postnatal ward, midwifery, obstetric and support staff will be able to support the needs of all women and the practical challenges of caring for newborns after birth.
On 13 July, the Scottish Government published a document indicating the plan for restoring visiting in maternity services, which can be seen here. Hospitals and maternity units are working hard to restore normal services, including supporting partners to attend antenatal appointments and scans.
The RCM has published guidance for maternity services on restoring visiting, which can be read here.
• Yes, you should be encouraged to have at least one well birth partner present with you during labour and birth. Your birth partner(s) must wear a mask in hospital.
• Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth.
• If a birth partner has symptoms of coronavirus or has recently tested positive for coronavirus, we do not recommend they go into the maternity suite, to safeguard the health of you, other women and babies and the maternity staff supporting you.
• In some hospitals and maternity units, restrictions on visiting remain in place which might mean that birth partners or other supportive companions are not able to attend routine antenatal appointments, or stay with women on antenatal or postnatal wards. However, this should not impact on your birth partner’s presence during your labour and the birth, unless they are unwell with coronavirus symptoms or have tested positive for coronavirus.
• We know that for some women, their chosen birth partner(s) may be from a different household due to their individual circumstances. You should be supported to have them with you, unless they are unwell with coronavirus symptoms or have tested positive for coronavirus.
• In line with new national guidance, visiting restrictions are being amended in hospitals and maternity units. The pace of this change will depend on local circumstances and will therefore vary. Some units are now able to begin easing this restriction to allow more than one birth partner to be present – please check what the local guidance is in your area. Decisions about the number of birth partners need to be made locally as they depend on the space available in labour rooms and units to support social distancing measures.
NHS Hospital teams are working hard to make hospitals as safe as possible during the pandemic and reduce the risk of virus transmission between visitors, staff and patients. Some maternity units are offering birth partners a test for Coronavirus when they come into the hospital in labour; some units will also ask partners to wear a mask in all parts of the hospital, including the labour room.
Will I be able to have my birth partner(s) with me if I am being induced?
- At least one birth partner without symptoms should be able to attend your induction of labour where that is in a single room (e.g. on the maternity suite) but potentially not if the induction takes place in a bay on a main ward, as it may not be possible to maintain the necessary social distancing
- On 5 June, NHS England’s suspension of hospital visiting was lifted. This means that visiting is now subject to local discretion by Trusts and other NHS bodies – please check with your maternity team for their policy on visitors to the antenatal ward.
- On 13 July, the Scottish Government published a document indicating the plan for restoring visiting in maternity services, which can be seen here.
- It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.
- In some areas, it is possible to return home if all is well during the early parts of the induction process so that you can be in your own environment and have the support of your partner. Ask your local maternity team if this is available in your area.
Will my birth partner be able to support me during labour if they have tested positive for COVID-19 or have symptoms?
Sadly we cannot allow a partner, or anyone else that has tested positive for Covid-19, to attend a birth. This is to protect you, your baby, midwives and other members of the maternity team and other women and their babies from catching the virus. Try to think about who else might be able to support you.
You are encouraged to have an alternative, trusted birth partner who is symptom free who can be with you if your ‘first choice’ birth partner is unwell and not able to be with you. Many midwives have been able to support women using video calls to stay in touch with their partners during parts of the labour and birth.
We know this is a really difficult situation, the midwives will be there to offer you support and kindness every step of the way.
Will my birth partner(s) be able to stay with me if I have a caesarean or instrumental birth that occurs in an operating theatre?
- We fully support women having at least one birth partner with them during labour and birth, unless they are unwell or have tested positive for coronavirus.
- Around one in four women in the UK has a caesarean birth. A caesarean birth may be recommended as a planned (elective) procedure for medical reasons or as an emergency – for example, if doctors and midwives are concerned that your baby is not coping with labour and needs to be born immediately.
- Furthermore, around one in five women in the UK has an instrumental birth (ventouse or forceps). Some instrumental births may also be recommended to occur in an operating theatre in order to allow the maternity team to modify plans and undertake a caesarean birth if necessary.
