COVID-19

The best advice for everybody in the population, not just if you’re pregnant, is to wash your hands very regularly and it is also the best way to clean them. If you haven’t got access to hand washing with soap and water you can use any kind of alcohol gel as long as it's got over 70% alcohol content. You should be washing your hands whenever you visit the toilet, before preparing food, whenever you've been out and about touching surfaces and really whenever you have got access to a wash basin wash your hands. If you're out and about, you want to be using alcohol hand gel, especially if you've been in confined spaces, touching door handles or surfaces. Remember once your hands look as if they're not visibly clean you need to wash them again with soap and water, not use hand gel on them to clean them.

The virus itself we're pretty sure with this virus it does live outside the body and so you need to think about that as well if you’ve been around people who have been coughing and sneezing, especially if it's in your home, you need to wipe down the surfaces with just a general disinfectant. Washing clothes is important too until we learn more about the virus. We know soap and water destroys the membrane of the virus and kills it, if you have got a tumble dryer just use that for drying too.

The virus itself is spread through direct contact as well as sneezing and coughing, so you will see lots of people wearing face masks. If you've got symptoms the best way to protect everyone else around you is to stay as far away as possible and try to isolate yourself within the home. Try not to come within 2 metres of others and wear a face mask whilst breastfeeding your baby if you have suspected or confirmed COVIS-19. If you cough and sneeze into a tissue or your arm this can help stop the spread. We know that people continuously touch their face naturally and I think if you're coughing and sneezing you inadvertently contaminate other things around you such as surfaces and people, whoever or whatever you are around. So, if you've got symptoms or if you've definitely got the virus certainly avoid close contact with people that you don't need to. No hugging or touching with symptoms, so anytime you don't need to have close contact just don't. If you’re on public transport, there will be social distancing measures in place and a facemask or face covering is compulsory. If you meet others whilst out walking or in the supermarket, keep at least 2 metres apart.

If you want to cough and/or sneeze you should try to think of how to stop the spread of the virus even if you don’t have the virus, the best advice is to use a tissue to cough and sneeze into and then bin that tissue, make sure it goes straight into the bin, don’t reuse it, if you don't have a tissue, which is possible, you can just cough or sneeze into the crook of your arm again. This is where washing your clothes more often comes in, just to make sure you get rid of that virus if it's on your clothes and stays there.

What it is like for pregnant women if they do catch this virus? Well, currently the advice says that for pregnant women it is no different than a non-pregnant person catching the virus so the symptoms will be very similar and are pretty much the same. For pregnant women the symptoms are expected to be mild to moderate but, it is possible that pregnant women may be more likely to acquire coronavirus. We know that just by nature of pregnancy, women’s bodies do suppress their immune systems. As we do not have enough information on how COVID-19 affects pregnancy it is advised that pregnant women avoid public facing roles in the workplace, where possible and after 28 weeks of pregnancy to be found a role within the company which allows you to work from home if possible to avoid unnecessary contact with others. Pregnant women should avoid contact with people outside their home unnecessarily and be a bit more careful with hand washing, cleaning surfaces etc.

Passing the virus from a pregnant mum, during pregnancy or labour, to their unborn baby (vertical transmission) is now thought to be ‘probable’. This advice has been changed recently due to some babies testing positive for COVID-19  after being born. It is still unclear how many pregnancies would be affected this way of or how babies could be affected. It is still thought unlikely that your baby will be affected during the pregnancy regarding their development or that your unborn baby would develop any abnormalities if you became infected with COVID-19.

For pregnant women who do have other conditions, such as asthma, heart disease or diabetes, it is recommended that you self-isolate. You're more likely to be affected by the virus so you need to consider seeking medical advice and help sooner rather than later if you have symptoms of COVID-19 or if you become more unwell than you might expect. Workplace advice is that this category of pregnant women should work from home where possible.

The most important thing is that each surgery and hospital will have their own way of working so it's really important that if you haven’t already been informed by your midwife or hospital, that you call them ahead of any appointments just to check whether or not it's still essential and what their plans are for your antenatal pathway of appointments are. Before attending any face to face appointments it’s really important to let your midwife or hospital know if you think you may have any symptoms of COVID-19.

