Illustration by Marta Pucci.
How coronavirus impacts pregnancy, breastfeeding, and postpartum
What we know about outcomes for pregnant and parenting people and infants
SARS-CoV-2 (the new coronavirus responsible for COVID-19) is a new virus. There is still so much to learn about this virus and how it impacts pregnancy, breastfeeding, and postpartum. Many pregnant and parenting people are rightfully concerned about how this virus will impact their health and families.
In general, the effects produced by coronavirus have created a global public health crisis and are putting a strain on health care systems (1, 2). This strain is likely to negatively impact maternal and infant health as families bear the brunt of overburdened healthcare systems (3). Maternal and infant health is a complex, gendered issue. We can’t address all of these complexities in one article, so we are specifically addressing how coronavirus impacts the immediate health of pregnant, birthing, and parenting people and their newborns.
How does coronavirus affect pregnancy?
Pregnancy causes changes to the immune system (4). The World Health Organization (WHO) and other national authorities like the Royal College of Obstetricians and Gynecologists (RCOG) suggest that pregnancy does not put a person at higher risk for severe illness from COVID-19 compared to the general population (5, 6). Most pregnant people with COVID-19 will experience mild to moderate cold or flu-like symptoms (6).
Both WHO and the American College of Obstetricians and Gynecologists (ACOG) agree that people who are pregnant are known to be at greater risk for illness from some respiratory infections such as influenza (5, 7). ACOG has explicitly stated that it considers pregnant people to be high risk for this virus (7).
There isn’t enough data to date on how coronavirus might affect a fetus.
Some pregnant people with COVID-19 have had preterm births (8), meaning the infants were born before 37 weeks gestation (9). It’s not clear if these preterm births were directly related to COVID-19 (8). There is limited data about COVID-19 and its transmission to a fetus during labor and delivery (5-7).
A critical way this pandemic may impact pregnancy is by increasing the prevalence of domestic violence. Some research suggests pregnancy and the postpartum period increase the risk for domestic violence (10). Quarantine has put many people face-to-face with their abusers, creating a dangerous situation. Domestic violence in pregnancy is associated with low birth weight, preterm birth, postpartum depression, difficulty breastfeeding, and of course, the risk for physical harm (10). If you are trapped in a domestic violence situation, see the end of this article for resources.
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How does coronavirus impact birth and newborn health?
Because coronavirus is so new in humans, there are only a few studies about how the virus impacts the health of infants born to a birthing parent with COVID-19. These studies show some insights into how the virus might impact newborns, but the data is not yet conclusive. Based on the percentage of people who have been diagnosed with this COVID-19, these studies give us only a tiny fraction of the potential consequences, including positive outcomes, and more research is needed. Some of these studies have flaws that make them imperfect, but that is the nature of trying to solve a new scientific problem (11).
This is what we know so far. Read below for details of each study:
Studies found no evidence of the virus in amniotic fluid, cord blood, or breast milk (8, 12).
Some case reports found infants had symptoms of the virus but tested negative. Blood work showed coronavirus antibodies, meaning they were exposed to the virus during pregnancy (13, 14).
A study of 33 mothers diagnosed with COVID-19 found three of their infants were positive for COVID-19 after birth but then recovered (15).
A case report of four infants of mothers with COVID-19 found that all were born full-term at average weight (16).
One study of ten infants born to nine mothers with COVID-19 reported that four were born at term and six were born preterm. Many had symptoms. Five of these infants were considered “cured,” while four were in the hospital considered stable, and one died (8).
Can coronavirus transmit from mother to child?
Some of the first clinical studies from Wuhan, China looked for what’s called vertical transmission, or passing coronavirus from pregnant parent to baby (8, 13-16). Vertical transmission is also called “mother-to-child” transmission and can occur through the placenta during pregnancy, the vagina during birth, or breast milk during lactation in some but not all viral infections.
While early studies suggest it’s possible to pass coronavirus from parent to newborn, these studies found no evidence of the virus in amniotic fluid, cord blood, or breast milk (8, 12).
