Everything You Need to Know about COVID-19, Pregnancy, and Breastfeeding

What is COVID-19?

COVID-19 is a new illness that affects the lungs and breathing. It is caused by a new coronavirus. Symptoms include fever, cough, and trouble breathing. It also may cause stomach problems, such as nausea and diarrhea, and a loss of sense of smell or taste. Symptoms may appear 2 to 14 days after you are exposed to the virus. Some people with COVID-19 may have no symptoms or only mild symptoms. 

How does COVID-19 affect pregnant women?

Researchers are still learning how COVID-19 affects pregnant women. Current reports suggest that pregnant women may have a higher risk for more severe illness from COVID-19 than nonpregnant women. Reports note that:

Also, it is important to know that reports suggest the risk of death is not higher for pregnant women with COVID-19 than for nonpregnant women with COVID-19. 

How can COVID-19 affect a fetus?

Remember that researchers are learning more about COVID-19 all the time. Some researchers are looking specifically at COVID-19 and its possible effects on a fetus. Here’s what they know now:

 

What should pregnant women do to avoid the coronavirus?

Pregnant women should take steps to stay healthy, including:

See more advice from the CDC on their website.

Why are face coverings important?

The CDC says all people, including pregnant women, should wear a cloth face covering or mask when they are in public to slow the spread of COVID-19. Face coverings are recommended because studies have shown that people can spread the virus before showing any symptoms. See the CDC’s tips on making and wearing a face covering.

Wearing a cloth face covering or mask is most important in places where you may not be able to stay 6 feet away from other people, like a grocery store or pharmacy. It also is important in parts of the country where COVID-19 is spreading quickly. But you should still try to stay at least 6 feet away from others whenever you leave home.

If you have COVID-19 or think you may have it, you should wear a mask while you are around other people. You also should wear a mask if you are taking care of someone who has COVID-19 or has symptoms. You do not need to wear a surgical mask or medical-grade mask (N95 mask). 

How will COVID-19 affect prenatal and postpartum care visits?

It is important to keep your prenatal and postpartum care visits. Call your obstetrician–gynecologist (ob-gyn) or other health care professional to ask how your visits may be changed. Some women may have fewer or more spaced out in-person visits. You also may talk more with your health care team over the phone or through an online video call. This is called telemedicine or telehealth. It is a good way for you to get the care you need while preventing the spread of disease. 

If you have a visit scheduled, your care team’s office may call you ahead of time. They may tell you about telemedicine or make sure you do not have symptoms of COVID-19 if you are going into the office. You also can call them before your visits if you do not hear from them. 

How can I stay physically healthy right now?

Pregnant women can stay healthy by following the usual recommendations during pregnancy, including:

How can I manage stress, anxiety, and depression?

Some pregnant and postpartum women may be feeling fear, uncertainty, stress, or anxiety because of COVID-19. Reaching out to friends and family during this time may help. Phone calls, texts, and online chats are safe ways to stay connected.

There also are treatment and support resources you can access over the phone or online. Talk with your ob-gyn or other health care professional about how to get help if you’re having symptoms like these:

If you are in crisis or feel like you want to harm yourself or others, call 911 right away.

Physical activity also may help your mental health. And it may be useful to focus on your breathing each day, especially if you are feeling anxious. Breathe in for 4 seconds, hold for 7 seconds, and breathe out for 8 seconds. Repeat three times.

I am being abused at home. How can I get help?

Times of crisis can be very hard for people in abusive relationships. Abuse at home is known as intimate partner violence or domestic violence. Abuse can get worse during pregnancy. If you need help, call the 24-hour, toll-free National Domestic Violence Hotline: 800-799-SAFE (7233) and 800-787-3224 (TTY). Or you can text LOVEIS to 22522 or use the live chat option at www.thehotline.org

Can I travel if I am pregnant?

The CDC is updating travel recommendations often. See the CDC’s Coronavirus Disease 2019 Information for Travel page for the latest updates. 

Other travel recommendations may be in place globally or locally as the virus continues to spread. Check with your local or state health department for information about travel in your area. 

What should I do if I am pregnant and think I have COVID-19?

