What are the considerations for labour and birth in asymptomatic women who test or have tested positive for SARS-CoV-2?
• Low risk women who test positive for SARS-CoV-2 within 10 days prior to birth who are asymptomatic and wish to give birth at home or in a midwifery-led unit, should have an informed discussion around place of birth with their clinician.
• For asymptomatic women who test positive for SARS-CoV-2 on admission, continuous electronic fetal monitoring (CEFM) during labour using cardiotocography (CTG) is not recommended solely due to a positive test. Fetal monitoring options should be discussed with the woman, acknowledging the current uncertainties in women who are asymptomatic with a positive test for SARS-CoV-2. Women who test positive for SARS-CoV-2 should be offered delayed cord clamping and skin-to-skin contact with their baby in line with usual practice.
What are the considerations for labour and birth in asymptomatic women who test or have tested positive for SARS-CoV-2?
• Low risk women who test positive for SARS-CoV-2 within 10 days prior to birth who are asymptomatic and wish to give birth at home or in a midwifery-led unit, should have an informed discussion around place of birth with their clinician.
• For asymptomatic women who test positive for SARS-CoV-2 on admission, continuous electronic fetal monitoring (CEFM) during labour using cardiotocography (CTG) is not recommended solely due to a positive test. Fetal monitoring options should be discussed with the woman, acknowledging the current uncertainties in women who are asymptomatic with a positive test for SARS-CoV-2. Women who test positive for SARS-CoV-2 should be offered delayed cord clamping and skin-to-skin contact with their baby in line with usual practice.
How should a woman with suspected or confirmed COVID-19 be cared for in labour if they are symptomatic?
• Women with mild COVID-19 symptoms can be encouraged to remain at home (self-isolating) in early (latent phase) labour consistent with routine care.
• If there are no concerns regarding the health of either the woman or baby, women who attend the maternity unit and would usually be advised to return home until labour is more established can still be advised to do so, unless private transport is not available. Women should be provided with the usual advice regarding signs and symptoms of labour, but also be informed about symptoms that might suggest deterioration related to COVID-19 and be advised to call back if concerned
• Women with symptomatic suspected or confirmed COVID-19 should be advised to labour and give birth in an obstetric unit.
• On admission, a full maternal and fetal assessment should be undertaken, including:
- Assessment of the severity of COVID-19 symptoms by the most senior available clinician.
- Maternal observations including temperature, respiratory rate and oxygen saturation.
- Confirmation of the onset of labour, as per standard care.
- CEFM using CTG.
• The following members of the MDT should be informed of the woman’s admission: consultant obstetrician, consultant anaesthetist, midwife-in-charge, consultant neonatologist, neonatal nurse-in-charge and the infection control team. Other members of the team may include an obstetric physician or respiratory physician.
• Standard hourly maternal observations and assessment should be performed (as per the recommendations in NICE CG190, Intrapartum care for healthy women and 33 babies), with the addition of hourly oxygen saturation monitoring. Oxygen therapy should be titrated to aim for saturation above 94%.
• CEFM should be offered to women with symptomatic suspected or confirmed COVID-19 during labour and vaginal birth.
• Maternal infection with SARS-CoV-2 is in itself not a contraindication to performing a fetal blood sample or using fetal scalp electrodes.
• The number of staff members entering the room should be minimised, and units should develop a local policy specifying essential personnel for emergency scenarios.
• Women with symptomatic suspected or confirmed COVID-19 should be offered delayed cord clamping and skin-to-skin contact with their baby if the condition of the woman and infant allows.