Perinatal and breastfeeding

Updated April 8, 2022.

Available languages: English

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It is important for health care facilities that provide obstetric care for pregnant and postpartum people to minimize the spread and impact of COVID-19 while ensuring evidence-based, high-quality patient care and support.

The following guidance is intended to aid facilities and clinicians in applying the American College of Obstetricians and Gynecologists Guidance, CDC Considerations for Inpatient Obstetric Healthcare Settings, and American Academy of Pediatrics (AAP) Guidance. Guidance is based on the research available to date about COVID-19 and is updated as new evidence becomes available. 

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Antepartum guidance

Based on what we know at this time, pregnant people are at an increased risk for severe illness from COVID-19 compared to non-pregnant people, including illness that results in ICU admission, mechanical ventilation, and death. Additionally, pregnant people with COVID-19 are at increased risk of preterm birth and stillbirth, and might be at increased risk for other pregnancy complications.

Health care providers should advise pregnant patients and the people they live with about:

  • The importance of getting the COVID-19 vaccination, including all additional and follow-up doses, plus flu and Tdap vaccines to protect their health and the health of their baby; 

  • The risks of COVID-19 infection during pregnancy; 

  • The availability of therapeutic treatments for people at high risk, including pregnant people, who have tested positive for COVID-19; and

  • Following COVID-19 precautions, including wearing a mask in public, washing hands frequently, and limiting gatherings. These precautions are especially important when COVID-19 is spreading widely.

Labor and delivery guidance

  • All individuals deserve the right to high-quality care and a positive birth experience.

  • Health care providers, pregnant patients, support people, and visitors should adhere to infection control practices and personal protective equipment (PPE) use. (Providers should monitor Crisis Standards of Care guidance.)

  • Pregnant patients with presumed or confirmed COVID-19 should be isolated from other patients. 

  • Pregnant patients who have or develop symptoms during their stay, or who may have been exposed to someone with COVID-19, should be tested. If your facility is offering testing to all patients at the time of birth admission, follow guidance from the American College of Obstetrics and Gynecology (ACOG), including shared decision making.

  • Support people should be allowed to accompany pregnant patients for labor and birth. If the pregnant patient is positive for or has symptoms of COVID-19, facilities should limit visitors to those essential for the pregnant person’s well-being and care (emotional support persons, including doulas). 

    • Screen all support people and visitors for symptoms of COVID-19 and do not allow entry if symptoms exist. 

    • Support people and visitors must wear masks and should only visit the birthing person’s room. 

  • Patients and newborns may practice skin-to-skin and room-in together regardless of whether the birthing person is positive for or has symptoms of COVID-19. The updated CDC and AAP guidance recommends patients with known or presumed COVID-19 take proper infection control precautions (i.e., washing hands, wearing a mask) to protect newborns from infection. If patients and families with known or presumed COVID-19 feel uncomfortable with potential risks, each family and the health care team should work together to discuss care and potential separation. Provide this information in the preferred language and at the appropriate health literacy level. The CDC states that “healthcare providers should respect maternal autonomy in the medical decision-making process.” 

  • Continue delayed cord clamping practices according to the facility’s usual guidelines regardless of COVID-19 status. 

  • Infants born to birth parents who are presumed or confirmed to have COVID-19 who require admission to the neonatal intensive care unit (NICU) should be:

    • In a single-patient room with negative room pressure or air filtration capacity, or

    • In a room with only other COVID-exposed newborns, placed 6 feet apart and/or placed in air temperature controlled isolettes.  

  • Staff providing continuous positive airway pressure or any form of mechanical ventilation to infants should wear a gown and gloves, with both an N95 respiratory mask and eye protection goggles, or with an air-purifying respirator that provides eye protection.

  • Any infant born to an individual who is presumed or confirmed to have COVID-19 should be presumed to have COVID-19 themselves. Test the infant if testing capacity allows.

