Coronavirus and your maternity care

This information was last updated on 17 December 2021, and we will keep it under review as the situation develops. The links were checked at that time but webpages are sometimes moved. If a link appears to be broken please let us know by emailing enquiries@aims.org.uk. You should still be able to find the page by entering the title in your browser.

For information about what AIMS is campaigning for during this crisis please see here.

We appreciate that it is going to be very stressful to be pregnant or a new parent at this time. We hope this information helps you navigate the changes in the maternity services. If there is any other general information that you would like to see on this page please let us know by emailing enquiries@aims.org.uk .

Latest Guidance

Here is the latest information about the implications of coronavirus for pregnant women, and the guidance that has been given to the maternity services.

Who can I speak to if I am concerned about my health?

You should have a contact number to contact your midwife, but you can also contact one of the following depending where you live.

AIMS Helpline

The AIMS Helpline volunteers have experienced an increased workload during the pandemic but continue to offer information and support to maternity service users. Please contact us by email helpline@aims.org.uk or phone 0300 365 0663 and leave a voicemail. We will respond to all enquiries as soon as we can.

The AIMS Helpline does not offer medical advice, but we can provide information and support to help you navigate the maternity system, to know your rights and to listen to your concerns. We will be regularly reviewing the issues brought to us on the Helpline, so we offer the best information and most effective support that we can.

AIMS is receiving questions about a variety of concerns and we try to answer some of those below. Different Trusts and Boards seem to be adopting different approaches, so you will need to check with your midwife about what is happening locally. There should also be information on your NHS Trust or Boards's website or Facebook page. The #ButNotMaternity spreadsheet is being kept up to date by Volunteers with information about current maternity service restrictions.

What are the risks for me if I am pregnant?

According to the latest RCM/RCOG guidance pregnant women do not appear to be more likely to contract the infection than the rest of the population, but so far we only have data about the original 'wild type' virus, and the Alpha and Delta variants. It is too soon to know what the impact of the Omicron variant is, but given that it is clearly spreading very rapidly, it is likely that your chances of catching it during pregnancy will be higher than with the previous variants.

Of those who do become infected during pregnancy, more than two-thirds will have no symptoms and most of the others will experience only mild or moderate cold or flu-like symptoms. A review summarising 70 studies from 25 countries (the PregCOV-19 Living Systematic Review) reported that 73% (almost three quarters) of pregnant women who were admitted to hospital for any reason and tested positive for COVID-19 had no symptoms, but much of this data comes from before the emergence of the latest variants.

There is growing evidence that pregnant women with COVID-19 are more at risk of severe illness and of being admitted to intensive care than those who are not pregnant (though it's possble that part of the difference in admissions may be because doctors are more cautious if someone is pregnant). Severe illness appears to be more common with infections that occur in the third trimester.

Evidence from the UK Obstetric Surveillance System (UKOSS) shows that for those who become ill enough to be admitted to hospital the outcomes can be very serious, for both them and their babies, and the proportion suffering these outcomes have been increasing with successive new variants. Early in the pandemic, around one in four (24%) of hospitalised pregnant women with symptoms of COVID-19 had a moderate to severe infection, and this rose to 45% in the period when Delta was the main type.

This infographic shows the latest findings from the UKOSS survey, covering the period from 16th May 2021 to 31st October 2021 when the Delta variant accounted for most infections. Pregnant women who were admitted to hospital during this time were more likely to need intensive care than those infected with the Alpha variant (16% compared to 11% with Alpha). Of the 1436 pregnant women admitted to hospital with symptoms, 474 (33%) needed support to breathe, a similar number (32%) developed pneumonia, and 230 (16%) were admitted to intensive care.

Although it remains very rare for pregnant or postnatal women to die from COVID-19 the chances of this have increased from 1.4 per 100,000 live births with the wild type variant, and 3.3 per 100,000 live births with the Alpha variant to 5.4 per 100,000 live births with the Delta variant ( (17 women, or 1% of those admitted to hospital with COVID-19 symptoms in the latest period) .

COVID-19 infection is associated with a higher chance of giving birth prematurely (see also 'What are the risks for my baby?) with 19% of hospitalised mothers experiencing this in the latest period, and also with a higher chance of having a caesarean (49% of those who had COVID-19 symptoms compared with 29% of a pre-COVID group). Both of these effects are, in the majority of cases, due to a decision to have the baby born early because of COVID-related concerns over the mother or baby's wellbeing.

The UKOSS study has found that (in common with what seems to be the case for the general population) pregnant women admitted to hospital with COVID-19 are about 6 times more likely to be of Black, Asian or minority ethnic heritage. Other risk factors were being overweight or obese, being over 35 years old or having pre-existing health problems such as diabetes.

As a result of these findings women of Black, Asian or minority ethnic heritage are being advised to seek advice without delay if they have a concern about their health, and doctors are advised to apply a lower threshold for reviewing or admitting them to hospital if they display symptoms of COVID-19. Remote consultations should be offered where appropriate, to reduce the risk of infection, The RCOG Q&A for women and families has a advice for women who are at higher risk of illness, including those of Black, Asian or minority ethnic heritage, and there is a video on the topic at the top of the webpage.

