The pregnancy and Covid guidance has been updated by the Royal College of Obstetricians and Gynaecologists (RCOG) to include testing for pregnant women.
I’m going to put the main points here to ease some of the confusion. Procedures will vary between NHS trusts so ask questions to clarify the situation where you are.
Pregnant women are currently categorised as vulnerable. Studies have found that some pregnant women are at an increased risk of serious illness if they have covid. This includes:
- black, Asian and minority ethnic women
- women over 35
- women who are obese
- and women with pre-existing conditions such as diabetes and high blood pressure
The majority of pregnant women who have been seriously unwell have been in their third trimester. RCOG is emphasising the importance of isolating and social distancing from 28 weeks.
RCOG states that women will have 6 face-to-face appointments and scans/tests could be combined with a routine appointment to prevent multiple visits to clinics.
Additional appointments can be scheduled in but depending on the individual medical need, these could take place over video/phone.
Currently, pregnant women have to attend these appointments on their own.
Pregnancy and Covid testing
RCOG states: “All women who are admitted to hospital for maternity care in England should be offered swab testing regardless of symptoms.”
The birth partners of labouring women should be offered testing as well.
Some maternity units will test women 72 hours before a planned procedure such as induction and caesarean.
Other maternity units are aiming to create a 14-day pathway. This means that women are being tested at around 38 weeks and then they can isolate for 2 weeks. Your maternity unit will have its own guidance on this. I am seeing variations with this – some units are doing this before planned procedures, others are testing all pregnant women.
If you test positive for covid, planned procedures may be postponed but my understanding is that decisions would be based on the severity of the illness.
This is where it gets more complicated because it sounds like maternity units are using this guidance differently.
In some maternity units swabs taken in advance (72 hours or 14 days followed by isolation at home) will be more accurate.
According to RCOG, all other women who go to hospital in labour will risk assessed to see whether an infection is possible and whether there are any symptoms.
“Women who are risk assessed as unlikely to be currently infected and who do not have a test result should be treated as though they DO NOT have Covid-19 when in labour. Their care should follow a similar plan to that prior to the pandemic.” The guidance goes on to say: “Women who decline testing should be cared for in the same way as women whose result is pending . Declining testing should not prejudice the woman’s care in any way.”
However, I have been told that some maternity units who swab women when they present at hospital in labour can get the results within an hour.
“Where a woman is admitted for birth, her birth partner should also be tested under the principle that they are also expected to be present for the duration of the birth.”
If a birth partner has symptoms or has tested positive, they will have to stay at home.
Options in labour
For women who are low-risk and test positive but have no symptoms, routine care will be provided with additional observations for covid symptoms and their severity.
For women who test positive and have symptoms care will be dependent on the severity of the symptoms. If mild, routine care will be offered with a few changes:
- labouring women will need to be admitted to an obstetric unit
- there will be additional monitoring of oxygen levels
- women will be offered continuous fetal monitoring
- birth pools will not be an option
If you are well and able you can be mobile to have gravity and be more comfortable within your birth room. You don’t have to be confined to a bed, even if your baby does need to be continuously monitored.
It is unclear if birth partners are able to be in hospital if they have no symptoms but a pregnant woman has tested positive. The only guidance I can find about birth partners is based on them having symptoms or testing positive, when they would have to stay at home.
For women who have symptoms/tested positive for Covid-19, their newborn baby will be examined and a test may be given. But this will be discussed with you.
The latest guidance states that as long as you and your baby are well, you will stay together and you can have skin-to-skin cuddles and breastfeed, if that is what you planned to do. You may need to wear a face mask.
I have read through the following pregnancy and covid guidance:
It’s far from a simple issue and the variation in procedures from one maternity unit to the next has raised concerns and fears. Some women are now worrying about the possibility of a positive test or having to do this on their own if their options are reduced. Read the RCOG info above and ask questions so you know what to expect.
As I have mentioned, I am trying to get clarity on a couple of issues. This is new information, maternity units are probably making sense of it and working out what they can offer for pregnant and birthing women. Please do message me below with questions or comments about pregnancy and covid.
Janine – a specialist in pregnancy, birth and early parenting