Some midwives and hospitals are now conducting appointments via video calls or telephone calls, so if you haven’t received information yet about any changes it may be wise to call before attending an appointment. They will also be able to provide you with more information around when you will have necessary face-to-face appointments for physical checks which cannot be performed over the phone, such as taking your blood pressure, testing urine and abdominal palpation (feeling your bump for size and position). If you’re unsure who to call you can ring your hospital switchboard and ask to be put through to the maternity assessment centre, who will be able to advise you. Do look out for advice on your hospital trust’s website for pregnant women, as some maternity units have created special helplines for pregnant women to ask questions during the pandemic.

We should all be responsible during these times of social distancing. It is so important to follow government health guidelines for social distancing to help slow the spread of coronavirus. The more we comply with this guidance the sooner social distancing restrictions will be lifted. The spread will slow, fewer people will become severely affected or die and the NHS will be able to cope with the amount of people who need treatment.

It's okay to be out for walksand to to travel to other areas in the car. Always keep at least 2 metres from anyone you might meet during your trip out. You can also be inventive at home and continue exercising by using the many online forms of exercise classes in yoga, Pilates etc. Try looking around for specific pregnancy exercise classes online. When you’re at home make regular efforts to walk around and go into the garden if you have one, this keeps your body moving and fitness levels up, as well as helping to protect you against developing a DVT (deep vein thrombosis or blood clot).

Try and avoid touching people and be careful touching surfaces and door handles. Keep at least 2 metres away when possible as per the government advice. Hand washing again is massively important to wash any potential viruses away, alcohol gel will kill them but from many studies that have been done previously we know that hand washing is much better at getting rid of viruses and keeping hands clean. You need to thoroughly wash your hands in warm soapy water for at least 20 seconds, wash more than you would normally and if you can’t get access to hot water or soapy water use hand gel with at least a 70% alcohol content. You have to make sure that your hands are clean before you use the hand gel otherwise it's not as effective and we don't want people to have a false sense of security that the alcohol gel is going to do everything when hand washing is preferable if available.

Official advice from the RCOG is that this is a precautionary measure whilst we learn more about the virus and what type of impact it has on pregnant women and their unborn babies. We know that data obtained from other countries and the UK indicates that pregnant women appear to be more adversely affected towards the end of their pregnancy in the third trimester.

Research and data are key to monitoring the ongoing situation and the UK obstetrics surveillance system will monitor all cases of pregnant women who have a diagnosis of COVID-19. Large numbers of pregnant women are needed to produce research from the data, so patterns can be recognised and examined. The advice from the RCOG is that pregnant women who can work from home should do so and that pregnant women should be self isolating from 28 weeks of pregnancy. During the first and second trimester, if you can't work from home and if you work in a public facing role, that should be modified appropriately to minimise your exposure. This should be considered and discussed with your occupational health team. If you work in close contact with other people but if it's an essential job that you need to do and you can't do it from home, then you need to speak to your line manager or to your occupational health department to discuss a safe way of working and so you can be risk assessed. 

Gill Walton is the CEO of the RCM, she states that, we understand that this must be an unsettling time for pregnant women but we would like to emphasise that attending antenatal and postnatal care when you are pregnant and have a new baby is essential to ensure the well-being of pregnant women and their babies and would urge all pregnant women who are well to attend their care as normal.

If you are pregnant and have symptoms of possible coronavirus infection you should call to defer any planned face-to-face visits until after your isolation period.

As you can well imagine probably every other pregnant woman that is booked there will be calling too for updates as well. This puts massive pressure on the system and your hospital should have a website and hopefully they are updating on that website any information that you as a pregnant woman will need. So please do check the websites as well just for general updates and general information as this is very changeable in the current climate.

If you are worried that you have been exposed to coronavirus or that you believe you have symptoms, it is important not to visit your GP surgery or A & E. You can check the latest information available online on the 111 website or call for advice if you are still unsure. For those living in England, Wales and Northern Ireland call 111 for advice. Those in Scotland, use the NHS 24 advice line.

In summary though, hand washing and social distancing are so important so we don't put other people at risk, not forgetting children as they can be vectors for the virus, these are the most important things to be aware of. Certainly, don't put yourself at any unnecessary risk by visiting friends or relatives and certainly stay away from elderly relatives. If you've got young children, check that before you go to the GP surgery that if your appointment is necessary, that still want you to go and what the procedure is when you get there. Most surgeries are doing video call appointments and telephone appointments, but it is still worth bearing in mind if you really need their time. Can your appointment wait until things are easier on the service?