There is some evidence that people with Vitamin D deficiency may be at greater risk of severe breathing problems if they develop COVID-19. People of Black, Asian or minority ethnic heritage are already advised to take a Vitamin D supplement, but this may be particularly important for those who are pregnant.

What are the risks for my baby?

The RCM/RCOG guidance reports that the majority (over 95%) of babies born to mothers diagnosed with COVID-19 have been born healthy. So far the evidence is that a COVID-19 infection in early pregnancy does not seem to increase the risk of a birth defect or miscarriage.

Although it is theorectically possible for the virus to be transmitted to babies in the womb, the RCM/RCOG guidelines say evidence now suggests that it is uncommon, if it happens at all. The risk of infection in the baby after birth appears to not be affected by whether the birth was vaginal or by caesarean, or by factors such as the timing of cord clamping, skin-to-skin contact, method of feeding or whether the mother and baby stay together. According to the Royal College of Paediatrics and Child Health "COVID-19 seems generally to be a fairly minor illness in young infants." However in the most recent period of the UKOSS study (16th May 2021 to 31st October 2021) sadly four babies in the UK died as a result of a COVID-19 infection after birth.

There is some evidence that COVID-19 infection is associated with an increased chance of a stillbirth, though the findings from different studies vary a lot and the actual numbers are small. Overall it looks as though the rate may be between 0.7% and 0.9% (seven to nine out of every 1000 births) for those with an infection compared to between 0.3% and 0.5% (three to five out of every 1000 births). However, the latest UKOSS survey found that of UK mothers who were ill enough to be hospitalised with a COVID-19 infection in the period when the Delta variant was dominant, 2% suffered a stillbirth. Having a severe COVID -19 infection may be associated with a slightly higher chance of having a very small baby, but the evidence on this is still unclear.

The greatest impact of COVID-19 on babies seems to arise not from any direct effect of the virus itself but because of births being deliberately brought forward due to concerns over mother or baby's well-being. This is leading to around two to three times more premature births in women with severe COVID-19 symptoms compared to the normal rate and therefore to more babies being admitted to a neonatal uit and more experiencing the complications that can result from prematurity, such as breathing difficulties. Being born prematurely can also have long-term health consequences.

According to the most recent UKOSS study 19% of women admitted to hospital with COVID-19 symptoms gave birth before 37 weeks, compared with the usual figure of 7% of births in the UK being pre-term. There are similar findings from the British Pediatric Surveillance Unit which collected reports on all babies under 28 days old with a confirmed infection and receiving inpatient care, and all those babies born to mothers with a confirmed infection who were admitted to neonatal care, in the 13 months to September 2021. It looked at 111 babies of whom 11 (10%) were diagnosed with a COVID-19 infection. Most had no symptoms or were only mildly ill. Two-thirds of babies in the sample were born prematurely, almost three quarters of these deliberately so, and two thirds needed some kind of help with breathing. It appears that there is no increase in the risk of prematurity for babies of mothers who have tested positive but have no symptoms.

What about vaccinations?

As of 16th December, pregnant women have been defined by the Government as a 'vulnerable group' who should be prioritised for vaccination if they wish to have it. Guidance in the UK is for all pregnant women to be offered vaccination with the Pfizer-BioNTech or Moderna vaccines unless they have already had one dose of the Oxford-AstraZeneca vaccine, in which case their second dose should be the same. This is because most of the information on the safety of vaccines in pregnancy is from the USA, where these were the main vaccines used. The new guidance also advises that if you are unvaccinated you should have your first two doses eight weeks apart. If you had your second dose at least three months ago you are advised to book a booster now.

As with any medical treatment it is up to you whether you wish to accept the offer of vaccination. The previous sections 'What are the risks for me if I am pregnant?' and 'What are the risks for my baby?' explain what the latest research evidence shows about the risks of catching COVID-19 during pregnancy. The RCOG Q&A gives some more information about the possible risks and benefits of vaccination, and you might want to discuss with your midwife or doctor how these might apply in your case. For more about making decisions about vaccination see out webage Vaccination During Pregnancy

The original clinical trials of the available vaccines did not include pregnant women, but there is now real-world data on large numbers who have been vaccinated during pregnancy (over 275,000 in the USA and UK). The RCM/RCOG guidance says that there is "no known risk" associated with giving similar vaccines in pregnancy, so there is "no reason to suppose that the adverse effects from these COVID-19 vaccines should be different for pregnant women compared to non-pregnant women" - though we can't be completely sure as yet that there are no additional risks. A number of studies are now in progress to look at the safety and effectiveness of COVID-19 vaccines in pregnancy.

The real-world data has so far shown no signs of an increase in miscarriages, birth defects or any other pregnancy-related concerns after vaccination, and it appears that the level of minor side-effects is similar to that in the general population . The most common side-effects are soreness at the injection site, headache and fatigue, and studies so far have found that rates of these are similar for pregnant women, with perhaps fewer experiencing fever but more reporting nausea and vomiting after a second dose of the Pfizer-BioNTech or Moderna vaccines compared to non-pregnant women. The very rare risk of blood clots found with the Oxford-AstraZeneca vaccine has not been observed with the Pfizer-BioNTech or Moderna vaccines.