One Chinese study looked at 33 babies born to mothers who were diagnosed with COVID-19. Three of these infants were positive for COVID-19 after birth. Three of the babies had symptoms and one had a more serious condition, called neonatal respiratory distress syndrome. This baby was born premature, which could have caused the severity of its illness. All three infants are believed to have recovered from the virus (15).
One case report looked at blood, nasal and vaginal secretions, and breastmilk of a mother with COVID-19. Vaginal secretions and breast milk were both negative for coronavirus. The baby did not have any symptoms of the virus. The infant’s blood work showed coronavirus antibodies, meaning it was exposed to the virus during pregnancy, although tests for COVID-19 were negative (13).
In a study of six pregnant women with COVID-19, all six infants were born with coronavirus antibodies, indicating they were exposed to the virus during pregnancy. None of the babies showed symptoms of COVID-19 and tests for the virus were all negative. This study didn’t report the outcomes of the infants (14).
Another case report of four infants born to mothers diagnosed with COVID-19 found that all four were born full-term at average weight. One set of parents did not give permission for testing, but the remaining three babies tested negative for the virus and did not have serious symptoms related to COVID-19. The four babies were healthy and being formula fed after hospital discharge (16).
One study of ten infants born to nine mothers with COVID-19 reported that four were born at term and six were born preterm. (All of the mothers tested positive for the virus, except for one who only showed symptoms.) Six of these infants had symptoms. Five of these infants were considered “cured,” while four were in the hospital considered stable, and one died. This is alarming news, but it’s worth noting that the researchers don’t claim COVID-19 caused the infant’s death. This infant was born premature at 34 weeks, which could be attributed to the poor outcome. Although these babies showed signs and symptoms of COVID-19, their test results were negative (8).
Does a COVID-19 diagnosis change the birth plan?
Many pregnant people are feeling anxious about how coronavirus and COVID-19 will impact their birth plan. Here is what we know so far:
Does coronavirus impact how to give birth?
There’s currently no evidence that mode of birth (vaginal vs. cesarean birth) either protects or puts an infant at risk (16). For the time being, the choice of vaginal or cesarean birth should be individualized based on the needs of the birthing parent and infant (5, 16). In most cases, labor and delivery plans won’t need to be changed, even with a COVID-19 diagnosis (17).
Is it safer to have a home birth because of coronavirus?
Some pregnant people have expressed a desire to give birth outside of the hospital to avoid contact with the virus. ACOG and the Society for Maternal Fetal Medicine (SMFM) report that the safest place to birth is in a hospital, hospital-based birth center, or accredited freestanding birth center (5, 18).
In countries where health systems can support homebirth, the International Confederation of Midwives supports low risk people without pregnancy complications can safely birth at home or birth center (19). An important consideration while choosing home birth is that in the event of an emergency, it may be more difficult to access an ambulance or rapidly transfer to the hospital due to lack of resources during this crisis (6).
Will hospitals limit visitors during labor because of coronavirus?
At this time, some hospitals have limited the amount of visitors a birthing person can have during labor, including doulas and partners. This policy contradicts the WHO, that states that all people have a right to have a companion of their choice present during labor and birth (5). Ask your provider about your choice of birth place’s policy regarding visitors. You may need to make a backup plan that involves birth support from a doula or loved one through video.
Hospital policies during this pandemic are imperfect and evolving.
If laboring without your doula or other birth support, a nurse trained in labor support will be available to you and you will not be left alone without emotional and physical support (18). It might be helpful to know that studies suggest that having continuous labor support of any kind, even from hospital staff unknown to the birthing person, are associated with improved birth outcomes (20).
How will a COVID-19 diagnosis impact the postpartum period?
If you are diagnosed with COVID-19, it’s likely your healthcare provider has a plan for how you should interact with your baby after birth. Even if you haven’t been sick, it’s likely this pandemic will have some effect on your postpartum experience.
Does a COVID-19 diagnosis impact breastfeeding/chestfeeding/lactation?
Since there is currently no evidence that the virus can be carried in breastmilk (21), the benefits of breastfeeding may outweigh any potential risks (5, 22). Discuss these benefits and risks with your provider (17). La Leche League International (23) encourages people diagnosed with COVID-19 to breastfeed. Lactating people with coronavirus produce specific antibodies called IgA that are believed to protect nursing infants from infection (23).
