COVID-19, Pregnancy, Childbirth, and Breastfeeding: Answers From Ob-Gyns

COVID-19 is an illness that affects the lungs and breathing. It is caused by a coronavirus. Symptoms may include fever, cough, sore throat, and congestion. Other symptoms are possible too. Symptoms may appear 2 to 14 days after you are exposed to the virus.

You may have no symptoms, mild symptoms, or severe symptoms. Symptoms may vary with new COVID-19 variants. They may also vary based on your vaccination status.

If you are pregnant or postpartum, you have a higher risk of more severe illness from COVID-19 than people who are not pregnant. Research has found that:

• Pregnant women who have COVID-19 and show symptoms are more likely than nonpregnant women with COVID-19 and symptoms to need care in an intensive care unit (ICU), to need a ventilator (for breathing support), or to die from the illness. They are also more likely to have a cesarean birth, preeclampsia or eclampsia, and blood clots. Still, the overall risk of severe illness and death for pregnant women is low.

• Pregnant and recently pregnant women with some health conditions, such as obesity, diabetes, high blood pressure, and lung disease, may have an even higher risk of severe illness, similar to nonpregnant women with these conditions. Risk may also increase with age.

• Pregnant women who are Black or Hispanic have a higher rate of illness and death from COVID-19 than other pregnant women, but not because of biology. Black and Hispanic women are more likely to face social, health, and economic inequities that put them at greater risk of illness.

• Pregnant women with moderate or severe COVID-19 may be more likely to have pregnancy complications than pregnant women without COVID-19. These complications may be related to high blood pressure, heavy postpartum bleeding, and other infections. They may also have an increased risk of coagulopathy (a blood clotting disorder).

Reports of COVID-19 infection during pregnancy have shown the following:

• There is an increased risk of preterm birth.

• Some data suggest a possible increased risk of stillbirth.

• COVID-19 may pass to the fetus during pregnancy, but this seems to be rare.

• In babies born to women who had COVID-19 during pregnancy, there is an increased risk that the newborn will need care in a neonatal intensive care unit (NICU).

• Any newborn can get the virus if they are exposed to it.

As the coronavirus changes, new variants of COVID-19 may keep emerging. Some variants may spread more easily than others or cause more severe illness. Other variants may cause milder illness.

The best way to protect yourself against severe illness new variants is to get the latest COVID-19 vaccine.

ACOG strongly recommends vaccination if you are pregnant, breastfeeding, or planning to get pregnant. The vaccine is safe during pregnancy. Read COVID-19 Vaccines: Answers From Ob-Gyns to learn about current vaccine recommendations, and talk with your obstetrician–gynecologist (ob-gyn) if you have questions.

If you are pregnant or postpartum, steps to stay healthy include

• staying up to date on COVID-19 vaccines (find answers from ob-gyns about the vaccines)

• following guidelines from health officials for when to wear a mask and take other steps to prevent infection

• talking with an ob-gyn or other health care professional if you have any questions about your health or COVID-19

• calling 911 or going to the hospital right away if you need emergency health care

Read more advice on preventing COVID-19 illness from the CDC.

It can be a good idea to consider wearing a face mask in these situations:

• If you are sick with COVID-19 or are caring for someone else with the illness

• If you are at high risk for severe illness (including during pregnancy and postpartum)

• In crowded areas like public transit, airports, or train stations

• In health care settings

Whenever you wear a mask, make sure it fits well, feels comfortable, and provides good protection. The CDC has advice for how to choose and wear a mask.

If you think you may have been exposed to COVID or if you have symptoms, you should take a COVID-19 test. You can also call your ob-gyn for advice.

If you test positive, talk with your ob-gyn about treatment options that are safe during pregnancy.

Talk with your ob-gyn about your birth plan. In most cases, the timing and method of delivery (vaginal birth or cesarean birth) do not need to be changed. Having COVID-19 is not a reason by itself to 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. Check with your hospital or birth center and ob-gyn about your birth plan. Be sure to mention if you are planning to have a doula with you during childbirth.

While you’re in the hospital or birth center, you should tell your health care team that you have COVID-19. They may take steps to keep the virus from spreading, such as asking you or the staff to wear a mask.

Yes. You can follow your hospital’s or birth center’s usual policy on rooming together with your baby.

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. And 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. (Read "How can I avoid passing COVID-19 to my baby?" below.)

Staying in a separate room may be recommended if you are very sick and unable to care for your baby.

Studies suggest that COVID-19 does not pass through breast milk and does not 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. Make your wishes known so that you can begin to express milk or breastfeed before you take your baby home.

If you have COVID-19, you should take the following steps to avoid passing the infection to your baby while you are in the hospital or birth center and after you go home:

• Wear a mask when holding your baby, including during feeding. Do not put a mask or covering over the baby’s face.

• Wash your hands before touching your baby. See the CDC’s handwashing tips.

• Wash your hands before touching any breast pump or bottle parts and clean all pump and bottle parts after use. See the CDC’s advice for cleaning a breast pump.

• If possible, let someone who is healthy help care for your newborn. They can bottle-feed your breast milk to your baby after you pump. They should wear a mask and keep their hands clean. And they should not be at risk of severe illness from COVID-19.

Centers for Disease Control and Prevention (CDC)
https://www.cdc.gov/covid/

• COVID-19 and Breastfeeding: Learn more about COVID-19 and breastfeeding.

• How to Protect Yourself and Others: Learn how to protect yourself and your family.

• Vaccines: Learn about the vaccines that can protect you from COVID-19.

• If You Are Sick: Guidance on what to do if you have COVID-19 or think you may have it.

• Health Department Directories: Find the health department in your area.

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

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that develops with the flu. An example of a pregnancy complication is preterm labor.

Diabetes: A condition that causes high levels of sugar in the blood.

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

Eclampsia [ee-KLAMP-see-uh]: Seizures in pregnancy or after pregnancy that are linked to high blood pressure.

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

High Blood Pressure: Blood pressure above the normal level. Also called hypertension.

Neonatal Intensive Care Unit (NICU): A special part of a hospital where sick newborns receive medical care.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with medical and surgical training and education in the female reproductive system.

Preeclampsia [pre-ee-KLAMP-see-uh]: A disorder during pregnancy or after childbirth that causes high blood pressure and other signs of organ injury. These signs include an abnormal amount of protein in the urine, a low number of platelets, abnormal kidney or liver function, pain over the upper abdomen, fluid in the lungs, a severe headache, or vision changes.

Preterm: Less than 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.