- Most caesarean and instrumental births in theatre are carried out under spinal or epidural anaesthetic, which means you’ll be awake, but the lower part of your body is numb and you cannot feel any pain. In this situation, everything will be done by the clinical staff – midwives, doctors (obstetricians) and anaesthetists – to keep your birth partner with you.
- Due to the coronavirus pandemic, staff in the operating theatre will be wearing enhanced personal protective equipment (PPE) to prevent the spread of infection, which will make it more difficult for them to communicate. To enable the clinicians to assist in the birth of your baby safely, it is very important your birth partner(s) follows the instructions from the maternity team carefully and quickly.
- Occasionally, a general anaesthetic (where you are put to sleep) may be used, particularly if your baby needs to be born urgently. During this type of caesarean birth, even under usual circumstances (before the coronavirus pandemic), for safety reasons it is not possible for birth partners to be present during the birth.
- While the maternity team will do all they can to ensure that your birth partner(s) is present for the birth, there will be some occasions when there is a need for an urgent emergency birth with epidural or spinal anaesthetic in which it will not be possible for your birth partner(s) to be present. This is because, during an emergency, operating theatres are more high-risk environments for the potential spread of coronavirus to anyone who is present.
- If it is the case that your birth partner(s) will not be able to be present during the birth, your maternity team will discuss this with you and will do everything they can to ensure that your birth partner(s) can see you and your baby as soon as possible after the birth.
What is the advice for birth partners during the coronavirus pandemic?
We are asking you to follow the guidance below to keep yourself, your family, other families and NHS staff as safe as possible during the pandemic:
- During the coronavirus pandemic, all hospitals have been restricting visitors, but there has always been an exception for a well birthing partner during active labour and birth.
- Birth partners will be required to wear a mask or face covering when entering a hospital under new NHS guidance. In Scotland this guidance was also given for visitors to hospitals on 24 June.
- Every woman should be able to have at least one birth partner stay with her through labour and birth, unless the birth occurs under a general anaesthetic.
- To help prevent spread of coronavirus to other women, their babies and key front-line healthcare staff, it is very important that you do not attend the maternity unit if you have any symptoms of coronavirus or have had any in the previous 7 days.
- If you are unwell, protect your family and NHS staff, and stay at home. To prepare for this, women and their current birth partner(s) are being encouraged to think about an alternative birth partner(s), if required. This person does not need to be from the same household as you.
- If you are supporting a woman during labour and birth, please be aware of the strict infection control procedures in place to prevent the spread of coronavirus to other pregnant women and their babies, as well as other people within the hospital and the maternity staff.
- Please wash your hands regularly with soap and water and use hand sanitiser gel in clinical areas as available.
- If you cough or sneeze, please cover your mouth with a tissue and dispose of it in a bin immediately.
- Stay in the labour room with the woman you are supporting. Do not walk around the maternity unit unaccompanied – use the call bell if you require assistance.
- If you are asked to wear any additional personal protective equipment (PPE) in addition to a mask or face covering during the labour or birth, please follow the instructions carefully and take it off before you leave the clinical area.
- If you are accompanying a woman to her birth in an operating theatre, please be aware that operating theatre staff will be wearing PPE and it may be more difficult for them to communicate with you:
- A staff member will be allocated to support you; please carefully follow their instructions and approach them if you have any questions.
- To enable the clinical staff to do their job, it is very important that you do not move around the operating theatre as you risk de-sterilising sterile areas.
- The maternity team will do everything they can to enable you to be present for the birth. However, if there is a particular safety concern, they may ask that you are not present in the operating theatre. If this is the case, the team should discuss this with you and explain their reasons unless it is an emergency.
- We understand this is a stressful and anxious time for pregnant women, birth partners and their families and we thank you for your cooperation during this time.
- Please be assured that the maternity team will do all they can to provide information, guidance and support to you and the woman giving birth.
If you are thinking of having a homebirth, discuss this as early as you can during your pregnancy with your midwife.