When a parent is too sick to breastfeed, expressing breastmilk, either by hand or with a pump, is possible. Another adult will need to offer support by offering the mother physical support during expression, potentially offering the milk to the baby, and disinfecting all equipment and hard surfaces (19). Whether feeding the baby at the breast or expressing milk, washing your hands thoroughly before and after touching the baby, keeping surfaces clean, and using respiratory hygiene like wearing a mask may prevent droplet transmission (5).
Can mothers with COVID-19 room-in with their babies?
The Centers for Disease Control and Prevention (CDC) currently recommends that the decision to separate a person from their infant should be made on a case-by-case basis with the parent’s preferences taken into consideration (22). WHO recommends holding and touching a newborn baby to encourage exclusive breastfeeding that can help a baby thrive (5).
In some countries, people with confirmed coronavirus have been advised to separate from their baby for two weeks. This lengthy separation might have negative effects on lactation and bonding. If this is recommended to you by your healthcare provider, discuss the risks and benefits specific to your family and baby and ask about alternatives (6).
The time around pregnancy and birth is already a vulnerable time for many people. Without a worldwide pandemic, depression during pregnancy and the postpartum period affects roughly one in five people (24). Stressful life events, like living through this pandemic, can increase the risk for postpartum depression (24) and other mood disorders like anxiety, postpartum obsessive compulsive disorder (OCD), and/or posttraumatic stress disorder (25).
Postpartum Support International (PSI), an organization designed to promote the mental health of postpartum parents, is experiencing a surge of requests for a mental health care and support services during this pandemic (26) This isn’t surprising, considering many new parents may be feeling isolated during this quarantine, and lack of social support is a risk factor for postpartum depression (27). It’s also possible that some people with newborns may receive more support from their quarantined partners during this health crisis.
Navigating coronavirus while pregnant or postpartum
This pandemic is no doubt a stressful time to be pregnant or parenting a newborn. Preparing and adding some flexibility to your plans may help you cope.
While you are pregnant, some of your scheduled visits with your obstetric provider may take place over the phone or video. Some online birth classes are currently being offered free of charge.
It might relieve some anxiety to make a postpartum plan before the birth of your baby. Ask friends and family to check in with you each day over phone or video. Ask critical support people to send groceries and baby supplies once a week for the first six weeks. Your obstetrician or midwife can refer you to a local postpartum doula or lactation consultant, or search online for one in your area. (See the end of this article for doula resources based on where you live.)
If you are pregnant or postpartum and have been diagnosed with COVID-19, look to your healthcare provider for how to manage your symptoms and make the best plan for you and your family. For people located in the United States, you can contribute to scientific knowledge about coronavirus and pregnancy by participating in the PRIORITY Study, a study designed to help researchers understand how pregnant people are affected by COVID-19.
*If you are currently experiencing domestic violence, and are located in one of the following countries, please call a hotline for resources. If your country is not listed below, please search for a trusted resource specific to your location online.
United States Domestic Violence Hotline 1-800-799-SAFE (7233)
United Kingdom National Domestic Violence Helpline 0808 2000 247
German Violence Against Women Hotline 08000 116 016
Australia National Sexual Assault, Domestic Family Violence Counselling Service 1800 RESPECT (1800 737 732)
New Zealand Women's Refuge 0800 REFUGE (0800 733 843)
France:
SOS Viols (rape) : 0 800 05 95 95
Domestic violence Victims : 08 842 846 37
Ending Violence Association of Canada Visit website for phone number for each state
*Birth and postpartum doulas may be offering free or low cost services during this pandemic. You can get more information by contacting the national doula organization where you live.
Germany https://www.doulas-in-deutschland.de/
France https://doulas.info/
US and Canada
Australia https://www.doulanetwork.org/
New Zealand https://www.facebook.com/DoulaNZ/
If you found this article informative, you might also want to read our pieces on how coronavirus could impact your period or access to contraception, or get some of the basics on the menstrual cycle, early signs of pregnancy, and birth control.
