The Guidance for maternity services provides guidance for the care of pregnant women by maternity care providers, this includes midwives, obstetricians and general practitioners.
If a pregnant woman requires admission to hospital or an intensive care unit due to her COVID‑19 infection, care would be provided by an extended multi-disciplinary team and may include obstetricians, respiratory physicians and intensivists. The care during this admission is beyond the scope of this guidance.
The safety of maternity patients and staff is a health system priority. The care of women should be individualised and based on comprehensive systematic A‑G assessment irrespective of a diagnosis of COVID‑19.
The utmost priority is the immediate medical and care needs of the pregnant woman and her baby. There should be no delay in providing optimal care for the woman or her baby regardless of the woman’s COVID‑19 status, vaccination status or whether the woman and her family reside in areas with high COVID‑19 prevalence.
Maternity services should monitor the COVID‑19 transmission risk level and respond according to COVID‑19 Infection Prevention and Control Manual. The manual includes information regarding personal protective equipment, outpatient appointments and visitors and participants in care. For information regarding participants in care during birth see Participants in Care (Birth partners)
Maternity care providers should inform pregnant women that they are at increased risk of severe disease of respiratory illnesses in pregnancy, this includes COVID‑19 and influenza.
Pregnant women should be advised of when and how to access care if required. This care may be provided by their GP, emergency department or maternity care provider as appropriate. Consumer resources include:
Vaccination reduces risk of severe disease from respiratory viruses during pregnancy. Pregnant women should be encouraged to ensure their COVID‑19 vaccinations are up to date and to have the influenza vaccine:
The most common symptoms of COVID‑19 are fever, cough, shortness of breath, sore throat and loss of smell or loss of taste. Other non-specific symptoms of COVID‑19 include fatigue, headache, runny nose, acute blocked nose (congestion), muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite.
Antenatal assessment can occur face-to-face or via virtual care. The decision regarding face-to-face visits should be made based on clinical risk and the woman's preference, irrespective of COVID‑19 status. Virtual care, also known as telehealth, safely connects patients with health professionals to deliver care when needed and can replace some antenatal appointments where physical examination is not required.
Changes to care should be based on all pregnancy risks, including but not limited to COVID‑19 status.
For home visits please refer to CEC – COVID‑19 Infection Prevention and Control Manual Chapter 5: Home visits
Local decisions should be made regarding the mode of delivery of antenatal classes. Classes may be held face-to-face, virtually or a hybrid model. Consumer need and COVID‑19 transmission risk level should be considered.
For information on carbon monoxide testing in pregnancy please refer to COVID-19 Infection Prevention and Control Manual Chapter 5: Maternity and neonatal services.
Having a trusted birth partner as a participant in care is known to make a significant difference to the safety and wellbeing of women during labour and birth and contributes to care being woman centred. A participant in care can be described as someone actively providing care, physical and/or emotional support.
For maternity services who are seeking to support the attendance of participants in care who are COVID‑19 positive, the following guidance applies:
Most pregnant women will be able to safely stay at home while they have COVID‑19. Every person who tests positive to COVID‑19 by PCR or who registers their positive rapid antigen test will receive a text message linking to Testing positive to and managing COVID‑19 safely at home, this includes the following advice for pregnant women:
If a pregnant woman contacts their maternity care provider with concerns related to their COVID‑19 infection, the maternity care provider should complete the following assessment, care plan and education.
Assessment should include:
Following assessment, all pregnant women with COVID‑19 should have a documented, individualised care plan as per Caring for adults and children in the community with COVID‑19 - Flow chart and care protocols.
The care plan should be developed with collaboration between the woman and maternity care provider and include:
The woman should be provided with information regarding:
All pregnant women who have had COVID‑19 in pregnancy should be provided with information regarding:
If any routine antenatal appointments have been missed during self-isolation, reschedule as soon as practical.
Antenatal, labour and birth care should remain unchanged.
All pregnant women with COVID‑19 should be risk assessed on presentation and an individualised plan of care be made regarding model of care and place of birth.
A comprehensive systematic A-G maternal and fetal assessment (as per Recognition and management of patients who are deteriorating) should be undertaken on presentation and be repeated as required. This includes:
Symptomatic women – should not labour and birth in water.
Asymptomatic women – water immersion or birth is not contraindicated, providing adequate PPE can be worn by maternity care providers.
Entonox can be used with a single-patient viral/microbiological filter that performs at or above 99.997% efficiency.
Check with the nitrous oxide equipment manufacturer to determine if there are recommendations for filters to be added into an individual delivery system in relation to COVID‑19. The make, model, other associated parts and delivery systems will be different across NSW hospitals.
Symptomatic women – an early epidural should be recommended in labour, particularly for women with acute respiratory symptoms, to minimise the need for general anaesthesia if urgent intervention for birth is needed.
Asymptomatic women – an epidural should not be routinely recommended solely because of a positive test.
There is no contraindication in women who are COVID‑19 positive to performing fetal blood sampling or applying a fetal scalp electrode if clinically indicated.
As per usual clinical practice – shared decision making, considering all individual risk factors and maternal and fetal clinical condition.
Placenta(e) should be sent for histological examination to local pathology services following serious or critical COVID‑19 infection at time of birth or if indicated as per NSW Health Guideline: Indications for placental histological examination (GL2014_006).
In the event of a perinatal or neonatal death, the placenta should be sent to a perinatal post-mortem service.
All care must be taken to avoid separation of a mother and baby unless medically necessary.
When mothers, babies/families are separated/isolated for any reason staff should acknowledge that this may be a trigger for anxiety. This may be an especially difficult time for Aboriginal families and refugees. Staff will need to identify mothers and families that may require additional support on referral or early intervention. Staff will need to partner quickly with appropriate local support, for example Aboriginal liaison officers, Aboriginal health workers, multicultural health staff, and social work. Staff should seek advice from clinical leads to ensure that the best plan for additional support is developed with local resources.
Refer to Breastfeeding with COVID-19 or Flu.
Private cord blood banking should be managed in line with contractor management.
Family cord blood collection and donation should be managed through a risk assessment process and in accordance with local protocols.
Individualised according to the woman's COVID‑19 disease severity and obstetric and neonatal outcomes.
For home visits please refer to CEC – COVID‑19 Infection Prevention and Control Manual Chapter 5: Home visits.
Health and Social Policy Branch (HSPB), NSW Ministry of Health.
Maternity services.