We would advise that women with symptoms of COVID-19 or who have had a positive test or who are living with someone with COVID-19, should go into hospital to give birth. This is so that you and your baby can have additional monitoring and care if needed.
If you and your household are symptom free and you are planning a home birth, it is important that you and your family follow careful infection control practices to keep the midwives who are caring for you and other women as safe as possible as they go about their work.
This includes regular cleaning of surfaces and door handles and opening windows in the home to provide good ventilation. Midwives attending you at home need to have access to facilities to wash their hands and follow their own infection control practices.
We have developed a poster to help you prepare for a home visit or birth.
If you or anyone in your household has symptoms of Coronavirus or a positive test in the run up to your planned homebirth, it is vital that you let your maternity service or midwifery team know.
Topic: Life and being pregnant during the pandemic
- If you are in the UK, you should follow the advice given by the Foreign and Commonwealth Office, which is being regularly updated in line with the evolving situation.
- All individuals, including pregnant women, should ensure they have adequate insurance arrangements prior to travel. You should also check that your travel insurance will provide cover for birth and care of your newborn baby if you give birth while abroad.
- There are differences between the UK countries in relation to quarantine regulations when returning from countries outside the UK, check on your individual country Government websites for your local information.
- Pregnant women were placed in the vulnerable category as a precaution during the coronavirus pandemic. The government‘s guidance on schools and early years settings advises that: children and young people who live with someone who is pregnant (vulnerable) can attend school and early years settings. See the next question for information about pregnant women who are classed as extremely vulnerable.
- All pregnant women are advised to follow government guidance on staying alert and safe (social distancing). In Scotland, the current Route Map to stay safe and protect others can be read here.
- Pregnant women are at no greater risk of contracting coronavirus or becoming seriously unwell than other healthy adults. However, there are additional concerns for pregnant women in the third trimester. This is based on the challenges in caring for women who are heavily pregnant, and the risk of the baby needing to be born early for the woman’s wellbeing.
- A recent report from a UK study showed that so far the majority of pregnant women who became seriously unwell with coronavirus were in the third trimester. This emphasises the importance of stringently adhering to social distancing from 28 weeks of pregnancy.
- If you choose to take your children to school/nursery/external childcare, you should ensure you practice social distancing– stay two metres away from teachers/carers and other parents and do not go inside the building. If this is difficult, then consider staggering your child’s drop off and pick up times. Remember to wash your hands when you return home and ensure that your children wash their hands when they leave the childcare setting. Alcohol gel can be used if they cannot wash their hands with soap and water. If you have to go inside school, it is advisable to wear a face covering, in line with current evidence and guidance on face coverings in enclosed spaces.
If you are concerned about the choice of returning to school or other childcare settings based on the risk to children attending, helpful information is available from the RCPCH.
Some pregnant women with pre-existing severe medical illnesses have been classed as extremely vulnerable and have been advised to shield. You will have been told this by your maternity team.
The government advice is that children and young people who live in a household with someone who is pregnant and shielding (extremely vulnerable) should only attend school/nursery/external childcare if stringent social distancing, and hand hygiene, can be adhered to – and the child or young person is able to understand and follow those instructions.
Shielding guidance is now being relaxed but this is happening differently in the four nations of the UK – advice in England, in Scotland, in Wales, and in Northern Ireland. Practical advice for measures that may be helpful to adopt within a family are now available within this guidance.
Becoming pregnant during the coronavirus pandemic is a matter of personal choice.
The Faculty of Sexual and Reproductive Healthcare (FSRH) recommend that when considering a pregnancy, women and their partners consider the risks of coronavirus transmission associated with routine contact with healthcare professionals during pregnancy, particularly if pregnancy complications may necessitate frequent hospital attendance.
For more information, see the FSRH clinical statement: Information to support management of individuals requesting to discontinue contraception to plan a pregnancy during the Covid-19 outbreak.
