The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have developed an algorithm to help clinicians assess and manage pregnant women with suspected or confirmed COVID-19. Also on the official ACOG website are answers to frequently asked questions about pregnancy and the postpartum period during the COVID-19 pandemic (American College of Obstetricians and Gynecologists. COVID-19 FAQs for obstetricians-gynecologists, obstetrics. Washington, DC: ACOG; 2020).
ACOG and SMFM often refer to CDC in their guidelines . At the same time, the recommendations are constantly updated with links to the studies that served as the reason for the changes.
Currently, the ideal is one where the mother and baby are housed together, as the benefits of early close contact between mother and newborn are evident, including better breastfeeding, facilitating a mother-infant bond, and promoting family-centered care. At the same time, the available data indicate that there is no difference in the likelihood of contracting an infant with COVID-19, depending on whether the infant is in a separate room or is housed with the mother.
However, the issue of placement and feeding of the newborn should be decided jointly by the mother, the child’s family and health workers. Moreover, this issue should be raised during antenatal care and clarified during childbirth.
However, even in the midst of the COVID-19 pandemic, obstetricians and other maternal health practitioners must respect and support every woman’s informed decision to start or continue breastfeeding, recognizing that she is uniquely qualified to make decisions about the best way to feed. her child. Coercion in this matter is unacceptable.
It is clarified that there are circumstances (including those not related to COVID-19) when a temporary separation is appropriate for the well-being of the mother and child, but even in this case, the decision to temporarily separate should be made in accordance with the mother’s wishes.
ACOG and SMFM recommend that mothers with suspected or confirmed COVID-19 who are considering temporary separation should be advised that they do not pose a potential risk of transmitting the virus to their newborns if they meet the criteria for ending isolation, take safety measures to minimize risk transmission of the virus.
Criteria for stopping isolation are the following: at least 10 days have passed since the first onset of their symptoms (up to 20 days if there is a severe form of the disease or their immunity is seriously weakened); at least 24 hours have passed since the last fever without antipyretics; positive dynamics for other symptoms. Moreover, it is important that all 3 criteria are present at once. If a mother does not meet these criteria, but after discharge is unable to maintain separation from her newborn until she meets the specified criteria, it is not clear how justified the separation would then be.
Safety precautions to minimize the risk of transmission of the virus include wearing a mask or cloth to cover the face and hygiene of the hands before and during any contact with the newborn, and placing the baby 6 feet (about 2 meters) or more from the mother outside of the feeding or grooming time.
Separation may indeed be necessary for mothers who are too sick to care for their babies, as well as when it comes to newborns at increased risk of serious illness (for example, premature babies; with underlying medical conditions; needing higher levels of care).
In the event of temporary separations of mothers who intend to breastfeed, the expression of breast milk should be supported and encouraged to establish and maintain lactation and to feed the baby with expressed milk. If possible, a dedicated breast pump should be provided.
If a child tests positive for COVID-19, separation is not required in principle.