In the UK, data published by the UK Health Security Agency (UKHSA) shows that for the 355 thousand women who gave birth between January and August 2021 there was "a similar very low risk of still birth, prematurity and low birth weight in vaccinated and unvaccinated women."

In the USA the Centers for Disease Control (CDC) has safety monitoring systems which have gathered information on over 178,000 pregnant women and people who have received vaccinations (mainly with the Pfizer-BioNTech and Moderna vaccines). Their website says that the preliminary analyses "did not identify any safety concerns for pregnant people who were vaccinated or for their babies. Additional follow-up is needed, particularly among those vaccinated in the first or second trimesters of pregnancy; however, these preliminary findings are reassuring."

If you are fully vaccinated and catch COVID-19 during your pregnancy, your chances of being hospitalised or admitted to intensive care appear to be greatly reduced. According to the latest data from UKOSS 96% of women admitted to hospital with COVID-19 had not been vaccinated at all, and about 3% had only had one dose. Of the 230 who needed intensive care, 98% were unvaccinated, and only one had had both doses.

Will I be able to have someone with me at my antenatal appointments?

The latest guidance from the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists (RCM/RCOG) suggests that the normal schedule of antenatal appointments should be offered in full wherever possible. Ideally these should be carried out face to face, especially for "those from BAME communities, those with communication difficulties or those living with medical, social or psychological conditions that put them at higher risk of complications, or adverse outcomes, during pregnancy." In cases where it is thought necessary to offer 'virtual' appointments (e.g. during a local lockdown) they recommend the use of teleconferencing and videoconferencing - which would have the advantage of allowing your partner or supporter to be present and participate if you wish.

The guidance on partners/supporters attending in-person antenatal appointments and scans is now different in the four nations of the UK. Please follow the links below to check details of the guidance for your country, but be aware that this may change at short notice. According to data collected by the But Not Maternity Alliance with one or two exceptions, all UK Trusts/Boards are now allowing a partner/supporter to attend at least the 12 and 20 week scans, as long as they have a negative test result. Most are allowing them at other scans and at hospital antenatal appointments as well, but the rules may be different for midwife appointments outside hospital. Trusts/Boards still have discretion about how far to implement the national guidance based on local risk assessments, so the position could change if there is a rise in cases either locally or nationally. Please check the current local rules, which should be available in your hospital's website.

The guidance in all four nations encourages Trusts/Boards to accommodate the support for those with communication or care needs , so if you feel this applies to you it is worth asking, even if restrictions are generally in place. AIMS has drafted a template letter which you can adapt to your own situation if your Trust/Board is not currently allowing partners or other supporters to be present at antenatal appointments or scans and you want to request them to allow it in your case.

If you attend any medical appointment you are legally entitled to make an audio or visual recording for your own use, and share it with your partner or other supporters. As this article from the British Medical Association says "Information disclosed during a consultation is confidential to the patient. Therefore, patients do not need doctors’ permission to make an audio or visual recording of a consultation" . The article does not cover making phone or video calls but AIMS believes that the same principle applies. You should therefore be able to have a call in progress with your partner or other supporter using your own smartphone or tablet, so that at least they can hear and take part in any discussions at your appointment or scan.

Some Trusts have been stating that recordings or calls are "not permitted" during scans, and may quote guidance from the Society of Radiographers in support of this. However this guidance has now been archived, and legal opinion commissioned by our partners at Birthrights concludes that “a blanket prohibition on the use of streaming or recording during antenatal appointments in circumstances where the support partner is unable to attend in-person with a pregnant woman is likely to be unlawful, discriminatory and violate both Articles 8 and 14” of the European Convention on Human Rights. Therefore Trusts should not be banning people from doing this without having done a full assessment which includes the clinical benefits of support and takes “proper account of the views and needs of the individual pregnant woman and her support partner.”

In England the latest guidance from NHS England Coronavirus » Supporting pregnant women using maternity services during the coronavirus pandemic: Actions for NHS providers asks all NHS Trusts "to urgently complete any further action needed so that partners can accompany women to all appointments and throughout birth" by undertaking risk assessments, making changes to their use of space and infection control measures, and using "any available testing capacity (including the national rollout of lateral flow testing) to test women and their support people.... Treat support people who test negative as part of the team supporting the woman." This should mean that as long as your partner or other chosen support person has a recent negative test result, including with a home test kit, they should be allowed to accompany you to "the early pregnancy unit, all antenatal scans and other antenatal appointments where the woman considers it important to have support". However, you might want to identify a back-up supporter in case your preferred supporter does not have a negative test result. You should "also have access to support people while admitted for early pregnancy loss or on the antenatal or postnatal ward in line with pre-COVID trust policies."

If you or your partner/supporter are not already being tested regularly e.g. by an employer, you can carry out a home test on the day of your appointment and report the results online. In either case you would need to take proof (e.g. the email or text that confirms the result of a home test) to your appointment. However, if you need to attend urgently then Trusts have been told that they should offer you both a rapid test on arrival.

The guidance also lists other solutions which some Trusts have introduced to reduce infection risks in antenatal care, and we hope that the remainder are now looking at which of these actions they can take to enable partners/supporters who have no symptoms or known exposure to COVID-19 to be admitted even if they do not have a recent negative test result.

