Coronavirus in Pregnancy

Although current research suggests that healthy pregnant women are no more likely than others to contract COVID-19, pregnant women are more at risk of becoming seriously unwell if they catch the virus. This increases the chances of complications, including admission to ICU and premature birth.

With new, more transmissible variants in circulation, it’s really important to keep yourself safe. As well as continuing to wear a mask in public spaces, especially indoors, washing your hands regularly and keeping to social distancing, getting the vaccine is the best way to protect yourself and your baby from the effects of COVID-19.

Make sure you attend all your regular antenatal appointments, including scans. Some appointments may be done over the phone or virtually, but they’re still really important to check on your health and the baby’s progress. If you have any concerns about your pregnancy – including about the baby’s movement – contact your midwife or maternity services.

Try to keep mobile and hydrated to reduce the risk of blood clots in pregnancy, and stay active with regular exercise, like swimming, pilates or yoga. Maintain a healthy balanced diet, and take folic acid and vitamin D supplements to help support a healthy pregnancy.

Key advice for pregnant women during the pandemic:

More information on pregnancy and coronavirus is available on the NHS website.

 

Q. What effect does coronavirus have on pregnant women?

The vast majority of pregnant women who get COVID-19 will experience only mild or moderate symptoms. However, increasing numbers of pregnant women are being admitted to hospital severely unwell with COVID symptoms, causing complications for themselves and their babies.

Since very early in the pandemic, we’ve known that women in the third trimester of pregnancy are at highest risk of complications due to COVID-19. A study from May 2021 found higher rates of preterm birth, pre-eclampsia, and emergency caesarean delivery study, while an earlier study found one in 10 pregnant women in the UK who were admitted with COVID required admission to intensive care.

Black and Asian women and those from minority ethnic backgrounds are more likely to be admitted to hospital too, as are pregnant women over the age of 35, those who are overweight or obese, and those who have pre-existing medical problems, such as high blood pressure and diabetes.

Q. What research is being done to monitor the effect of coronavirus on pregnant women and their baby?

• 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.

 

Q. Should I take Vitamin D supplementation?

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.

 

Q. What should I do if I develop symptoms when I am pregnant?

Testing positive for COVID won’t change the level of support you’re given by your midwife, but it might change how that support is given. It may mean that antenatal appointments have to be done over the phone or virtually.

If you’ve had a positive test before you go into labour at the end of your pregnancy, make sure you let your maternity team know before you go to the hospital. That will enable them to put the proper measures in place, including different PPE, and make sure they’ve got everything they need to make sure you and baby are safe.

 

Q. What should I do if I test positive when I am pregnant?

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 isolate and recover at home. If you have more severe symptoms, you might be treated in hospital.

Q. What is the travel advice if I am pregnant?

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.

Make sure you have adequate insurance arrangements prior to travel and 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.

Q. Should I plan a pregnancy during the coronavirus pandemic?

Becoming pregnant during the coronavirus pandemic is a matter of personal choice. However, you might like to take a look at the Faculty of Reproductive Healthcare (FSRH) website for useful on planning a pregnancy at this time.

 

Q. What is the advice for women from a Black, Asian or minority ethnic background?

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.

The Royal College of Midwives has 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.

 

Mental health

Q. How can I protect my mental wellbeing during the pandemic?

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 pandemic also increases the risk of domestic abuse or violence.

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 provided remotely, where possible. If you are experiencing domestic abuse or violence, please disclose this to a healthcare 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. 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:

 

Antenatal care

Q. What do I do if I feel unwell or I am worried about my baby during self-isolation?

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.

 

Q. Why are changes to antenatal and postnatal care necessary during the coronavirus pandemic?

These changes are a way of ensuring we deliver the best care without overloading our NHS services, which are crucial during the coronavirus pandemic. This helps us to:

  • Reduce the number of people coming into hospitals where they may come into contact with other people and spread the virus
  • Ensure staff are not overwhelmed and stretched too far by the additional strain on services, which could be due to staff sickness and self-isolation as well as the higher numbers of patients needing care and overnight hospital stays due to coronavirus

This allows us to care for you and protect you from coronavirus while also ensuring we protect NHS staff and services.

 

Q. Can I still attend my antenatal appointments if I am in self-isolation?

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 a virtual appointment will be offered instead, and 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. 

Q. How many antenatal appointments will I have?

You will have at least six face-to-face antenatal appointments in total. Where possible, essential scans/tests and routine antenatal care will be offered within a single appointment. This is to prevent multiple journeys and visits to clinics/hospital, and will involve contact with as few staff as possible to prevent the spread of coronavirus to you, your family and other patients/staff.

This may mean that your initial ‘booking in’ appointment will take place at the same time as your 12-week (dating) scan.

You should be asked about your mental health at every appointment, whether in person or via phone/video.

In the third trimester, you should be asked about your baby’s movements at every appointment, whether in person or via phone/video.

All pregnant women should be provided with information about Group B streptococcus (GBS) in pregnancy and newborn babies.

Sometimes, you may need additional antenatal appointments and medical care. This will depend on your individual medical needs. These appointments may be carried out over the phone or via video, provided a physical examination or test is not required. This will enable partners and other family/household members to join you for support and allow social distancing to protect you and your baby from coronavirus.

 

Q. Will I need to wear a facemask when I attend hospital for antenatal appointments, or to have my baby?

To reduce transmission of coronavirus in hospitals, you and your partner will be asked to wear a face covering or mask when you attend a clinical environment for appointments as stated in the guidance for Scotland and EnglandAll visitors and outpatients, including pregnant women attending antenatal appointments or scans, must always wear face coverings to protect themselves, other women and staff from coronavirus. The same recommendations on face-coverings apply when receiving visits at home. 

At present hospital inpatients, including women giving birth, are not required to wear face coverings or masks. The RCM has developed guidance about the wearing of face coverings 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. 

 

Pregnancy scans

Q. Will I be able to bring someone with me to scans?

In some hospitals and maternity units, there are restrictions on visitors which might mean that birth partners or other supportive companions are not able to attend routine antenatal appointments, including scans, with you.

On 5 June, the NHS’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 and sonography unit for their policy on visitors attending antenatal appointments, including scans. It is important that any visitors and outpatients follow guidance in hospitals about social distancing, wearing a face covering and handwashing.

If you are unable to bring someone with you to your scan, we encourage units to allow women to share the ultrasound scan experience with their partner (or other family members and friends) by saving a short 10–30-second video clip of the baby at the end of the dating scan and/or anomaly scan.

In the current pandemic situation, when women attend alone, virtual attendance by partners or companions by online video call, or the filming of the dating and/or anomaly scan, is not recommended. While we understand this may be disappointing, virtual attendance can be distracting to the sonographer and prevent them from doing their job effectively.

We understand it may be upsetting if you are asked to come alone to a scan, but this measure has been put in place to protect maternity staff, other women and babies, and you and your family from the risk of infection. Scans are an essential part of pregnancy care and it is important that you continue to attend them for your and your baby’s wellbeing.

 

Childbirth choices

Q. Will being in self-isolation for suspected or confirmed Covid-19 affect my birthplace choices?

If you have COVID symptoms or have tested positive, let your midwife know. When you go into early labour, let your maternity team know and come into the maternity unit rather than stay at home. This is to keep you, and those caring for you, safe.

If you have COVID, or even think you might, Being in the hospital is the safest option 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. The sort of close, continuous monitoring needed during labour can only be done in hospital.

It’s safer for the midwives and other staff caring for you too. Hospital labour rooms have a specialised deep clean before each admission and midwives have access to the full range of protective equipment. Being in hospital also means that other members of the team are on hand if you need more or different care.

 

Birth partners

Q. Will I be able to have my birth partner(s) with me during labour and birth?

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.

 

Q. 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 measures.

On 5 June, the NHS’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. It is important that any visitors follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

We understand this must be a very worrying and anxious time if you are pregnant and your birth partner(s) cannot be with you while you are being induced. However, hospitals still need to limit the number of visitors during this time.

This guidance is in place to protect other pregnant women and babies and birth partners themselves.

Please be assured that if your birth partner(s) is unable to be with you on a ward during your induction, this will not impact on your birth partner’s presence during labour and the birth, unless they are unwell with symptoms of coronavirus or have tested positive for coronavirus. At the point you go into active labour, you will be moved to your own room and at least one well birth partner will be able to join you.

 

Q. Will I be able to have a birth partner with me on the postnatal ward?

On 5 June 2020, the NHS’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 postnatal wards.

We understand that not having a birth partner with you on the postnatal ward after you have given birth may be upsetting but these restrictions are in place to reduce the risk of transmission of coronavirus to you, your baby, the maternity staff and birth partners themselves.

Please be reassured that during this time, midwifery, obstetric and support staff will do their best to support the needs of all women and the practical challenges of caring for newborn babies after birth. If visitors are permitted, it is important that they follow guidance in hospitals about social distancing, wearing a face covering and regular handwashing.

Q. What if I decline testing for coronavirus?

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.

 

Information for healthcare professionals:

The Royal College of Midwives have published guidance for health professionals on the Coronavirus (COVID-19) infection in pregnancy which is now available to download

 

Updated: August 2021