Birth

The safest place for you to give birth is still a hospital, hospital-based birth centre, or accredited freestanding birth centre, states the American College of Obstetricians and Gynaecologists (ACOG). However, it is important to avoid any risks that might put you or your newborn’s health in danger, especially while there is a high risk for getting COVID-19. Every woman has the right to choose where she will give birth. Therefore, it is best to talk to your midwife/nurse or gynaecologist about your birth plan and any concerns you have. They know your situation and can give you valuable advice.

(Source: ACOG)

The World Health Organization (WHO) advices that caesarean sections should only be performed when medically justified. The mode of birth should be individualised and based on a woman’s preferences alongside obstetric indications.

(Source: WHO)

Recent findings show that vaginal as well as caesarean section delivery both carry a low risk of SARS-Cov-2 (the virus that causes COVID-19) transmission from the mother to the newborn. After birth, the newborn is susceptible to person-to-person spread. Breastfeeding for COVID positive mothers is considered safe and supported by the WHO guidelines. Viral precautions such as mask wearing and handwashing are recommended.

(Source: WHO; BJOG; ANZJOG)

According to the World Health Organization (WHO), delayed umbilical cord clamping is highly unlikely to increase the risk of transmitting pathogens from the mother to the foetus even in the case of maternal infection.
After giving birth, a mother that is actively ill with COVID-19 can transmit the virus to her newborn through close contact. To current knowledge, the umbilical cord blood will not contain COVID-19, even if the mother is ill at the time of delivery, therefore delayed cord clamping should still be possible.
The American College of Obstetricians and Gynaecologists (ACOG) recommends as follows:
Delayed cord clamping is still appropriate in the setting of appropriate clinical personal protective equipment. Although some experts have recommended against delayed cord clamping, the evidence is based on opinion. Current evidence-based guidelines for delayed cord clamping should continue to be followed until emerging evidence suggests a change in practice.

(Sources: The Lancet , ACOG)

One should note that policies might vary from country to country and even between hospitals. Parents-to-be should talk to their healthcare team and ask them how to proceed in the delivery room and postnatal and make a joined decision.
It is important to keep in mind, that the main purpose and aim of the clinical and healthcare team is to protect themselves and other patients appropriately, thus avoid the spread of the virus and reduce the risk of infection.

Here are the measures that should be taken:
• If the pregnant woman is infected, her birth partner can accompany her into the delivery room protecting him-/herself from infection by wearing appropriate masks and clothing
• If only the birth partner is infected, he/she would not be allowed to join the birth process (simply for reducing the risk of an infection); Although this might seem extremely hard to accept, this measure is used to protect each person involved in the process of birth
• If both parents are infected, most of the clinics worldwide would still try to reduce the risk of infection to a minimum by not allowing the infected birth partner to attend

Please note that these measures are provided to protect patients, the healthcare team, and also of family-to-be.
After discharge, the recommendations for hygiene measures by the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) should be strictly followed, personal contact to family members (as long as the infected person can spread the virus by aerosol or close contact) should be avoided.
It seems impossible for parents not to have close contact to their newborn baby.
The recommendation that a newborn child should stay in a separate room to reduce the risk of infection for the baby may not be justified in most circumstances. Except, if one family member is severely ill (in that case, this person should anyway be admitted to the hospital). If the mother or the birth partner is COVID-19 positive she/he should restrict contact to the baby as much as possible and perform strict hygiene measures.
In some countries postnatal home visits by midwifes or other health workers are offered, please talk to them about how they would like to proceed, when visiting you.

(Source: ACOG)