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COVID-19 vaccine guidance

Based on new safety data in pregnant people, the CDC is recommending all people aged 5 year and older get vaccinated against COVID-19, including pregnant and chest feeding people. Several new CDC analyses did not find any safety concerns for pregnant individuals or their babies, whereas the increased risk of severe illness and complications in pregnant individuals related to COVID-19 infection remains high.  Additionally, the American College of Obstetricians and Gynecologists (ACOG) strongly recommends all eligible persons, including pregnant and breastfeeding individuals, receive a COVID-19 vaccine. 

Important points:

  • Patients are not required to get approval or documentation from their health care provider to receive the vaccine. A pregnancy test is not required to receive a COVID-19 vaccine. 

  • CDC recommends people who are starting their vaccine series or getting a follow-up doses to get either Pfizer-BioNTech or Moderna (mRNA) vaccines. 

  • Health care providers are encouraged to get vaccinated themselves, to discuss COVID-19 vaccination side effects, benefits and potential risks with their patients, and document patients’ COVID-19 vaccination status.

  • COVID-19 vaccines may be given simultaneously with other vaccines during pregnancy, including within 14 days of receipt of another vaccine such as those routinely administered during pregnancy (e.g., influenza, Tdap). 

  • Lactating individuals who get the vaccine are encouraged to continue chest feeding their babies after being vaccinated. Antibodies created after a individual receives the vaccine also transfer into human milk and could provide some protection to the baby.

  • Those who are trying to conceive do not need to avoid pregnancy after COVID-19 vaccination. There is no evidence that COVID-19 vaccination causes problems with fertility.

  • If pregnant individuals experience a fever as a side effect to the COVID-19 vaccine, advise patients to take acetaminophen (Tylenol®) to reduce the risks associated with having a fever during pregnancy. Learn more about Possible Side Effects After Getting a COVID-19 Vaccine.

For more information about COVID-19 vaccines during pregnancy and lactation, please see the following available guidance:

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Chest/breastfeeding guidance

For additional guidance, visit CDC’s Pregnancy and Breastfeeding website. For the purposes of this information, the term “breastfeeding” is used interchangeably with the term “chestfeeding” to describe the action of feeding a baby human milk, including expressed/pumped milk or directly chest/breastfeeding. The word “chestfeeding” is offered as a different word for people that prefer not to use the word “breast” when referring to their own bodies. 

  • Human milk is the best source of nutrition for most infants and provides protection against many illnesses. 

  • Limited data suggest that human milk does not transmit COVID-19 virus. 

  • Breastfeeding should be promoted and supported for patients wishing to chest/breastfeed their infants. Patients with COVID-19 can chest/breastfeed if they wish to do so. 

  • A chest/breastfeeding individual with presumed or confirmed COVID-19 should be advised to take all precautions to prevent the spread of the virus to the infant, including: 

    • Washing hands or using hand sanitizer with at least 60% alcohol prior to touching the infant.

    • Wearing a face covering while feeding at the body.

    • Washing hands and breast pump parts thoroughly before and after expressing human milk. Expressed human milk should be fed by a healthy caregiver if possible. 

    • Facilities should continue to use pasteurized donor human milk when supplementation is necessary, as human milk is important in the care of preterm and fragile infants.

  • The CDC does not recommend disinfecting the outside of human milk containers after pumping or before feeding an infant. It is unnecessary and unsafe to apply chemical disinfectants to milk storage containers. If a facility is concerned, follow guidance from the Human Milk Banking Association of North America (HMBANA) and use a simple Bottle Transfer Technique

  • Facilities should provide adequate lactation support during the hospital stay and prior to discharge. The support should come from staff trained in lactation.

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Discharge guidance
  • Patients with COVID-19 can be discharged whenever clinically indicated. Patients do not need to meet the CDC criteria for Discontinuation of Transmission-Based Precautions and Disposition for discharge.

  • Facilities should coordinate discharge so families have timely access to ongoing lactation support and care, either directly through the facility or community partnerships. Patients on Medicaid or with lower-income households may be eligible to join the Women, Infants and Children (WIC) Program to receive lactation and nutrition support. Refer patients to WIC online.

  • Pregnancy-related (postpartum) depression symptoms may worsen because of COVID-19 social distancing measures. Providers should screen all patients and share resources about coping with stress during the COVID-19 pandemic.

 

Stay informed