At present it seems that Trusts are still maintaining the 2-metre rule, even though this has been lifted for other locations. The guidance recognises that for some Trusts the size and layout of rooms makes it hard to maintain the 2-metre distance rule for supporters and that thererefore "some trusts will need to make changes to the way they use their facilities... While we recognise that these challenges exist, it is important that trusts should find creative solutions to overcome them while ensuring the safety of their staff."

The Government regulations on self-isolation in England make an exception for someone who is otherwise required to self-isolate "to accompany an expectant mother (“K”) to any medical appointment related to the pregnancy throughout the antenatal period, at K’s request." This means that it's not illegal for someone who is required to self-isolate to leave home in order to accompany you to appointments. However, it's up to the Trust, and partners or other supporters may not be admitted if they are required to self-isolate.

It will still be up to individual NHS Trusts to decide how far they go in implementing the guidance, and it may take time for some of the changes to be made, especially where this requires reorganisation of the available space. The guidance says that "Communications plans should be clear about the timescale for these actions, and information should be readily accessible to women, support people and their families, digitally and in accessible formats" - so if this information is not available to you we suggest you write to the Chief Executive of your Trust and ask them to publish their plans.

NHS England says that "Trusts should especially prioritise the need for continuous support for women with particular needs, such as those with a disability, significant communication challenges or complex medical, mental health or social factors" and should carry out an "equality impact assessment" to make sure that "their approach does not have a disproportionate impact on women with protected characteristics as described in the Equality Act 2010." (A list of protected characteristics is here.) So even if your Trust has not yet enabled partners/supporters to be present in all cases, they really should be doing so for people who have these particular needs.

In Scotland the guidance sets out minimum standards according to which 'protection level' the hospital's local authority area is in. Even at levels 3 & 4 one supporter is allowed at the booking scan, 20 week scan and any emergency appointments "subject to local risk assessments and physical distancing". At level 2 one supporter is allowed at all appointments, and at level 1, in addition, a second adult or child is allowed - though still "subject to local risk assessments and physical distancing" - so it isn't guaranteed.

In Wales the guidance makes recommendations for the support that should be available at four different "Risk Ratings": Very High, High, Medium and Low. It appears that these will be determined by a local risk assessment, so AIMS hopes that Boards and hospital managements will be transparent about both what their current Risk Rating is, and the basis on which the judgement has been made, as well as providing detailed information about any current restrictions.

We have attempted to summarise the guidance, but suggest you check the document for the full details.

Health Boards are encouraged "be innovative in the way that visiting access is enabled." In addition, they are told to give consideration to reasonable adjustments for those with specific needs leading them to require etra support, such as mental health issues, learning disabilities, communication needs and "Where the treatment/procedure is likely to cause the woman distress and the partner/nominated other can provide support."

If the Risk Rating is Very High the recommendation is for women to attend all inpatient and outpatient appointments and scans alone. However they can be accompanied by"essential support assistants" (defined as someone required "for specific additional support eg a support worker, BSL or foreign language interpreter", but who could be a partner or family member in some circumstances.) In addition "One nominated adult may accompany the woman attending where she requires familiar support for consultations which may cause her distress."

If the Risk Rating is High, in addition to the above support, one nominated adult can accompany a woman to an early pregnancy assessment unit scan, the (12-14 week) dating scan, the (18-20 week) anomaly scan, and for any attendance at the Fetal Medicine Department, as long as 2-metre social distancing can be maintained.

If the Risk Rating is Medium, essential support assistants and/or up to one designated /nominated visitor are allowed for all antenatal appointments, and one designated supporter is allowed at the above list of scans, all subject to social distancing rules being possible.

If the Risk Rating is Low, there should be a "phased reintroduction of usual visiting policies" if different to the medium risk level.

In Northern Ireland while in the Gradual Easing phase the maternity services should allow for a birth partner to "be facilitated to accompany the pregnant woman to any pregnancy related appointments and ultrasound scans with particular effort made to keep the environment COVID secure." A COVID-19 secure envirment is defined as: a social distance of 2 metres wherever possible, optimal hand hygiene and personal hygiene measures, good ventilation, use of PPE when required and all visitors to wear appropriate face coverings.

Will I be able to have my Birth Partner(s) with me when my baby is born and afterwards?

We are aware that some Trusts/Boards have been restricting the number of people who can accompany pregnant women and people in labour to one. It is also still the case in some areas that birth partners are not to be admitted to the hospital or birth centre until the pregnant woman or person is considered to be in 'active labour'. The amount of time that partners/supporters are allowed to be present in the postnatal ward varies enormously. Some hospital are still not allowing them in at all, and many for only one or two hours a day.

The guidance on this is now different in the four nations of the UK. Please follow the links below to check details of the guidance for your country, but be aware that this may change at short notice. Trusts/Boards still have discretion about how far to implement the guidance based on their own risk assessment, so check the current local situation too.

The RCM//RCOG guidelines recommend that "Women should be supported and encouraged to have a birth partner present with them during active labour and birth if they wish to do so."

