Prisons, jails, and detention facilities are high-risk environments for COVID-19 transmission. These 14 guides cover a range of different types of work. If possible, a dedicated breast pump should be provided (see How should women be counseled about special considerations for infant feeding with breastmilk in the setting of suspected or confirmed maternal COVID-19 infection?). HCP with mild to moderate illness who are not severely immunocompromised: Note: HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test. Further, maternal health care professionals should advocate for every possible protection from exposure to COVID-19 (eg, masks, gloves, remote working, proper ventilation, etc) for pregnant women in the work place. A facemask instead of a cloth face covering should be used by these HCPs for source control during this time period while in the facility. Practices, hospitals, and health care systems are beginning to identify and consider how to safely resume care for non-COVID-19-related issues, such as preventive services, primary care, and non-urgent surgeries. What health and safety protection do I have at work? Checking with their pediatric clinician or family physician regarding newborn visits because pediatric clinicians or family physicians also may be altering their procedures and routine appointments (, Postpartum contraception. View the algorithm (Spanish version). Similar to the general population, Black and Hispanic individuals who are pregnant appear to have disproportionate SARS CoV-2 infection and death rates (Ellington MMWR 2020, Moore MMWR 2020, Zambrano MMWR 2020). In the setting of a mild infection, management similar to that for a patient recovering from influenza is reasonable. Obstetric care clinicians should be prepared to explain the rationale for any change in prenatal care or delivery scheduling, emphasizing that these modifications have been made in order to limit the risk of exposure to the virus for the mother and the fetus or infant. These treatments should not be considered the standard of care for treatment of COVID-19. Postpartum Support International’s online facilitated, Pregnant women admitted for labor and delivery with suspected COVID-19 or who develop symptoms suggestive of COVID-19 during admission should be prioritized for testing (. ), Last updated August 4, 2020 at 4:45 p.m. EST, Yes, many facilities are currently experiencing a PPE shortage, and CDC provides strategies for how to optimize the supply of PPE. There are a number of aspects that need to be considered, including timing and scaling up of healthcare services, logistics in outpatient and inpatient facilities, COVID-19 testing and surveillance, current community prevalence, use of personal protective equipment (PPE), COVID-19 effect on the health care workforce, and others. Obstetrician–gynecologists and other obstetric care professionals should proactively identify local resources and be prepared to offer or provide referrals for social work services, mental health care, or additional resources for patients who disclose intimate partner violence. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice of delayed umbilical cord clamping with the rare exception of medical indications for directed donation (Committee Opinion 771). Currently, there are insufficient data in pregnant health care personnel that stratify these risks by either gestational age, medical comorbidities, the availability of recommended personal protective equipment (PPE), capacity to screen for SARS-CoV-2 infection, or the effect of the level of community prevalence of SARS-CoV-2 infection. Especially during this challenging time, obstetrician–gynecologists and other maternal health care professionals should screen all pregnant individuals at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool (. If a pregnant individual requests a letter to support a COVID-19-specific work accommodation, maternal health care professionals can respond to the request in the context of the risk to the pregnant individual considering the particular patient’s circumstances. An ACOG Position Statement  has been developed that addresses these considerations in general and relevant to resumption of comprehensive routine women’s health care. Alternate prenatal care delivery approaches have been proposed as a strategy in the effort to control the spread of COVID-19 among patients, caregivers, and staff. Mother using a mask or cloth face covering and practicing. More data are needed to assess the effect of monoclonal antibodies on the disease course of COVID-19 and to identify those people who are most likely to benefit from the drug. Any special considerations for infant feeding. COVID-19 is a pandemic with a rapidly increasing incidence of infections and deaths. It should be emphasized that patients can decompensate after several days of apparently mild illness, and thus should be instructed to call or be seen for care if symptoms, particularly shortness of breath, worsen. SMFM members