Perinatal and breastfeeding

Updated November 18, 2020.

Available languages: English

It is important for health care facilities that provide obstetric care for pregnant individuals 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 limited research available to date about COVID-19 and is updated as new evidence becomes available. 

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. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth.

  • Health care providers should advise pregnant patients and the people they live with to take COVID-19 precautions, understand the risks, and know how to be as safe as possible. 
  • People at higher risk are strongly encouraged to stay at home at all times, except when they need medical care. Encourage patients to limit interactions with the public. Patients should work with their employer to identify ways to limit exposure. 
  • Pregnant patients and the people they live with should get the flu and Tdap vaccines to protect their health and the health of their baby. Getting vaccinated will also help reduce the likelihood they need to seek healthcare services outside the home and avoid unnecessary exposures.
  • When prescribing medications, including psychotropic medications, ensure patients have a 30-day supply.

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 in all encounters. (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 to one support person. In the absence of a positive test or symptoms of COVID-19, additional support people, including doulas, should be allowed. Facilities may limit the number of additional people depending on the degree of community spread in the community.

    • 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. There is currently no clear evidence of transplacental viral transmission.

  • 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.

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

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

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

  • A 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 breast.

    • Washing hands and breast pump parts thoroughly before and after expressing breast milk. Expressed breast 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 breast 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 breastfeeding support during the hospital stay and prior to discharge. The support should come from staff trained in lactation. 

Discharge guidance

 

Stay informed

For the latest information, continue to monitor COVID-19 guidance from the CDC, AAP, the State of Colorado, and local public health agencies. For breastfeeding resources and support, visit BreastfeedColorado.com. For pregnancy-related depression resources and support, visit www.colorado.gov/cdphe/pregnancy-related-depression.