Birthrights have expressed the view in their statement www.birthrights.org.uk/2020/03/12/coronovirus-how-will-it-affect-my-rights-to-maternity-care/ that “Trusts that restrict a woman’s right to choose who will be present at her birth, for example by restricting birth partners to one, will need to be very clear that this response is proportionate to the additional threat of infection, and be prepared to look at exceptions on an individual basis. Birthrights does not believe that banning all birth partners can be justified as a proportionate response to the current pandemic.”

We know that some Trusts/Boards are being flexible about allowing a second birth partner at least for people with a particular need for extra support. If yours is limiting you to one birth partner you may want to challenge this and refer them to the relevant national guidelines, especially if there are exceptional circumstances which mean that you need more than one person for support. You may want to ask them to give you their justification for the decision. AIMS has drafted a set of template letters which you can adapt to your own situation to request the support you want for your birth.

AIMS hopes that all Trusts and Boards will at the very least to consider on a case-by-case basis requests for support beyond these minimum levels, which may be critical to some people’s mental well-being or other needs e.g. due to disability or being non-English speakers.

In England the latest guidance from NHS England Coronavirus » Supporting pregnant women using maternity services during the coronavirus pandemic: Actions for NHS providers asks all NHS Trusts "to urgently complete any further action needed so that partners can accompany women to all appointments and throughout birth" by undertaking risk assessments, making changes to their use of space and infection control measures, and using "any available testing capacity (including the national rollout of lateral flow testing) to test women and their support people.... Treat support people who test negative as part of the team supporting the woman." This should mean that as long as your partner or other chosen support person has a recent negative test result, including with a home test kit, they should be allowed to accompany you during "labour and birth from the point of attendance at the hospital or midwifery unit". In other words, you should no longer have to wait for a midwife to decide that you are in active labour before your partner/supporter is admitted.

If you or your partner/supporter are not already being tested regularly e.g. by an employer, you can carry out home tests twice a week and report the results online. In either case you would need to take proof (e.g. the email or text that confirms the result of a home test) to your hospital or birth centre. However, if you do not have home test results, Trusts have been told that they should offer you both a rapid test on arrival. You might want to identify a back-up supporter just in case your preferred supporter does not have a negative test result.

The guidance points out that "Where women and their support people test negative for COVID-19 and both staff and support people follow IPC guidelines, including use of PPE, the additional risk of COVID-19 transmission is likely to be small". AIMS therefore believes that in this situation a second birth supporter who has a negative test result should not be refused, as long as social distancing can be maintained, as this would not be a proportionate response to the risk.

In England the Government regulations on self-isolation makes an exception for someone who is otherwise required to self-isolate if "the person concerned is attending an expectant mother giving birth (“M”) at M’s request." This means that it's not illegal for someone who is required to self-isolate to leave home in order to attend the birth. However, it's up to the Trust and birth partners probably won't be admitted if they are required to self-isolate, so you may want to have someone else on stand-by to support you. One option for this would be to employ a doula (paid birth supporter). You can find out more about this and look for doulas in your area on the website of Doula UK. Not all doulas are members of this organisation, so try social media, word of mouth and search online as well.

The NHS England guidance says that partners/supporters should be admitted to the postnatalward "in line with pre-COVID trust policies." Trusts may be reluctant to do this because of the difficulty in maintaining social distancing in multi-bedded wards. The guidance recognises the challenges but says "it is important that trusts should find creative solutions to overcome them while ensuring the safety of their staff." AIMS hopes that all Trusts will move swiftly to adopt risk reduction measures and allow partners/supporters to attend the postnatal ward as normal, at least as long as they have a negative test or have no COVID-19 symptoms and are not required to self-isolate.

It will still be up to individual NHS Trusts to decide how far they go in implementing the guidance, and it may take time for some of the changes to be made, especially where this requires reorganisation of the available space. The guidance says that "Communications plans should be clear about the timescale for these actions, and information should be readily accessible to women, support people and their families, digitally and in accessible formats" - so if this information is not available to you we suggest you write to the Chief Executive of your Trust and ask them to publish their plans.

In Scotland the guidance sets out minimum standards according to which protection level the hospital's local authority area is in. Even at the highest levels (3 & 4) one birth partner should be allowed "throughout induction, labour and birth (except during a general anaesthetic)." At levels 1 & 2 a second birth partner should be allowed on request "subject to local risk assessments and physical distancing." However the guidance also states that "In addition, in line with national visiting guidance, a carer or interpreter – or someone else fulfilling a similar necessary function – should not be considered as a visitor" - which should mean that these additional support people should be allowed at all protection levels.

People who are staying in maternity wards (presumably both antenatal and postnatal wards) are allowed "One birth partner only (as essential) with time restrictions and subject to risk assessments and physical distancing" at levels 3 and 4. At level 2 they can have one additional "designated visitor" and at level 1 they can have two additional "designated visitors", subject to local risk assessments and physical distancing. Again, carers, interpreters or other people fulfilling "a similar necessary function" should not be counted as visitors.

In Wales the guidance makes recommendations for the support that should be available at four different "Risk Ratings": Very High, High, Medium and Low. It appears that these will be determined by a local risk assessment, so AIMS hopes that Boards and hospital managements will be transparent about both what their current Risk Rating is, and the basis on which the judgement has been made, as well as providing detailed information about any current restrictions.

