Coronavirus (COVID-19) information

Pregnant women do not appear to be more severely unwell than the rest of the population.

It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

When you are pregnant you are more vulnerable to getting infections than a woman who is not pregnant. If you have an underlying condition, such as asthma or diabetes, you may be more unwell if you have coronavirus.

It is therefore important that you take precautions to protect yourself against COVID-19.

If you have any of the symptoms of coronavirus, however mild, get tested. Symptoms include fever, chills or sweats, acute respiratory infection (e.g. cough, sore throat, shortness of breath, runny nose or loss of smell).

If you develop more severe symptoms or if you are not getting better you should contact your maternity hospital and speak to a midwife in Pregnancy Assessment, in the first instance.

As this is a very new virus we are just beginning to learn about it.

Given current evidence, it is considered unlikely that if you have the virus it would cause problems with the baby’s development.

As we learn about the coronavirus infection we will update this information.

The most important thing to do is to wash your hands regularly and effectively as soon as you come from public places to your home or workplace.

There is useful advice on the https://monashhealth.org/patients-visitors/coronavirus/

• Wash hands often with soap and running water, for at least 20 seconds. Dry with paper towel or hand dryer.
• Try not to touch your eyes, nose or mouth.
• Cover your nose and mouth with a tissue when you cough or sneeze. Then dispose of the used tissue immediately.
• Cough or sneeze into your upper sleeve or elbow if you don’t have a tissue.
• Social distancing and keeping a space between yourselves and others.
• Phone your doctor or the hotline – 1800 675 398 – if you need medical attention. They will tell you what to do.
• Continue healthy habits: exercise, drink water, and get plenty of sleep.
• Buy an alcohol-based hand sanitiser with over 60 per cent alcohol.
• Keep in touch with friends and family using remote technology such as phone, internet, and social media.
• Use telephone or online services to contact your GP or other essential services.

Everyone should be trying to follow these 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 this infection have a higher chance of serious complications than any other healthy individuals.

We advise all pregnant women to be very cautious and follow the advice above to reduce the risk of exposure to Coronavirus.

Although there is currently no vaccine for Coronavirus, we strongly encourage all pregnant women to have influenza and whooping cough vaccinations.

All pregnant women should follow government advice:

• Practice social distancing.
• Access fact sheets for patients from the Department of Health and Human Services
• If you are in your third trimester (more than 28 weeks pregnant) or have an underlying health condition – such as heart or lung disease – you should be particularly attentive to social distancing and minimising any contact with others.

Pregnant women who can work from home should do so.

If you can’t work from home and you work in a public-facing role that can be modified appropriately to minimise your exposure, this should be considered and discussed with your occupational health team.

Yes. Ongoing pregnancy care and postnatal care when you have a new baby is essential to ensure the wellbeing of you and your baby.

We are increasingly providing consultations on the phone or telehealth, when this is appropriate, so you do not have to travel unnecessarily to the hospital. However, some in person visits are essential and it is important for the wellbeing of you and your baby that you attend these to have routine checks.

If you have symptoms of possible coronavirus infection, please arrange for testing, and contact your maternity hospital for further advice regarding appointments.

The following practical advice may be helpful:

• If you have a routine scan or visit due in the coming days, please contact your maternity clinic for advice and a plan. You may still need to attend for a visit but the appointment may change.
• Some appointments may be conducted on the telephone or using Telehealth.
• If you are between appointments, please wait to hear from your maternity team.
• If you are attending more regularly in pregnancy, then your maternity team will be in touch with your plan for pregnancy.
• If you miss an appointment and haven’t heard from your maternity team, please contact them to rearrange the appointment.

Whatever your personal situation, please consider the following:

• If you have an urgent problem related to your pregnancy get in touch using the same emergency contact details you already have.
• If you have symptoms suggestive of coronavirus, contact your maternity services and they will arrange the right place and time to come for your visits. You should not attend a routine clinic.
• To maintain social distancing no other person can attend any face to face clinic appointments.
• There may be a need to reduce the number of pregnancy care visits. This will be communicated with you.
• Do not reduce your number of visits without communication first with your maternity team.

You may be advised to self-isolate because:

• You have symptoms of coronavirus, such as a high temperature or new, continuous cough.
• You have tested positive for coronavirus.
• You have been in contact with someone who has tested positive.

You should contact your midwife, doctor or the hospital maternity clinic to inform them that you are currently in self-isolation for possible/confirmed coronavirus and request advice on attending routine pregnancy care appointments.

