The Latest Covid-19 Recommendations for New Moms and Babies

After testing positive for Covid-19 earlier in the morning, Manuel Carchipulla cries as he sees his wife Diana Garcia Garcia hold her baby Danaey for the first time via FaceTime, at Mount Sinai South Nassau Hospital in Oceanside, New York on April 28, 2020. Photo: Newsday LLC/Getty Images

“Will they take my baby away if I have the coronavirus?

New moms ask this question every day in my Texas OB-GYN practice located in the heart of a Covid-19 hot spot. During each office visit, providers and pregnant patients discuss the challenges of the pandemic as it relates to pregnancy, labor and delivery, and newborn care.

No expecting couple ever wrote a birth plan listing “have my baby in the middle of a global pandemic” as a goal. Everyone wants to share the magic of childbirth with the people they love. It is the job of labor and delivery units to adopt policies and procedures that strike a balance between patient safety and celebrating the birthday party.

Hospitals continue to adapt to the challenges of Covid-19 — working to provide care to the acutely ill, prevent spread, and keep health care staff safe while finding ways to preserve the normalcy and beauty of childbirth.

Coronavirus does not stop pregnancy. Pandemic or not, babies are being born — and each new birth represents hope for humanity.

The first 60 minutes of life is known as the “golden hour.” This period immediately after delivery contributes to infant temperature regulation, reduces stress for mom and baby, improves mother-baby bonding, and increases breastfeeding success.

To preserve the sanctity of the golden hour, labor and delivery units needed to answer this important pandemic question: “Can we keep mom and baby together safely?”

According to the updated American Academy of Pediatric’s (AAP) guidelines, released on July 22, the answer is yes.

Hospitals continue to adapt to the challenges of Covid-19 — working to provide care to the acutely ill, prevent spread, and keep health care staff safe while finding ways to preserve the normalcy and beauty of childbirth.

Neonatal Covid-19 risks

SAR-CoV-2 is a novel virus, meaning no human on Earth has baseline immunity. We have limited treatment options and do not have a vaccine. Preventing infection in precious newborns, who do not yet have fully developed immune systems, is of utmost importance.

The exact risks of neonatal Covid-19 infections are unknown, but early data based on limited case reports show the immature immune system and smaller infant airways predispose newborns to more severe disease.

Current data suggest that approximately 2% to 5% of infants born to women with Covid-19 have tested positive in the first 24 to 96 hours after birth. Providers and patients should be aware that there are published reports of infants requiring hospitalization before one month of age due to severe Covid-19 infection.

SARS-CoV-2 is a respiratory virus primarily passed via droplets. An infected mother can pass the infection to her baby and precautions must be maintained to protect the newborns. Research continues to evaluate the possibility of transplacental (vertical) transmission.

Can a Covid-19-positive mom and baby stay together after birth?

Over the past few months, scientists have studied over 1,500 cases of maternal coronavirus infections. The updated AAP guidelines are based on data from the National Registry for Surveillance and Epidemiology of Perinatal Covid-19 Infection.

Mothers with Covid-19 can safely room in with their newborn with precautions to prevent the transmission of respiratory droplets. Separating infants from the mother did not reduce the risk of newborn infection.

Data from the registry shows no published cases of an infant dying during the initial birth hospitalization as a direct result of SARS-CoV-2 infection.

What that means in practice is that a Covid-19-positive mom will not be separated from her child unless she or the baby is acutely ill — requiring specialized treatment. Hospitals and labor delivery units use AAP guidelines to develop safe protocols to deliver care. These guidelines are not mandates, so the implementation speed may vary.

The National Perinatal Covid-19 Registry indicates there is no reduction in risk when a baby is separated from a Covid-19-positive mother when compared to keeping the couplet together with mitigation strategies.

Current data suggest that approximately 2% to 5% of infants born to women with Covid-19 have tested positive in the first 24 to 96 hours after birth.

What cautions do Covid-19-positive moms take?

The AAP guidelines currently recommend mothers with the coronavirus follow certain steps to reduce the risk of transmission. Given the immature newborn’s immune system, reducing the risk of transmission to the baby while maintaining the critical maternal bonding time is the goal.

Social distancing, face covers, and hand hygiene remain our greatest weapons against transmitting this respiratory virus. Mothers are asked to maintain a six-feet separation when not providing hands-on care. When handling the baby, moms should wash their hands and don a face mask.

Noninfected birth partners or family members should also wear a mask and practice diligent hand-washing when caring for babies.

Health care workers should wear proper PPE (personal protective equipment) when providing newborn care, including an N95 mask when present in the same room as the Covid-positive mother.

Updated American Academy of Pediatric newborn guidelines

At the beginning of the pandemic, the AAP’s first round of neonatal Covid-19 guidance recommended a more cautious approach around immediate mom-baby separation.

During the hospital stay, the recommendations were to “admit the infant to an area separate from unaffected infants or if the mother chooses rooming in despite recommendations — ensure the infant is at least six feet from the mother.”

With very little information beyond the limited case reports from China, the AAP chose caution. Moms and babies were separated until we gathered enough safety data.

This was hard to stomach. Mothers struggling with fears for their own life due to coronavirus infection were faced with the added prospect of not seeing their newborn baby.

The updated evidence-based AAP guidelines allow Covid-19-positive moms to stay with their newborns and assist hospitals in providing a safe environment

SARS-CoV-2 is a very contagious virus and continues to pose a risk to infants. While precautions to reduce the risk of transmission are still necessary, families will be comforted to know mother-infant separation is no longer automatically recommended.

Can Covid-positive moms still breastfeed?

Breastfeeding is strongly encouraged by the AAP. SARS-CoV-2 has been detected in breast milk but no definitive studies have been done to date to determine if the active infectious virus is secreted in breast milk.

We also do not yet know if protective antibodies are secreted in breast milk. The recommendation is for Covid-positive mothers to breastfeed after performing hand hygiene and while wearing a face mask to reduce the transmission of respiratory droplets.

What if mom is too sick to care for the baby?

The goal for labor and delivery is to have a healthy mom and baby on the other side of every birth. Women’s service units are prepared to care for maternal and neonatal illness, from Covid-19 or any other medical issue.

Health care teams practice drills of various scenarios to make certain all staff are prepared to expect the unexpected.

If a mother is too sick to care for her infant, it may be appropriate to temporarily separate mother and newborn. If mom requires medical care at a level that inhibits her ability to care for her infant, the baby will be taken care of by the medical team and the patient’s family.

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