Health Boards are encouraged to "be innovative in the way that visiting access is enabled." In addition, they are told to give consideration to reasonable adjustments for those with specific needs such as mental health issues, learning disabilities, communication needs and "Where the treatment/procedure is likely to cause the woman distress and the partner/nominated other can provide support."

If the Risk Rating is Low, there should be a "phased reintroduction of usual birth policies" in all areas of maternity care.

Even at the Very High and High risk ratings those in active labour should be able to have an essential support assistant and/or a single birth partner. (An essential support assistant is defined as someone required "for specific additional support eg a support worker, BSL or foreign language interpreter", who could be a partner or family member in some circumstances.) At the Medium risk rating this is extended to an essential support assistant and/or a single birth partner at all stages of labour, as long as social distancing can be achieved.

Support on the postnatal ward in Very High/High risk areas appears to be limited to essential support assistants, plus "One nominated adult may accompany the woman attending where she requires familiar support for consultations which may cause her distress." In Medium risk areas "essential support assistants and/or up to one designated /nominated visitor" are allowed subject to social distancing.

In Northern Ireland while in the Gradual Easing phase "A chosen birth partner will be facilitated to accompany the pregnant woman for induction of labour, duration of labour and birth and, for up to three hours after the birth." After this for the rest of the postnatal stay people are allowed one visit a day from one of two nominated people (who can be from different households) "within COVID secure environments" . This is is defined as a social distance of 2 metres wherever possible, optimal hand hygiene and personal hygiene measures, good ventilation, use of PPE when required and all visitors to wear appropriate face coverings. However there is no guidance on how long these visits should be - it simply says " Duration of visits should be agreed with person in charge" and that alternatives such as outdoor or virtual visitng should continue to be made available.

Following review at the end of uly the decision was taken to remain in this phase of 'gradual easing'. Subject to review in another 4 weeks hospitals may move to he 'Further easing' phase under which it will be possible to have one daily visit from two nominated people at the same time. If they are not from the same household and social distancing is not possible then the two people can visit at different times.

Can I have a birth partner with me for an induction or caesarean?

As with the general guidance on birth partners in labour, there are now differences between the four nations of the UK on access for partners/supporters in the antenatal ward. The rules remain subject to local discretion by trusts and other NHS bodies so please check with your maternity team for their policy.

It may be worth asking whether your hospital has facilities for you to be in a separate room from the start of the induction, especially if your circumstances mean that you have a particular need to have the support of a birth partner throughout. AIMS has drafted a template letter which you can adapt to your own situation to request the support you want for your birth.

On 14 December 2020 NHS England published new guidance for NHS Trusts in England Coronavirus » Supporting pregnant women using maternity services during the coronavirus pandemic: Actions for NHS providers . [see the previous section for details of what this says]. This recommends making sure that a woman can safely have a support person with her throughout "labour and birth from the point of attendance at the hospital or midwifery unit" - which should include during induction of labour. It also says that "Women should also have access to support people while admitted... on the antenatal or postnatal ward in line with pre-COVID trust policies." So if birth supporters were previously allowed to be with someone undergoing the early stages of induction on the antenatal ward, the Trust should be looking to reinstate this.

In Scotland the guidance sets out minimum standards according to which protection level the hospital's local authority area is in. Even at the highest levels (3 & 4) one birth partner should be allowed "throughout induction, labour and birth (except during a general anaesthetic)."- so that should include any caesarean which are not done under general anaesthetic. At levels 1 & 2 a second birth partner should be allowed on request "subject to local risk assessments and physical distancing." However the guidance also states that "In addition, in line with national visiting guidance, a carer or interpreter – or someone else fulfilling a similar necessary function – should not be considered as a visitor" - which should mean that these additional support people should be allowed at all protection levels.

See above for details of the guidance on birth supporters in Wales. It appears from this that a birth supporter would only be admitted once a woman is in active labour in areas that have been given a Very High/High Risk rating, but if the Risk rating is Medium a partner should be able to be present at all stages of labour (so including the early stages of induction), as long as social distancing can be achieved. At a Low Risk rating there should be a phased return to the usual local practice. However, the guidance talks about the need to to give consideration to reasonable adjustments for those with specific needs such as mental health issues, learning disabilities, communication needs and "Where the treatment/procedure is likely to cause the woman distress and the partner/nominated other can provide support." It may therefore be possible to negotiate for support during the early stages of induction if you can demonstrate a specific need.

In Northern Ireland while in the Gradual Easing phase the guidance says that " a chosen birth partner will be facilitated to accompany the pregnant woman for induction of labour, duration of labour and birth and, for up to three hours after the birth." It does not specifically mention caesareans but presumably that is covered by being present for birth.

The RCM/RCOG Q&A for pregnant women and their families says "A birth partner without symptoms should be able to attend your induction of labour, particularly if that is in a single room (e.g. on the maternity suite or labour ward). Whether a partner can visit you if the induction takes place in a bay on a main ward, will be dependent on the local NHS Trust/Board assessment of safety, including whether it is possible to maintain the necessary social distancing measures." Some hospitals will only allow your birth partners in once you have been admitted to a birth room in active labour. However, some are willing to be flexible about this for those who have a specific need to have a supporter with them during the early stages of induction or while waiting to be admitted to a birth room. It is worth seeing if you can negotiate to have your needs met.