Topic: Advice for women at higher risk of serious illness, including women who are Black, Asian or from other ethnic minorities
Pregnant women with significant heart disease (congenital or acquired) are classed as clinically extremely vulnerable and have been advised to shield, because they are at very high risk of developing severe illness from coronavirus. Shielding guidance is now being relaxed but this is happening differently in the four nations of the UK – advice in England, in Scotland, in Wales, and in Northern Ireland.
If you are pregnant and have significant heart disease, you should continue to take the precautions outlined in this updated guidance, and speak to your midwife or doctor (obstetrician) with any questions you may have.
Data from the UKOSS study of 427 pregnant women in May 2020 found the majority of women who have become severely ill from coronavirus were in their third trimester of pregnancy, emphasising the importance of social distancing and regular hand washing from 28 weeks of pregnancy.
The study also found pregnant women from Black, Asian and minority ethnic (BAME) backgrounds are more likely than other pregnant women to be admitted to hospital for coronavirus. Pregnant women over the age of 35, those who are overweight or obese, and those women who have pre-existing medical problems, such as high blood pressure and diabetes, also appear to be at higher risk of developing severe illness.
All pregnant women are advised to follow government guidance on staying alert and safe (social distancing). If you develop coronavirus you are still most likely to have no symptoms or a mild illness from which you will make a full recovery.
It is important that if you feel your symptoms are worsening or if you are not getting better, you should seek medical help, particularly if you are at higher risk of becoming seriously unwell and being admitted to hospital. You should contact your maternity team, your GP, or use the NHS 111 online service/NHS 24 in Scotland online service for further information and advice. In an emergency, call 999.
The increased risk to pregnant women from a BAME background, those who are over the age of 35, those who are overweight or obese, and those women who have pre-existing medical problems, such as high blood pressure and diabetes, will mean that your maternity team may offer you additional appointments, or refer you to a doctor or specialist clinic should there be any concerns about your or your baby’s health.
This will be discussed and planned with you by your community midwife or maternity team through a risk assessment, and personalised antenatal and postnatal care plan.
The recommendation to all pregnant women remains that you should seek medical advice as early as possible if you have any questions or concerns about your or your baby’s health. Your maternity team is there for you and you will receive safe, personalised and respectful care.
Women from Black, Asian and minority ethnic (BAME) backgrounds are at higher risk of becoming seriously unwell and being admitted to hospital so it’s important that if you feel your symptoms are worsening or if you are not getting better, you should seek medical help.
Your maternity team may offer you additional appointments, or refer you to a doctor or specialist clinic if there are any concerns about your or your baby’s health.
If you aren’t already, you should consider taking a vitamin D supplementation, which is recommended to all women during pregnancy. There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop coronavirus. However, there is not enough evidence to show that taking vitamin D prevents coronavirus infection or is an effective treatment.
Women from BAME backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D and are advised to take a higher dose of vitamin D. Speak to your community midwife or maternity team if you have any questions about vitamin D supplementation.
We have developed new guidance for midwives and maternity support workers to ensure that they are aware of the increased risks for BAME women and can pass on relevant advice and support to the women in their care.
The NHS in England has written to all maternity units in the country calling on them to take four specific actions to minimise the additional risk of coronavirus on BAME women and their babies.
Topic: Mental health
We understand that the coronavirus pandemic will inevitably result in an increased amount of anxiety in the general population, and this is likely to be even more so for pregnant women and their families as pregnancy presents an additional period of uncertainty.
Specifically, these anxieties are likely to revolve around:
- The virus itself
- The impact of social isolation resulting in reduced support from wider family and friends
- The potential of reduced household finances
- Major changes in antenatal and other NHS care, including appointments being changed from face-to- face to virtual contact
Isolation, bereavement, financial difficulties, insecurity and inability to access support systems are all widely recognised risk factors for mental ill-health. The Coronavirus epidemic also increases the risk of domestic abuse or violence.
If you already have mental health problems, these may become worse as a result of the additional stress of the pandemic. Please maintain contact with your mental health team if you have one, or with your GP if you are under their care. Talk to your midwife if you feel you are not getting the support with your mental health that you need.