are also invited to join our new online community dedicated to COVID-19. As such, facilities should consider suspending routine use of intrapartum oxygen for indications where benefits of use are not well-established (eg., category II and III fetal heart rate tracings). We understand that our patients are experiencing increased stress because of COVID-19. Pregnant health care workers should limit exposure to patients with confirmed or suspected COVID-19, as they would with other infectious cases. In the event that an individual should request a cesarean delivery because of COVID-19 concerns, obstetrician–gynecologists and other obstetric care clinicians should follow ACOG’s guidance provided in Committee Opinion 761, Cesarean Delivery on Maternal Request. | Terms and Conditions of Use. Jeanne Sheffield, M.D., an expert in maternal-fetal medicine at Johns Hopkins, explains what pregnant women should know about the impact of the coronavirus and COVID-19 on pregnancy. If extended use or limited reuse is being implemented, polices regarding extended use or limited reuse should be in accordance with, Although limited data have noted subtle physiologic changes (with no known clinical impact) associated with extended wear of N95 masks (, Respirator or Facemask (cloth face coverings are NOT PPE and should not be worn for the care of patients with known or suspected COVID-19 or in other situations where a respirator or facemask is warranted), Put on a respirator or facemask (if a respirator is not available) before entry into the patient’s room or care area. NHS Midwives Employment. Finally, pregnant women should do the same things as the general public to avoid infection. Last updated September 2, 2020 at 10:13 a.m. EST. In some instances, a test-based strategy could be considered to allow HCP to return to work earlier than if the symptom-based strategy were used. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. (. Another report of pregnancy outcomes by SARS-CoV-2 exposure of 252 individuals in a more racially and ethnically diverse cohort also suggested no differences in a composite outcome of preterm birth, preeclampsia with severe features, or cesarean for abnormal fetal heart rate (Adhikari 2020). Last updated September 9, 2020 at 1:16 p.m. EST. Although the absolute risk for severe COVID-19 is low, available data indicate an increased risk of ICU admission, need for mechanical ventilation and ventilatory support (ECMO), and death reported in pregnant women with symptomatic COVID-19 infection, when compared with symptomatic non-pregnant women (Zambrano MMWR 2020). Consider grouping components of care together (eg, vaccinations, glucose screenings, etc) (. Last update December 14, 2020 at 2:03 p.m. EST. Health care facilities may consider limiting exposure of pregnant health care personnel to patients with confirmed or suspected COVID-19 infection, especially during higher risks procedures (, When all recommended PPE is not available, pregnant health care personnel should avoid exposure to high-risk procedures in patients with suspected or confirmed COVID-19. Pregnant healthcare workers should follow CDC guidelines on risk assessment and infection control for healthcare workers exposed to patients with known or suspected COVID-19. Alternate or reduced prenatal care schedules. ACOG and SMFM have also made statements regarding the urgent need for PPE in obstetrics. It should be noted that it may be necessary to provide these services or enhanced resources by phone or electronically where possible. Therefore, obstetrician-gynecologists and other maternal care practitioners should counsel women with suspected or confirmed COVID-19 who intend to infant feed with breastmilk on how to minimize the risk of transmission, including: Even in the setting of the COVID-19 pandemic, obstetrician–gynecologists and other maternal care practitioners should support each woman's informed decision about whether to initiate or continue breastfeeding, recognizing that she is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal for her and her infant (Committee Opinion 756). Additional key resources include: Last updated September 10, 2020 at 8:52 a.m. EST. Clinicians should follow CDC guidance in regards to properly cleaning surfaces. Emphasize the importance of taking all available precautions to avoid exposure to COVID-19 and to prevent infection including: maintain an adequate supply of preparedness resources including medications, Offer mental health or social work services or referrals to provide additional resources, particularly for patients who are experiencing anxiety regarding the COVID-19 pandemic or are at an increased risk of intimate partner violence (. During the COVID-19 pandemic, screening may need to be provided by telehealth. Pregnant patients were excluded from the clinical trials that evaluated the safety and efficacy of remdesivir for the treatment of COVID-19, but preliminary reports of use in pregnant patients through the remdesivir