It is also good to remember that whilst adhering to government guidance that most people who contract COVID-19 have mild to moderate symptoms.

When you go into labour, if you are not symptomatic or do not have a diagnosis of the virus then it is advised to continue with your chosen place of birth, i.e. hospital, a midwife led unit or a homebirth.

If you are symptomatic or have a diagnosis of COVID-19 then the advice is to use an obstetric led unit for the birth (a hospital that has obstetric and neonatal doctors, as well as midwives). This is because electronic fetal monitoring of your baby’s heartrate is advised during labour, however, this advice is based upon the few cases seen in China and is not robust evidence, but the RCOG are working with the little amount of information that they have, so it is precautionary. It is also advised that as that as this is a respiratory infection that your oxygen levels are monitored more frequently during labour, if you have symptoms of COVID-19. You and your baby will also be in a place where you can receive further medical treatment if you have symptoms or a positive test for COVID-19, should that be required during labour and in the postnatal period. Although some babies born to women who have COVID-19 have tested positive directly or soon after birth, it is thought they have displayed mild symptoms.

Going into labour, as we know in most hospitals there isn't a staffing crisis at the moment, so there's enough midwives and doctors. However, there is probably going to be a point in time where people do start to go off sick and that subsequently even if they're not that poorly they will need to self-isolate. So then that might mean that things are affected but again you can confirm with your maternity assessment centre and they will be able to advise you exactly what the situation is, when to come in and give you advice regarding how far on in labour you are, taking into consideration your wishes as well when you want to come in too.

The current advice is that if you go into labour and you think that you might have symptoms of the virus or you've been diagnosed with COVID-19, then it is recommended by the Royal College of Obstetricians and Gynaecologists (RCOG), that you give birth in an obstetric unit (with doctors as well as midwives) this is a precautionary measure because you might need extra care from the medical team whilst you're there, if there are any complications with the baby and then you've got a neonatal team there as well.

After many homebirth services being suspended during the pandemic, it seems that plenty have been reinstated. If you haven’t been contacted by your midwife or hospital then contact them and check if your homebirth service is affected.

If you have an elective (planned) caesarean section booked this should go ahead as planned, however, it will be dependent on the current demands placed on the maternity services in your hospital, so delays are possible. If you are symptomatic with COVID-19 it could be that your elective caesarean section is delayed until the medical team have assessed that your condition is stable.

Elective caesarean sections aren’t an emergency procedure, so it is possible in the future that they could be slightly delayed or the dates changed around if staffing becomes an issue. Make sure you are in contact with the hospital and checking up on these things, so you get your appointment for your caesarean section at the right time.

There are currently babies in the UK who have tested positive for coronavirus who have been born to COVID-19 positive women. At the moment we don’t know much about how this has affected these babies (symptoms are believed to be mild), but they will all be having ongoing care and close monitoring during this period. What we do know though is that children seem to, on the whole, have less severe symptoms when they contract coronavirus than the adult population does, so it suggests this could be the case for most babies too.

Most hospital trusts in the NHS are starting to limit birth partners because this  would make sense if we're trying to promote social distancing. If there is only one person accompanying a woman in labour then it reduces the chances of the virus spreading. For scans and hospital appointments women are asked to attend alone unless they have a physical or learning disability which requires them to need assistance.

If you can only take one birth partner to the hospital it can be not only physically demanding but emotionally challenging for that person so it’s best to prepare for this in advance. You could be asking them to do something for 24 hours and for the person going through labour it can go quite quickly, but it could be quite a long drawn out process for the people that are watching you do it, so we thought we would provide advice on how you can prepare for this.

Make sure your birth partner is not exhausted before you get to hospital, so whilst you are home labouring you could use another household member for support, if possible, so that when you arrive at hospital your birth partner is well rested, well fed, well-watered and your bags are ready. If not, whilst you are coping during early labour at home, encourage them to rest, so they can have more energy for later. They may get offered a cup of tea and some at hospitals but there may be limited food available and especially open during the night-time. Meat or cheese can make a sandwich which freezes and defrosts well, so that when you do actually leave for the hospital you take them with you, and they are defrosted by the time you need them. Prepack a snack bag with your favourite biscuits, crisps, cereal bars and other non-perishable items so it’s ready to grab when you need it. Take plenty of water and/or isotonic drinks (you can freeze these too so you both have cool drinks once you are at the hospital). Clothes to be cool in as well as warm clothes if you get tired as you may get cold. We can recommend packing a bag for yourself and baby and a bag for drinks, snacks and what you and your partner may need during the labour. Don’t forget to pack any medication you or your partner may need for potentially the next 48hrs or so.  