You should be asked about your mental health at every contact with a health professional. By acknowledging these difficulties, healthcare professionals can help to contain some of these anxieties. If you require support, you should be signposted to resources which can be remotely provided, where possible. If you are experiencing domestic violence, please disclose this to a health professional who can provide information and support to keep you safe.
Where necessary, women in England can self-refer to local IAPT (Improving Access to Psychological Therapies) services. In Scotland, advice is available from Parentclub and NHS Inform.
Further information is available from the following organisations:
- Public Health England – COVID-19: guidance for the public on mental health and wellbeing
- NHS – Every Mind Matters
- Royal College of Psychiatrists
- Maternal Mental Health Alliance
- Women’s Aid
Where necessary, women in England can self-refer to local IAPT (Improving Access to Psychological Therapies) services. In Scotland, advice is available from Parentclub and NHS Inform. More information about mental health and pregnancy, including the signs of perinatal depression, is available from the NHS website.
Further information is also available from the following organisations:
Topic: Testing for coronavirus
• The process for diagnosing coronavirus infection is changing rapidly. The offer of testing is now open to anyone in the UK (including pregnant women) with coronavirus symptoms. You should visit the NHS website or call 119 to arrange testing. The list of symptoms has also been expanded to include loss of or change in someone’s normal sense of smell or taste.
• To minimise the spread of coronavirus in hospitals, the offer of testing is being expanded to include all patients admitted to hospital in England, regardless of whether they have coronavirus symptoms or not. This includes offering tests to all women who attend hospitals for urgent or emergency maternity care, including attendance for spontaneous labour and birth.
• New national guidance from NHS England and Northern Ireland recommends that individuals admitted for elective procedures should be offered testing prior to admission, following a period of self-isolation. For maternity units, there are particular practical concerns and the RCOG has developed more detailed information about this. Approaches to testing are somewhat different in Scotland and Wales.
• If you have an elective caesarean birth or induction of labour planned, you may be asked to follow a period of self-isolation and offered a test for coronavirus prior to admission. You may also be asked to self-isolate and offered a test prior to a home birth. Your maternity team will discuss this with you.
• The ability for widespread testing in a hospital trust or Board will depend upon the availability of testing kits, testing capacity in the local laboratory and available staff to take the tests. This is likely to vary across the UK and local adaptations will be required according to local capacity and disease prevalence.
Pregnant women are tested in the same way as anyone else. Currently, the test involves swabs being taken from your mouth and nose. You may also be asked to cough up sputum, which is a mixture of saliva and mucus.
The most effective tests currently take 24–48 hours for the result to be available. This means that if you have symptoms suggestive of coronavirus and you are awaiting test results whilst in hospital, you may be treated as potentially infectious until the result is returned.
If you have symptoms of coronavirus but have recently received a negative test result, your maternity team may still use caution when caring for you. Sometimes, the virus doesn’t show on the test results if you have been tested not long after you have become infected. You may be offered another test in a few days.
You may also have heard about antibody testing for coronavirus. This is a blood test that can show whether you have previously come into contact with the virus or not. It does this by detecting antibodies, which your body produces if you have had coronavirus. This is called an immune response.
At present, this type of test is only being offered to NHS staff and some individuals across the UK. It is hoped the results of these tests will help us to understand how immunity to coronavirus works as we do not yet know how the antibodies develop and how long immunity lasts. Therefore, we do not currently recommend that results from antibody tests are offered when caring for pregnant women.
It is possible that your birth partner(s) may also be offered testing for coronavirus when you are admitted to hospital. Your maternity team will be able to advise you further.
If you decline testing for coronavirus prior to attending hospital for urgent or planned maternity care (including labour and birth), your care will be the same as any woman who is admitted to hospital and who does not yet have a test result.
If you have symptoms suggestive of coronavirus you will be treated as potentially having coronavirus.
If you do not have symptoms you will be treated as other asymptomatic women who do not yet have a test result. For most units, this will mean that you are presumed to not have coronavirus.
