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
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:
Coronavirus Disease 2019 (COVID‑19) CDNA National Guidelines state 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
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
For home visits please refer to CEC –COVID‑19 Infection Prevention and Control Manual Chapter 8: 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.
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.
There is an
Exemption to the Public Health (COVID‑19 Self Isolation) Order (No 4) 2021 that allows for a person required to self-isolate to attend a birthing unit/environment for the purposes of providing care and physical/emotional support during labour, birth and the immediate postnatal period. The Exempt Person is subject to conditions, including that they must only attend with the informed consent of the pregnant woman (which is documented in the woman's healthcare record) and if permitted to do so by staff at the healthcare facility.
For maternity services who are seeking to support the attendance of participants in care who are
COVID‑19 positive or contacts, the following guidance applies:
Local procedures should be in place to reduce the risk of
COVID‑19 exposure to healthcare workers and patients as per
COVID‑19 Infection Prevention and Control (IPAC) Manual, including the following requirements for the participant in care:
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
GL2014_006 Maternity - Indications for Placental Histological Examination.
In the event of a perinatal or neonatal death, the placenta should be sent to a perinatal post-mortem service.
NSW Health Guidance for Neonatal Services.
Care of the newborn – NSW Health Guidance for Neonatal Services is relevant to all postnatal wards, special care nurseries and neonatal intensive care units and provides guidance regarding care of the well as well as
COVID‑19 affected newborn.
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.
Where possible, transfer the baby in a closed incubator between locations in the facility. For further information refer to:
NSW Health Guidance for Neonatal Services.
Guidance on infant feeding.
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 8: Home visits.
Health and Social Policy Branch (HSPB), NSW Ministry of Health.
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.