compassionate use program are reassuring. Testing capacity. Available data suggest that symptomatic pregnant women with COVID-19 are at increased risk of more severe illness compared with nonpregnant peers (Ellington MMWR 2020, Collin 2020, Delahoy MMWR 2020, Panagiotakopoulos MMWR 2020, Zambrano MMWR 2020), however the data have limitations (see FAQ “Does COVID-19 present an increased risk of severe morbidity and mortality for pregnant women compared with non-pregnant women?”). The Centers for Medicare and Medicaid Services (CMS) has released suggested guidance regarding the timing of resumption of elective surgeries as well as non-surgical care. Other considerations that may guide testing are epidemiologic factors such as the occurrence of local community transmission of COVID-19 infections. Last updated December 17, 2020 at 9:55 a.m. EST. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The visitor policy should not be a barrier to an individual receiving medically-indicated in-person care. and to encourage patients to communicate regularly with their health care team. To the extent possible, patients should be connected to community support resources. However, it should be noted that some patients may lose insurance before 12 weeks postpartum; in this case, the comprehensive postpartum visit should be prioritized and scheduled before the patient loses insurance and also can be completed by telehealth visit. However, based on recent data supporting the use of corticosteroids in severely ill patients in the treatment of COVID-19, it does not appear that the administration of corticosteroids leads to maternal harm. Health care professionals are encouraged to share ACOG’s patient resources as appropriate. In particular, all persons entering a health care facility should wear a cloth face covering or facemask for the duration of their visit. As such, and given the considerations listed below, this approach is likely most beneficial in areas where there is wide community spread with the potential for many asymptomatic individuals. If possible, individuals should consider having someone who does not have suspected or confirmed COVID-19 infection and is not sick feed the expressed breastmilk to the infant. UPDATED: SOGC Statement on Pregnant Workers during the COVID-19 Pandemic (November 19, 2020) SOGC Statement on Pregnant Workers during the COVID-19 Pandemic Diabetes Canada Clinical Practice Guidelines Steering Committee and the Society of Obstetricians and Gynecologists of … The time period used depends on the patient’s severity of illness and if they are severely immunocompromised. Depending on the state, employers may be required by law to provide accommodations to pregnant and breastfeeding employees that minimize risk of exposure to COVID-19. Pregnant workers and COVID-19 If you are pregnant the government has issued “strong advice” that you should work from home, if possible and to be particularly stringent about ‘social distancing’ during the coronavirus pandemic. As part of the COVID-19 emergency response, several new federal telehealth allowances have been made. Breastmilk expression with a manual or electric breast pump. During a possible N95 shortage, extended use or limited reuse of N95 masks may be implemented or necessary. Based on limited data, high-flow oxygen use is not considered an aerosol-generating procedure (CDC). Obstetrician–gynecologists and other obstetric care clinicians should continue to provide medically necessary prenatal care, referrals, and consultations. The Society of Critical Care Medicine also offers a series of resources in response to COVID-19. Guidance for individuals and households with possible coronavirus infection. Labor, delivery, and postpartum support may be especially important to improve outcomes for individuals from communities traditionally underserved or mistreated within the health care system. Q: I am pregnant and a health care worker. However, modifying or reducing care is only appropriate because the risk of inadvertent exposure from receiving or delivering care can be high at this time; normal care approaches and schedules should resume when this risk subsides. For obstetrics, it may be appropriate to temporarily consider tubal sterilization only when performing cesarean birth (unless the patient is considered high risk) and all others as elective, so long as an alternative form of contraception is provided (eg, immediate postpartum long-acting reversible contraception), if desired by the patient. Use of this Web site constitutes acceptance of Terms of Use, Coalition to Advance Maternal Therapeutics, Contemporary Guide to Practice Management, Strategies to Provide Equitable Care During COVID-19, American Journal of Obstetrics & Gynecology. In areas where COVID-19 is particularly prevalent or where there is particular stress on the health care system, it may be advantageous to identify and modify surgical scheduling, including for procedures that are medically indicated, when a patient’s health and safety would not be harmed by such delay. Maternity Action is experiencing exceptional demand for our advice line at present so we have put together some frequently asked questions on rights at work and benefits during pregnancy and maternity leave during the Covid-19 pandemic. COVID-19 status alone is not necessarily a reason to transfer non-critically ill pregnant women with suspected or confirmed COVID-19, but care location planning should be based on the levels of maternal and neonatal care (Obstetric Care Consensus No 9 “Levels of Maternal Care”, AAP’s Levels of Neonatal Care). Facilities may consider routine screening for women and visitors in labor and delivery units until the local prevalence has significantly decreased. Similar to the general population, Black and Hispanic individuals who are pregnant appear to have disproportionate SARS CoV-2 infection and death rates (Ellington MMWR 2020, Moore MMWR 2020, Zambrano MMWR 2020). Health care personnel are not ethically obligated to provide care to high-risk patients without adequate protections in place (see. Given the available evidence on this topic, mother-infant dyads where the mother has suspected or confirmed SARS-CoV-2 infection should ideally room-in according to usual facility policy. While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. Although evidence is lacking for or against thromboprophylaxis for pregnant and postpartum patients with suspected or confirmed COVID-19, it is reasonable to consider anticoagulation treatment for these patients, particularly if they have severe or critical disease. Pregnant women admitted for labor and delivery with suspected COVID-19 or who develop symptoms suggestive of COVID-19 during admission should be prioritized for testing (CDC, ACOG Practice Advisory, AMA statement). Last updated March 26, 2020 at 8:00 a.m. EST. Importantly, any determination of whether to keep individuals with known or suspected SARS-CoV-2 infection and their infants together or separate after birth should include a process of shared decision-making with the patient, their family, and the clinical team. COVID-19: Pregnancy, Breastfeeding & Infants. Last updated December 17, 2020 at 9:58 a.m. EST. In addition to possibly screening during prenatal telehealth appointments, screening is important to perform during in-person appointments and at hospital admission in a private and safe setting with the patient alone and not in the presence of a partner, friends, family, or caregiver. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (SMFM) have developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19. According to the CDC, based on limited data, forceful exhalation during the second stage of labor would not be expected to generate aerosols to the same extent as procedures more commonly considered to be aerosol-generating (such as bronchoscopy, intubation, and open suctioning). Any modifications made to care should be relayed to patients with a discussion of the altered balance of risks and -benefits of coming to the office for testing or ultrasonography in the setting of a global pandemic, and should be documented in the medical record. Change gloves if they become torn or heavily contaminated. Even in the setting of COVID-19, delayed pushing is not recommended as a strategy to avoid forced exhalation due to the adverse maternal outcomes associated with delayed pushing (Committee Opinion No. The COVID-19 Treatment Guidelines Panel (the Panel) recommends that potentially effective treatment for COVID-19 should not be withheld from pregnant women because of theoretical concerns related to the safety of therapeutic agents in pregnancy (AIII). To limit the risk of inadvertent exposure and infection, it may be appropriate to expedite discharge when both the mother and the infant are healthy (Committee Opinion 726). Safety measures if breastfeeding. Last updated May 1, 2020 at 8:50 a.m. EST. But according to the American Academy of Obstetricians and Gynecologists (ACOG), the overall risk of intensive care admission and the need for … All health care personnel, including pregnant women, should be: provided and appropriately using the recommended PPE, especially face masks (. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Currently, ACOG is not aware of scientific evidence connecting the use of NSAIDs, like ibuprofen, with worsening COVID-19 symptoms. Facilities are encouraged to consult with their obstetric, pediatric, and family medicine teams and temporarily modify their policies based on COVID-19 community spread, health care personnel availability, and access to readily available local resources. Information on whether ICU admission or mechanical ventilation were related to pregnancy complications rather than for COVID-19 illness are not available, which limits the interpretation. Consideration may be given to a phased approach to increasing non-urgent visits, with an emphasis on virtual visits early on and gradually increasing in-person visits as