Some doulas are offering virtual support for women in early labour, including the early stages of an induction. You may be able to find someone offering this service here doula.org.uk/find-a-doula but not all doulas are members of this organisation, so try social media, word of mouth and search online as well.

The RCM/RCOG guidelines for antenatal care suggest that Trusts "Consider offering outpatient induction of labour for low-risk women." This means going home in early stages of an induction once a slow-release pessary or mechanical dilation device has been inserted, after waiting a short period to check that there are no problems. You would then return to hospital 24 hours later, or sooner if labour has started. If you are planning an induction you may want to ask your midwife or doctor about doing this.

If you are having a caesarean, unless this is being done under general anaesthetic, the RCM/RCOG Q&A says "While the maternity team will do all they can to ensure that your birth partner is present for the birth, there will be some occasions when there is a need for an urgent emergency birth with epidural or spinal anaesthetic in which it will not be possible for your birth partner to be present. " This is a clear expectation that staff should be enabling birth partners to be present during a caesarean unless it really is an emergency. It also says that should it not be possible for the birth partner to be present "your maternity team will discuss this with you and will do everything they can to ensure that your birth partner can see you and your baby as soon as possible after the birth."

Will I be able to birth my baby at home?

Many women are asking about whether they and their babies would be safer if they stayed at home for the birth. The evidence about the safety of homebirth can be found in the "Your Choice - where to have your baby" leaflets for first time mothers and for those having a subsequent baby which your midwife should already have given you at antenatal appointment early in your pregnancy. You will also need to take into account any specific issues that might affect your birth, as well as the chance of catching Covid-19.

Article 8 of the Human Rights Act protects your right to birth where you choose. In normal circumstances if you made the decision to birth at home, you should be able to expect NHS care for the birth. However in the current circumstances there may be situations where this in not possible. This does not mean that you can be legally required to birth in hospital, but that you may not be guaranteed medical support if you decide to birth at home.

RCM/RCOG’s “Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic” recognises that “Continuation of as near normal care for women should be supported, as it is recognised to prevent poor outcomes.” It also says that “The positive impact of midwife-led birth settings is well documented, including reductions in the need for a range of medical interventions. These positive impacts remain of significant importance to prevent avoidable harm, and availability of midwife-led care settings for birth should therefore be continued as far as is possible during the pandemic.” The guidance notes that “Emerging evidence from European settings supports continuing to strengthen community services in order to enable social distancing and minimise spread in healthcare settings.”

Some NHS Trusts/Boards have been withdrawing support for all home-births or advising that this support cannot be guaranteed on the grounds that they have insufficient midwifery staff and/or that local ambulance services cannot guarantee timely transfer in the event of an emergency. However, others have put arrangements in place to ensure that women wishing to have a homebirth can be supported to do so.

This article Homebirthing in the United Kingdom during COVID-19 includes a discussion of the legal position and states that “we argue that it is illogical to assert that the blanket removal of homebirthing service meets the test of ‘necessity’ when two-thirds of Trusts have continued to offer some form of homebirth service throughout the pandemic. The blanket removal of homebirthing services is neither necessary nor proportionate, therefore these policies amount to a violation of the Article 8 rights of birthing people.”

In fact, the RCM/RCOG guidance recommends that Trusts take a phased approach based on levels of midwifery shortage and how the ambulance service is running. They indicate that if the midwifery shortage is under 20% and the ambulance service is running as usual, all places of birth should continue to be available. The calculation of available midwifery resources should include " additional midwives from the NMC emergency register, independent midwives, those previously in non-clinical roles or year-3 student midwives."

Before moving to restrict homebirths this guidance says that Trusts should consider adapting the usual policy of having two midwives at a homebirth “to include senior student midwives, returning registered non-clinical midwives, returning recently retired midwives or appropriately prepared maternity support workers to attend as the second member of the team for low-risk home births.” They should also consider a combined rota for community midwives and those at freestanding birth centres “so as to maximise the spread of resources and maintain the full range of maternity settings for as long as sustainable staffing allows.”

Even with a midwifery shortage of over 30% and/or ambulance service experiencing severe delays either an alongside midwife-led unit or allocated midwife-led rooms on obstetric units should still be available, if Trusts feel unable to offer support for homebirths.

Trusts should review the constraints on a daily basis and follow a corresponding ‘de-escalation plan’, reinstating services as midwifery shortages reduce.

If you are planning a homebirth, you will need to check the situation in your local area, and be aware that this can change at short notice. You may want to check whether your Trust has followed the escalation/de-escalation plan which RCM/RCOG recommend, and the current state of midwifery staffing levels and ambulance services.

If your local Trust is one of those that has said that they will not support homebirths, you could try writing to your local Head/Director of Midwifery asking them to consider the solutions adopted elsewhere to enable support to be provided for homebirths. AIMS has drafted a template letter which you may like to adapt to your own situation. You can find it here www.aims.org.uk/information/item/booking-a-home-birth .