Some appointments can be undertaken by telephone or telehealth.

It is likely that routine 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 other patients.

If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged 14 days after your recovery, to check that your baby is well. (This will depend on how many weeks pregnant you are and when other routine ultrasounds are due). This 14 day period may be reduced as more information on how infected people are as they recover becomes available.

If you have recovered from coronavirus and tested negative for the virus before you go into labour, where and how you give birth will not be affected by your previous illness.

If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, contact the staff in Pregnancy Assessment at the hospital where you are booked. They will provide further advice, including whether you need to attend hospital.

If attendance at the hospital is advised, pregnant women are requested to travel by private transport, and alert the staff in Pregnancy Assessment or Emergency Department reception once on the premises, prior to entering the hospital.

Women with suspected or confirmed coronavirus are advised to attend a maternity hospital for birth, so that their baby can be monitored using continuous electronic fetal monitoring, and maternal oxygen levels can also be monitored.

We will keep this advice continually updated as new evidence emerges.

There is currently no evidence to suggest you cannot give birth vaginally or that you would be any safer having a caesarean birth if you have suspected or confirmed coronavirus.  However, if your respiratory condition (breathing) suggests that birth is urgently needed, a caesarean birth may be recommended.

Water immersion and water birth will not be available if you are suspected or confirmed COVID-19 infection, to maximise safety for mother, baby and staff.¹

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block.

There is also no reason you cannot use Entonox (gas) in labour.

If you go into labour, you should call your maternity hospital for advice, and inform them that you have suspected or confirmed coronavirus infection.

If you have mild symptoms, you will be encouraged to remain at home (self-isolating) in early labour, as per standard practise.

Your maternity team have been advised on ways to ensure that you and your baby receive safe, quality care, respecting your birth plan as closely as possible.

When you and your maternity team decide you need to attend the hospital, general recommendations about hospital attendance will apply:

• You will be advised to attend hospital via private transport where possible.
• You will be met at the Emergency Department entrance and provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room.
• Coronavirus testing will be arranged.
• One birth partner if well, will be able to stay with you throughout labour. Other visitors are unable to attend.

The current diagnostic testing advice for COVID-19 in the baby is only indicated if the mother is confirmed as being positive and the baby has symptoms of cold or flu.

If you have confirmed or suspected coronavirus when the baby is born, doctors who specialise in the care of newborn babies (neonatal doctors) will examine your baby and advise you about their care, including whether they need testing.

• We are asking you to follow the guidance below to keep yourself, your family, other families and our staff as safe as possible during the pandemic.
• During the coronavirus pandemic, all hospitals are restricting visitors but there are exceptions for a birth partner.
• Every woman is able to have 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 mothers, their babies, and to 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 our staff and stay at home.
• 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 pregnant women and their babies, as well as other vulnerable 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 this in a bin immediately.
• Stay in the birth suite with your partner. Do not move (walk) around the birth suite unaccompanied – use the call bell if you require assistance.
• You will be asked to a wear a mask or any personal protective equipment (PPE) it is very important to please follow the instructions carefully..
• If you are accompanying a woman to her caesarean birth, be aware that operating theatre staff will be wearing PPE (mask, protective eye wear, sleeved grown, theatre cap, gloves) 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 and spreading the virus.
  • 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 and their partners and we thank you for your cooperation during this time
• Please be assured that all of the maternity team staff will do all we can to provide information, guidance and support to you and your partner.

Yes, if that is your choice. Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth.

A discussion about the risks and benefits should take place between you and your family and the doctors caring for your baby (neonatologists) to individualise care for your baby.

This guidance may change as knowledge evolves.

Yes. At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognised benefits of breastfeeding outweigh any potential chance of transmission of coronavirus through breastmilk.

The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.

A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team. This guidance may change as knowledge evolves.

If you choose to breastfeed 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.
• Consider wearing a face mask while breastfeeding, if available.
• Follow recommendations for pump cleaning after each use.
• Consider asking someone who is well to feed your expressed breast milk to your baby.
• Routinely clean and disinfect surfaces you have touched.

If you choose to feed your baby with formula or expressed milk, it is recommend that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

• Royal College of Obstetricians & Gynaecologists
• World Health Organisation (WHO) | Guidance on COVID-19 for pregnant women

https://www.health.gov.au/resources/publications/covid-19-vaccination-covid-19-vaccination-decision-guide-for-women-who-are-pregnant-breastfeeding-or-planning-pregnancy