In several countries pregnant women confirmed or suspected to have COVID-19 are being required to have caesarean sections or be separated from their newborn babies to restrict COVID-19 transmission.
Such measures may help health services better manage COVID-19 caseloads, but what are the consequences, and how do these practices compare with evidence-based global recommendations for maternity care during the pandemic?
Changes in maternity care practices
Early in the pandemic, a private hospital in Sydney, Australia had told mothers with COVID-19 they would be separated from their babies after birth, but later apologised.
Mother-baby separation has occurred in several countries during the pandemic, including the United States (US), China and Indonesia.
Many women have also experienced forceps or vacuum during birth, induction and cesarean section, irrespective of their infectious status, and with little choice.
In April, a study reported a case of an uncomplicated vaginal birth at an Australian hospital in a mother with COVID-19, without separation and with ongoing breastfeeding.
These examples highlight the value of evidence based international guidance, such as from the World Health Organization (WHO). Released early in the pandemic and regularly updated, WHO recommendations are to encourage breastfeeding and its early initiation, placing the newborn skin to skin, and in the same room as the mother during hospital stay, after birth during the COVID-19 pandemic.
The WHO guidance was that new mothers and babies should be exempted from distancing or isolation, even if they are confirmed or suspected of having COVID-19.
The guidelines state these are safe when hospitals adhere to adequate infection prevention and control measures.
staff wearing full personal protective equipment, including N95 masks
mothers wearing a surgical mask during the second stage of labour
strict handwashing procedures and use of a surgical mask around the baby.
New research from John Hopkins University and Western Sydney University states policymakers should consider the cumulative impact of mother-baby separation.
‘Conserving’ hospital resources?
Natural childbirth is unpredictable, and scheduling it could be seen to conserve hospital resources; however childbirth does not fit easily into hospital routines, and during the current pandemic, health services have been stretched.
Midwives and nurses have reportedly been redeployed from looking after women during labour to other areas.
Hospitals can manage scarce staff and other resources better if births are scheduled and timings managed. This strategy, while seeming beneficial for hospitals, is not so for the health and safety of the mother and baby.
Some hospitals have also implemented policies preventing partners or other support people from attending the birth.
To minimise virus spread, both for health-care staff and pregnant women, some eliminated what is deemed non-essential face-to-face hospital visits, such as antenatal classes or support persons. And some have spaced out and reduced the time of antenatal visits.
In high-income countries such as Australia and the US, telehealth is compensating for this lack of in-person support. But in many low and middle income countries, telehealth is not established. Lack of access to good internet and low health literacy are further challenges which limit the effectiveness of this medium.
Anxiety in the hospital
Some level of anxiety is quite normal for pregnant women, especially if this is their first baby, but this anxiety has been heightened by the pandemic.
With many health workers also infected, expectant mothers have experienced controversy and fear. Cutbacks in antenatal and community-based midwifery services (reported in the United Kingdom), and increased enquiries about homebirth, prompted warnings about women choosing to birth without a skilled attendant.
Medical organisations, including the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG),