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

COVID-19 is a new illness that affects the lungs and breathing. It is caused by a new coronavirus. Symptoms include fever, cough, sore throat, and trouble breathing. COVID-19 may also cause stomach problems, such as nausea and diarrhea, and a loss of your sense of smell or taste. Symptoms may appear 2 to 14 days after you are exposed to the virus. Some people with COVID-19 may have no symptoms or only mild symptoms.

Reports and research show that pregnant and recently pregnant women have a higher risk of more severe illness from COVID-19 than nonpregnant women. Reports note 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. 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 and gestational diabetes, may have an even higher risk of severe illness, similar to nonpregnant women with these conditions.

• 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. Visit the Centers for Disease Control and Prevention (CDC) website to learn more about these inequities.

Reports also note the following for pregnant women with COVID-19:

• They 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. This is especially true for pregnant women with moderate and severe illness.

• They may 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.

After birth, reports have shown the following:

• 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).

• A 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, such as the Omicron variant.

The Omicron variant can still cause severe illness in certain people, especially if they are unvaccinated. The best way to protect yourself against illness from Omicron and other new variants is to get a COVID-19 vaccine.

Yes, you should get a COVID-19 vaccine. ACOG strongly recommends vaccination if you are pregnant, breastfeeding, or planning to get pregnant. Read COVID-19 Vaccines: Answers From Ob-Gyns to learn more, and talk with your obstetrician–gynecologist (ob-gyn) if you have questions.

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

• getting a COVID-19 vaccine (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

• keeping your prenatal and postpartum care visits

• 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’s important to follow current mask guidelines from the CDC. Mask guidelines may change based on how COVID-19 is affecting your community. You can look up your county on the CDC website to see the current guidelines for your area. Sometimes the CDC may recommend that everyone wears a face mask, or that people who are at high risk for severe illness consider wearing a face mask. Remember, if you are pregnant or postpartum, you are at high risk for severe illness.

It is still recommended that you wear a mask on public transit and in travel hubs like airports or train stations. In health care settings, follow the guidelines of the health care facility. But it may be a good idea to wear a mask even if it is not required, especially when COVID-19 is spreading at the same time as the flu.

Always wear a mask if you are sick with COVID-19 or caring for someone else with the illness.

If you want to keep wearing a mask for any other reason, you can still do so. 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.

Your mask can help protect you and others because the virus spreads through the air. Also, studies have shown that people can spread the virus before showing any symptoms. Wearing a mask can reduce the chance of spreading COVID-19, along with getting vaccinated and taking other steps to stay safe. See the CDC's latest recommendations on masks.

It's normal to feel fear, uncertainty, stress, or anxiety because of COVID-19. Reaching out to friends and family during this time may help. There are also treatment and support resources you can access in person, over the phone, or online.

Talk with your ob-gyn about how to get help if you’re having symptoms like these:

• Feeling sad, hopeless, worthless, or helpless

• Feeling afraid or worried, which may cause a fast heartbeat

• Feeling that life is not worth living

• Having repeated, scary, and unwanted thoughts that are hard to get rid of

If you are in crisis or feel like you want to harm yourself or others, call 911 right away. See the Resources section for other support options, including helplines you can text or call and online support groups for pregnant and postpartum women.

Physical activity may also help your mental health. And it may be useful to focus on your breathing each day, especially if you are feeling anxious. Breathe in for 4 seconds, hold for 7 seconds, and breathe out for 8 seconds. Repeat three times.

Times of stress and uncertainty can be very hard for people in abusive relationships. Abuse at home is known as intimate partner violence or domestic violence. Abuse can get worse during pregnancy. If you need help, call the 24-hour, toll-free National Domestic Violence Hotline: 800-799-SAFE (7233) and 800-787-3224 (TTY). Or you can text LOVEIS to 22522 or use the live chat option at www.thehotline.org

In most cases, you can travel safely until close to your due date. Read general information about travel during pregnancy, and follow CDC travel guidelines related to COVID-19.

Other travel recommendations may be in place globally or locally. Check with your local or state health department for information about travel in your area.

It’s important to keep your prenatal and postpartum care visits. If COVID-19 is spreading quickly in your area, you can ask your ob-gyn how your visits may be changed. Some women may have fewer or more spaced-out in-person visits. You may also talk more with your health care team over the phone or through an online video call. This is called telemedicine or telehealth. It’s a good way for you to get the care you need while preventing the spread of disease.

If you have a visit scheduled, your care team’s office may call you ahead of time. They may tell you about telehealth or make sure you do not have symptoms of COVID-19 if you are going into the office. You can also call them before your visits if you do not hear from them.

Yes, it’s important to continue getting the care you need to stay healthy. Pregnant and postpartum women who are due for screenings, tests, vaccines, or other care from any health care professionals should continue with their appointments. If you missed a routine health care visit because of COVID-19, schedule a new visit as soon as you can.

Ask the office about policies related to COVID-19, including mask and support-person policies. You can also ask if telehealth is an option for your appointment. Talk with your ob-gyn if you have questions about how to stay safe at a health care visit.

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

If you have emergency warning signs, call 911 or go to the hospital right away. Emergency warning signs include the following:

• Having a hard time breathing or shortness of breath (more than what has been normal for you during pregnancy)

• Ongoing pain or pressure in the chest

• Sudden confusion

• Being unable to respond to others

• Blue lips or face

If you go to the hospital, try to call ahead to let them know you are coming so they can prepare. If you have other symptoms that worry you, call your ob-gyn or 911.

If you are diagnosed with COVID-19, follow the advice from the CDC and talk with your ob-gyn. Your ob-gyn may offer you medication to help treat COVID-19, depending on your symptoms and your risk for severe illness.