Topic: Occupational health guidance for pregnant women who work in a public-facing role
We understand that it must be an anxious time if you are pregnant and you work in a public-facing role.
National policy on social distancing measures has shifted considerably since the peak of the pandemic and now varies regionally. However, the UK Government has maintained the precautionary measure of classing pregnant women as clinically vulnerable. Therefore, despite the easing of restrictions from 4 July 2020, the advice remains that pregnant women who can work from home should continue to do so. You can find the latest guidance here, in particular section 7 on clinically vulnerable people.
Since the government has lifted restrictions on individuals who are extremely vulnerable to the effects of COVID-19 (those who have been shielding), we believe it is appropriate to archive our occupational health guidance for pregnant women. While the clinical information in this guidance about the risks of the COVID-19 infection during pregnancy still stands, the action to be taken by employers needs to be guided by the government.
We have been consulting with the UK Government in recent months to revise the current occupational health guidance for pregnant women during the pandemic and we continue to do so.
Employers have a responsibility to protect the health and safety of pregnant women who are working. This responsibility is laid out in the Management of Health and Safety at Work Regulations 1999. Under these regulations, employers are required to carry out risk assessments. If there are risks, your employer must take reasonable action to remove the risks by altering your working conditions or hours of work; by providing suitable alternative work on the same terms and conditions; or by suspending you on full pay (if there is no suitable alternative work).
How and where you can safely work should be advised by your employer, after they conduct their risk assessment of your workplace and your individual situation. UK Government guidance on Working Safely during the Coronavirus (COVID-19) pandemic and guidance on the NHS Employers website (for healthcare professionals) is available to help them to do this. The RCOG is unable to provide guidance on individual risk assessments which must be conducted by your employer in line with the government guidance.
We have kept the archived RCOG, RCM and FOM joint occupational health guidance available to provide you and your employer with the clinical information about the risk and potential implications of being severely affected by COVID-19, particularly if you are 28 weeks’ pregnant or more. This information is still relevant and can be used to inform your risk assessment. This information is also available in our clinical guidance on coronavirus in pregnancy.
If you are unable to work from home, you can work in a public-facing role provided your employer conducts the risk assessment and is able to make appropriate arrangements to sufficiently minimise your exposure to the virus.
If you have concerns about your risk assessment and the resulting recommendations, you should speak to your employer in the first instance. If you are still not satisfied, consider contacting your trade union representative or, if you do not have a trade union representative, Maternity Action has published lots of helpful information here. Maternity Action has also published FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful.
If you are in your first or second trimester (less than 28 weeks’ pregnant), with no underlying health conditions, you should avoid, where possible, caring for patients with suspected or confirmed coronavirus infection. If this is not possible, you should use personal protective equipment (PPE) and ensure a thorough risk assessment is undertaken. Pregnant women can only continue working where the risk assessment supports this.
Some working environments, such as operating theatres, respiratory wards and intensive care/high-dependency units, carry a higher risk for all pregnant women of exposure to the virus and all healthcare workers in these settings are recommended to use appropriate PPE.
If you are in your third trimester (more than 28 weeks’ pregnant), or have an underlying health condition – such as heart or lung disease – we strongly recommend you avoid direct patient contact. It is better to work from home where possible, avoid contact with anyone with symptoms of coronavirus and significantly reduce unnecessary social contact.
Data from the UKOSS study of 427 pregnant women in May 2020 found the majority of women who have become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing from 28 weeks of pregnancy.
We encourage employers to seek opportunities for pregnant healthcare workers in their third trimester to work flexibly in a different capacity, to avoid roles where they are working directly with patients.
Whatever the gestation of your pregnancy, you should discuss your individual circumstances with your local Occupational Health department.
The evidence base for this new virus is growing rapidly and as and when new information emerges, the government and professional bodies will update the guidance.
Maternity Action has published FAQs around rights and benefits during pregnancy and maternity leave which you may find helpful.