If you think you may have been exposed to the coronavirus and have a fever or cough, call your ob-gyn or other health care professional for advice. 

If you have emergency warning signs, call 911 or go to the hospital right away. Emergency warning signs include the following:

If you go to the hospital, try to call ahead to let them know you are coming so they can prepare. If you have other symptoms that worry you, call your ob-gyn or 911. 

What should I do if I am pregnant and diagnosed with COVID-19?

If you are diagnosed with COVID-19, follow the advice from the CDC and your ob-gyn or other health care professional. The current CDC advice for all people with COVID-19 includes the following:

Should I make any changes to my labor and delivery plans?

Talk with your ob-gyn or other health care professional about your birth plan. In most cases, the timing and method of delivery (vaginal birth or cesarean birth) do not need to be changed. Women who are sick probably do not need a cesarean birth.

ACOG believes that the safest place for you to give birth is a hospital, hospital-based birth center, or accredited freestanding birth center. Your hospital or birth center may be adjusting their policies. For example, there may be changes to the number of visitors allowed and how long you will stay in the hospital. Check with your hospital and ob-gyn or other health care professional about your birth plan. Be sure to mention if you are planning to have a doula with you during childbirth. 

How many visitors can I have during and after birth?

Check with your hospital or birth center. They may limit the number of visitors to help prevent the spread of COVID-19. The number of visitors you can have may depend on local and state recommendations and how quickly COVID-19 is spreading in your area.

Some hospitals and birth centers may consider doulas to be visitors. Check the hospital or birth center policy if you are planning to have a doula with you.

Would a home birth be safer while COVID-19 is spreading? 

ACOG believes that the safest place for you to give birth is still a hospital, hospital-based birth center, or accredited freestanding birth center. COVID-19 has not changed this recommendation. Even the healthiest pregnancies can have problems arise with little or no warning during labor and delivery. If problems happen, a hospital setting can give you and your baby the best care in a hurry. Keep in mind that hospitals, hospital-based birth centers, and accredited freestanding birth centers follow strict procedures to clean and control infection. 

What will happen during labor and delivery if I have COVID-19?

While you are in the hospital or birth center, you should wear a mask if you have COVID-19. But when you are pushing during labor, wearing a mask may be difficult. For this reason, your health care team should wear masks or other protective breathing equipment. They also may take other steps to reduce the risk of spreading the virus, including wearing goggles or face shields.

Where will my baby stay after delivery if I have COVID-19?

There are many benefits to having your baby stay in the same room as you after delivery, even if you have COVID-19. For example, rooming together may help you bond with your baby and help you start breastfeeding if desired.

You also may choose for your baby to stay separated from you, such as in the hospital nursery. But current reports suggest that the risk of a baby getting COVID-19 does not change based on whether the baby stays in the mother’s room or in a separate room. If you room together, the baby’s crib may be kept at least 6 feet away from you. Some facilities use clear plastic cribs that are enclosed and keep an even temperature.

Staying in a separate room may be encouraged if you are very sick or your baby is at a high risk of getting very sick. If you choose to be separated and you plan to breastfeed, you can ask for a breast pump and use it to express (pump) milk. This will allow someone who is not sick to bottle-feed breast milk to your baby. Pumping also may help you maintain your milk supply for when you begin breastfeeding.

Talk with your health care team about the options at your hospital or birth center well before your due date. Together you can discuss what you think is right for you and your baby. Be sure to talk about the best ways to:

Can COVID-19 pass to a baby through breast milk?

Researchers are still learning if COVID-19 can pass through breast milk and cause infection in the baby. Most information shows that it is safe to feed breast milk to your baby when you have COVID-19. Remember that breast milk is the best source of nutrition for most babies. Breast milk also helps protect babies from infections, including infections of the ears, lungs, and digestive system. For these reasons, having COVID-19 should not stop you from giving your baby breast milk.

If you plan to breastfeed, talk with your ob-gyn or other health care professional. Make your wishes known so that you can begin to express milk or breastfeed before you take your baby home.

How can I avoid passing COVID-19 to my baby?

While you are in the hospital or birth center and after you go home, you should take the following steps to avoid passing the infection to your baby:

What should I do if I could be exposed to COVID-19 at work?

Tell your employer if you are pregnant or if you have a health condition that may put you at higher risk. People with some health conditions, such as diabetes mellitus, lung disease, heart disease, and obesity, have a higher risk of severe illness from COVID-19. 

Talk with your employer about how you can stay safe while doing your job. Ask if remote work is possible. If remote work is not possible, and you work in a job with a high risk of exposure to COVID-19, ask your employer if you can switch to a role with lower exposure risk.

No matter what your job is, your employer should follow guidelines from the CDC and state and local health departments. These guidelines can help reduce the risk of infection for employees. If there is a chance you could be exposed to the virus at work, ask your employer about masks, gloves, and other equipment that can help protect you. 

If you aren’t given the protection you need, tell your ob-gyn or other health care professional. Together you should talk about how you can discuss your safety with your employer.

 

What if I have other questions about my pregnancy right now?

Your ob-gyn or other health care professional should continue to be your main resource for all questions about your pregnancy. For the most current information about the coronavirus and COVID-19, check CDC web pages, which are updated often and listed below.

I want to get pregnant. Should I wait because of COVID-19?

Pregnancy is a personal choice. It may help to think about your health and the potential risks of COVID-19. You and your ob-gyn or other health care professional should talk about the latest research on possible increased risk of severe illness during pregnancy. You also should talk about taking steps to prevent exposure to COVID-19 during pregnancy.

Research does not show that pregnant women are at an increased risk of death from COVID-19. But current reports suggest that pregnant women may have a higher risk for more severe illness from COVID-19 than nonpregnant women. Also remember that pregnant women with some health conditions, such as gestational diabetes and obesity, may have an even higher risk of severe illness from COVID-19.

Also, there are some reports that COVID-19 may have passed from a woman to her baby during pregnancy or delivery, but this seems to be rare.

If you have further questions, contact us 509-392-6700.

Resources

Centers for Disease Control and Prevention (CDC)

National Association of County and City Health Officials
www.naccho.org/membership/lhd-directory
A tool to help you search for health departments in your area. Your local health department can advise on travel and other local restrictions. 

Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Distress Helpline
www.samhsa.gov/find-help/disaster-distress-helpline
1-800-985-5990 (TTY 1-800-846-8517)
Text TalkWithUs to 66746 
Offers crisis counseling for people in emotional distress and referrals to local crisis call centers for follow-up care and support.

Postpartum Support International Helpline
https://www.postpartum.net
1-800-944-4773
Text 503-894-9453 (English) or 971-420-0294 (Spanish)
Contact this non-emergency helpline for support, information, or referrals to postpartum mental health providers. The helpline is open 7 days per week. Leave a confidential message at any time, and a volunteer will return your call or text as soon as possible.
PSI also offers online support group meetings to connect with other pregnant and postpartum women. You also can join PSI’s weekly Chat with an Expert.  

National Domestic Violence Hotline
800-799-SAFE (7233) and 800-787-3224 (TDD)
Text LOVEIS to 22522
Live chat and more information: www.thehotline.org

National Suicide Prevention Lifeline
1‑800-273-8255
https://suicidepreventionlifeline.org
Lifeline chat: https://suicidepreventionlifeline.org/chat
Offers free, confidential support 24/7

Glossary

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman’s abdomen.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Doula: A birth coach who gives continual emotional and physical support to a woman during labor and childbirth.

Fetus: The stage of human development beyond 8 completed weeks after fertilization.

Gestational Diabetes: Diabetes that starts during pregnancy.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Preterm: Less than 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.

Lisa M. Hollier, MD, MPH, FACOG, is a past president of ACOG. She is an obstetrician–gynecologist, maternal–fetal medicine specialist, and a professor in the department of obstetrics and gynecology at Baylor College of Medicine in Houston, Texas. She serves as the Chief Medical Officer for Texas Children’s Health Plan.

FAQ511. Copyright September 2020 by the American College of Obstetricians and Gynecologists

Reviewed by: Lisa Hollier, MD, MPH, FACOG, Baylor College of Medicine, Houston, Texas
Last updated: September 29, 2020 at 10:10 a.m. ET

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