The current CDC advice for all people with COVID-19 includes the following:

• Stay home except to get medical care. Avoid public transportation.

• Speak with your health care team over the phone before going to their office. Get medical care right away if you feel worse or think it’s an emergency.

• Separate yourself from other people in your home.

• Wear a face mask when you are around other people and when you go to get medical care.

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. Your hospital or birth center may be adjusting their policies. For example, there may be changes to the number of visitors allowed and how long you will stay in the hospital. 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.

Check with your hospital or birth center. They may limit the number of visitors to help prevent the spread of COVID-19. The number of visitors you can have may depend on local and state recommendations and how quickly COVID-19 is spreading in your area.

Some hospitals and birth centers may consider doulas to be visitors. Check the hospital or birth center policy if you are planning to have a doula with you.

ACOG believes that the safest place for you to give birth is still a hospital, hospital-based birth center, or accredited freestanding birth center. COVID-19 has not changed this recommendation.

Even the healthiest pregnancies can have problems arise with little or no warning during labor and delivery. If problems happen, a hospital setting can give you and your baby the best care in a hurry.

Keep in mind that hospitals, hospital-based birth centers, and accredited freestanding birth centers follow strict procedures to clean and control infection.

While you are in the hospital or birth center, you should wear a mask if you have COVID-19. But when you are pushing during labor, wearing a mask may be difficult. For this reason, your health care team should wear masks or other protective breathing equipment. They may also take other steps to reduce the risk of spreading the virus, including wearing goggles or face shields.

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.

You may also choose for your baby to stay separated from you, such as in the hospital nursery. But 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. (See "How can I avoid passing COVID-19 to my baby?") If you room together, the baby’s crib may be kept at least 6 feet away from you. Some facilities use clear plastic cribs that are enclosed and keep an even temperature.

Staying in a separate room may be encouraged if you are very sick or your baby is at a high risk of getting very sick. If you choose to be separated and you plan to breastfeed, you can ask for a breast pump and use it to express (pump) milk. This will allow someone who is not sick to bottle-feed breast milk to your baby. Pumping may also help you maintain your milk supply for when you begin breastfeeding.

Talk with your health care team about the options at your hospital or birth center well before your due date. Together you can discuss what you think is right for you and your baby. Be sure to talk about the best ways to

• reduce the risk of infection for your baby

• support the long-term health of you and your baby

• help you start breastfeeding if desired

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.

Tell your employer if you are pregnant or if you have a health condition that may put you at higher risk. People with some health conditions, such as diabetes mellitus, lung disease, heart disease, and obesity, have a higher risk of severe illness from COVID-19. Getting a COVID-19 vaccine is an effective way to protect yourself from infection, severe illness, and death. 

Talk with your employer about how you can stay safe while doing your job. Ask if remote work is possible. If remote work is not possible, and you work in a job with a high risk of exposure to COVID-19, ask your employer if you can switch to a role with lower exposure risk.

No matter what your job is, your employer should follow guidelines from the CDC and state and local health departments. These guidelines can help reduce the risk of infection for employees. If there is a chance you could be exposed to the virus at work, ask your employer about masks, gloves, and other equipment that can help protect you.

If you aren’t given the protection you need, tell your ob-gyn. Together you should talk about how you can discuss your safety with your employer.

Your ob-gyn should continue to be your main resource for all questions about your pregnancy. For the most current information about the coronavirus and COVID-19, check CDC web pages, which are updated often and listed below.

Pregnancy is a personal choice. It may help to think about your health and the potential risks of COVID-19. You and your ob-gyn should talk about the latest research on the increased risk of severe illness during pregnancy. You should also talk about taking steps to prevent exposure to COVID-19 during pregnancy, including getting a COVID-19 vaccine.

Current reports show that pregnant women have a higher risk of more severe illness and death from COVID-19 than nonpregnant women. And pregnant women with some health conditions, such as gestational diabetes and obesity, may have an even higher risk of severe illness from COVID-19.

Also, there are some reports that COVID-19 may have passed from a woman to her baby during pregnancy or delivery, but this seems to be rare.

Centers for Disease Control and Prevention (CDC)
www.cdc.gov/coronavirus

• Pregnant and Recently Pregnant People: Learn more about COVID-19 and pregnancy.

• Breastfeeding and Caring for Newborns: Learn more about COVID-19 and newborn care.

• Prevent Getting Sick: Learn how the virus spreads and 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.

Postpartum Support International Helpline
www.postpartum.net
800-944-4773 (English and Spanish)
Text 800-944-4773 (English) or 971-203-7773 (Spanish)
Contact this non-emergency helpline for support, information, or referrals to postpartum mental health providers. The helpline is open 7 days per week. Leave a confidential message at any time, and a volunteer will return your call or text as soon as possible.
PSI also offers online support group meetings to connect with other pregnant and postpartum women. You also can join PSI’s weekly Chat with an Expert.  

National Domestic Violence Hotline
800-799-SAFE (7233) and 800-787-3224 (TDD)
Text LOVEIS to 22522
Live chat and more information: www.thehotline.org

National Suicide Prevention Lifeline
800-273-8255
https://suicidepreventionlifeline.org
Lifeline chat: https://suicidepreventionlifeline.org/chat
Offers free, confidential support 24/7.

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

Complications: Diseases or conditions that happen as a result of another disease or condition. An example is pneumonia that occurs as a result of the flu. A complication also can occur as a result of a condition, such as pregnancy. An example of a pregnancy complication is preterm labor.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

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

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

Gestational Diabetes: Diabetes that starts during pregnancy.

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

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Preterm: Less than 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.