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 mellitus, 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, 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 stay up to date on COVID-19 vaccines. ACOG strongly recommends vaccination if you are pregnant, breastfeeding, or planning to get pregnant. 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

• 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.

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 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. 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 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.

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)
www.cdc.gov/coronavirus

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

• 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.

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 and a 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

988 Suicide & Crisis Lifeline
988
https://988lifeline.org
Lifeline chat: https://988lifeline.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.

Eclampsia: Seizures occurring 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 in which sick newborns receive medical care.

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

Preeclampsia: A disorder that can occur during pregnancy or after childbirth in which there is 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, or a severe headache or changes in vision.

Preterm: Less than 37 weeks of pregnancy.

Stillbirth: Birth of a dead fetus.