Midwives and doctors in the UK don’t want to see a mother and the baby separated even if the mother tests positive for COVID-19. Similarly, the advice is that there is no evidence not to breastfeed as coronavirus has not been found to be present in the breastmilk tested from COVID-19 women and there are many other protective benefits of breastfeeding for your baby. Make sure you wash your hands before handling your baby and that if you are breastfeeding or bottle feeding and handling your baby closely and suspect you have symptoms of COVID-19, that you wear a mask while your baby is close to you.

When babies were separated from their mothers in China, it was because they knew less about the coronavirus and its effects upon babies then than we do now. Separating mothers and babies is known to be detrimental for bonding and breastfeeding, so not advised unless necessary.

Once baby is born, from a practical point of view for women who are not symptomatic of COVID-19 and are well, the advice is to follow the usual hygiene measures. So wash your hands regularly and before you have contact with your baby and if you're preparing a bottle of formula milk, make sure all the equipment is thoroughly washed and sterilised. Anybody with any symptoms in your household should try and keep their distance from baby and limit their time around the areas that you and baby use e.g. rooms and surfaces that you use until they have finished their self-isolation period. Follow the usual hygiene measures if you think that you might have some symptoms, such as a dry cough, you don’t feel well and/or you have a temperature. The advice is that if you have symptoms, to wear a mask when you're feeding baby if by breast or having close contact with baby such as changing their nappy or when you're putting your baby’s clothes on. This is because the virus is spread by infective airborne droplets and the mask will minimise these falling onto baby during close contact.

The benefits of breastfeeding still apply during this time, even more so for the immunity to other diseases you can pass on to your baby too. Your breastmilk is packed with antibodies which go to protect your baby. There is currently no evidence that coronavirus exists within breastmilk. If you are symptomatic or have been diagnosed with coronavirus the advice is to wear a mask during this time when feeding to help reduce the chances of your baby contracting it.

If you are feeling too ill to breastfeed your baby you could consider the following:

• Expressing your breastmilk via a pump and giving this to your baby via a cup or bottle
• Expressing your breastmilk and asking someone in your family who is well to feed your baby
• Temporarily stopping breastfeeding and then seeking advice on relactation after you have recovered

Firstly, we recommend you do some research about breastfeeding as this will help you to prepare well for when baby is born, La Leche League is an excellent place to start. They also offer an amazing support network if you need it for more information, as well as online support and telephone support for any problems encountered with breastfeeding.

We would advise you start hand expressing and colostrum harvesting from 36/37 weeks in pregnancy. Any colostrum (the first breast milk) which you obtain you can collect in sterile syringes (available from a chemist or midwife) or in another sterile container that can then be frozen and used in the early days after your baby is born, if they don’t feed straight away. Teaching yourself to hand express will also help you to become familiar with your breasts and how they work, ready for when your baby comes. Stocks of formula milk are not anticipated to run out if you decided to formula feed.

One of the main questions coming through is what to do about friends and family visiting the new baby during social distancing. Unfortunately, there is no way around the problem of being unable to allow friends and family into your house, as every encounter has the potential to spread the virus around. Controlling and minimising all contact is necessary at this time to help to slow the spread of the virus, so there shouldn’t be any contact with extend family or friends indoors. Families are now able to meet outdoors and in gardens, but the advice is changing week by week, so refer to the government website for further up to date information. 

It will put you under a lot of stress and anxiety if someone starts to display symptoms of COVID-19 in your household, however it is important to follow the government advice given and if anybody does have any symptoms definitely don’t come near the baby and try to isolate in one room. If possible use a separate bathroom but if not then they need to use their own towel and remove it from the bathroom each time they use it. Wash towels and clothes regularly to get rid of the virus and self- isolate for the time recommended on the government website. If the mother of the baby is symptomatic then, wear a mask with close handling and follow the hygiene guidance already outlined.