necessary. However, pregnancy increases the risk for severe illness with COVID-19.Pregnant women who have COVID-19 appear more likely to develop respiratory complications requiring intensive care than women who aren't pregnant, according to the Centers for Disease Control and Prevention. Interim General Guidelines on Protecting Workers from COVID-19 ... Short-term benefit payments to eligible workers who have a full or partial loss of wages due to a non-work-related illness, injury, or pregnancy. FAQ). Engineering controls such as using physical barriers (eg, placing the neonate in a temperature-controlled isolette) and keeping the neonate 6 feet or more away from the mother as often as possible. It's important to tell your midwife or maternity team if you have symptoms of coronavirus. RANZCOG recommends that, where possible, pregnant health care workers be allocated to patients, and duties, that have reduced exposure to patients with, or suspected to have, COVID-19 infection. ACOG is aware of news reports suggesting that the use of nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, could worsen COVID-19. In instances where a patient who is COVID-19 positive and requires an aerosolizing procedure, a transducer cover should be used and all equipment requires low-level disinfection both inside and outside of the exam room. This is a rapidly changing landscape, and FAQs will be added or modified on a regular basis as the pandemic evolves and additional information becomes available. In both the inpatient and outpatient settings, it is recommended that the number of visitors be reduced to the minimum necessary, for example, those essential for the pregnant individual’s well-being (emotional support persons). Should new literature indicate any increased risks to pregnant individuals compared to nonpregnant individuals from COVID-19, ACOG will update our recommendations accordingly. Although some experts have recommended against delayed cord clamping, the evidence is based on opinion; a single report later confirmed COVID-19 transmission most likely occurred from the obstetric care clinician to the neonate. This includes the importance of proper hand hygiene before touching any pump or bottle parts and following recommendations for proper pump cleaning after each use. Data indicate that preventive health care visits drastically declined at the beginning of the pandemic, which resulted in a concerning decrease in important routine screenings, tests, and vaccines. Last updated March 23, 2020 at 11:30 p.m. EST. Based on these concerns for potential maternal harm and weighing them against the neonatal benefits of antenatal corticosteroid administration during different gestational ages, ACOG originally suggested to continue offering antenatal corticosteroids in the preterm period for women with suspected or confirmed COVID-19 but to not offer antenatal corticosteroids to pregnant individuals with suspected or confirmed COVID-19 at 34 0/7 – 36 6/7 weeks of gestation. In considering visitation policies, institutions should be mindful of how restrictions might differentially and negatively affect these communities, which in many areas are also disproportionately affected by COVID-19. No. These factors include lack of adequate staff to care for a critically ill patient, need for frequent assessments, special equipment, and access to trials for novel treatments. Last updated December 14, 2020 at 2:03 p.m. EST. Several systems are implementing masking for both patients and clinicians in outpatient settings, and types of PPE used in the labor and delivery or surgical setting may be determined based on admission or preoperative testing. Given the growing evidence, the CDC now includes pregnant women in its “increased risk” category for COVID-19 illness. Thus, any recommendations related to the work environment specific to health care personnel with comorbidities should be applied to pregnant health care personnel with similar comorbidities. Screening all patients multiple times is important because some women do not or cannot disclose abuse each time they are asked. Postpartum contraception. The Society for Maternal-Fetal Medicine offers a COVID-19 response bundle at no cost addressing: Pulmonary Hypertension, Pulmonary Embolism, Hemodynamic Monitoring and Mechanical Ventilation, Sepsis, and ARDS/Respiratory Failure. Even if an individual is screened during pregnancy, additional screening also should occur during the postpartum period (Committee Opinion 757). Throughout the COVID-19 pandemic, the World Health Organization (WHO) Director General’s has emphasized that “All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights”. Some studies have suggested that there may be an increased rate of preterm delivery and stillbirth in pregnant women with active SARS-CoV-2 infection compared with those in the general population (Knight 2020, Delahoy MMWR 2020, Panagiotakopoulos MMWR 2020, Woodworth MMWR 2020). 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