In some areas, Trusts/Boards are asking people to sign a “Homebirth Contract” before they will agree to provide midwifery support. The article by Romanis and Nelson states “These documents do not carry any legal weight when it comes to decisions during birth – the fact that a pregnant person preparing to birth has signed cannot compel them to have any intervention during their birth, such as transfer to hospital, to which they do not consent.”

You may also want to find out whether you could go to a birth centre or a midwife-led room in the hospital instead, as in line with the RCM/RCOG guidance at least one of these should be an option. Another option for some families could be to hire an independent midwife. Independent midwives work separately to the NHS and so can offer support for a homebirth even when the NHS will not, or there is a threat of withdrawal. Some Independent Midwives can be found on the IMUK website but not all midwives are part of IMUK so try social media, word of mouth and search online.

If neither of these is an option for you, and your Trust continues to decline support for a homebirth, you will need to decide whether to go to hospital or birth at home without medical support. If you are considering remaining at home for the birth even if a midwife may not be available please see the section "Can I birth at home without a midwife?" below.

Will I be able to go to a birth centre?

See "What are my birth choices if I have tested positive or have symptoms of coronavirus?" for how this might affect your ability to access a birth centre.

Many women feel that this would be the option they would prefer because they feel it would be safer for them, their baby and their family. You should have already been given information about birth outside an obstetric unit, but you can also find it here: "Your Choice - where to have your baby" leaflet for first time mothers and for those having a subsequent baby. Your midwives should be able to answer any questions that you have. You will also need to take into account any specific issues that might affect your birth, as well as the chance of catching Covid-19.

Please see the section “Will I be able to have my baby at home?” for details of guidance from RCM/RCOG on maintaining midwife-led care settings for birth, depending on the levels of midwifery shortage and how the ambulance service is running. If there are problems with these, the guidelines say that Alongside Midwifery units (AMUs) may be prioritised over Freestanding Midwifery units (FMUs) where a Trust has both. If a Trust decides that it needs to close an FMU, then an AMU should still be available. If there is no AMU then they should arrange for “allocated midwife-led rooms on obstetric units”.

Confusingly, Trusts around the country have taken different approaches to the use of birth centres. We are aware that in some areas efforts are being made to support more birth centre births, as this may help to reduce the transmission of coronavirus and relieve pressure on staff in the obstetric unit. You may even find that you are encouraged to consider this option even if you were previously planning to have your baby in hospital. In other areas, birth centres are being closed for birth, in order to concentrate staff in the obstetric unit or so they can be used for providing other care. If this is the case in your area and you had planned to birth there, you may want to discuss the option of a homebirth.

The RCM/RCOG guidelines on Coronavirus infection in pregnancy say that "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." It also says that continuous monitoring should not be recommened if the only factor is that someone has tested positive, but they have no symptoms. This means that if a birth centre is available in your area, you should not be prevented from using it on the grounds that you need continuous monitoring, if there is no other reason why you might choose yo have it.

Can I birth at home without a midwife?

We are receiving increasing numbers of contacts from women who tell us that they are now considering remaining at home to give birth even though a midwife may not be available to come out to them. A planned birth without the presence of a health professional is known as a freebirth. It is your right to birth without a midwife or doctor present.

We would hope that women who are planning a homebirth and want a midwife present will not be forced into a choice between leaving their home to birth elsewhere or having to birth without that support, but in the current situation we know this is happening. If you are in this position you will need to weigh up the risks and benefits of remaining at home without medical support compared to going into hospital.

Guidance from the RCM suggests that maternity services should seek to build a dialogue with women considering a freebirth. This should include a chance to “share what is important to her in relation to her psychological and physical safety”, time to “explore why she wants to have an unassisted birth” and the offer of support for previous birth trauma. AIMS hopes that this means that midwives will listen to such women with empathy.

It is important for midwives to give objective, factual evidence about the risks of all of a mother’s birthplace options in order to enable her to make an informed decision. However, mothers have the right to decline further discussion for any reason, including if they feel that they are being subjected to unwanted repetition of the risks of freebirth.

The RCM guidance suggests asking the woman “what plan for the birth would feel safe and acceptable to her” and that “The senior midwifery management team should then assess what individualised, flexibility of service provision might be possible to avoid an unassisted birth as far as possible.” AIMS hopes that this would include the option of providing support for a homebirth if this is the only way in which a woman can feel safe and/or able to protect her mental well-being.

It is not acceptable, and could be illegal, for anyone to coerce you, or threaten to refer you to Child Services if you decide to remain at home to birth your baby unattended by a midwife. Anyone who tries to do so should be reminded that this is not a valid reason for referral and that it goes against the code of practice for both doctors and midwives, and could lead to a complaint not only to their employer, but to the General Medical Council (GMC) or Nursing and Midwifery Council (NMC). The RCM guidance reminds midwives that “It is not illegal for a woman to give birth unattended by a midwife or healthcare professional” and that “It is not appropriate for healthcare professionals to refer a woman to social services with concerns about the unborn baby, solely on the basis that she has declined medical support, as she is legally entitled to do."

If you are considering a freebirth we would suggest gathering as much information and emotional and practical support as possible in order to prepare for a birth without a doctor or midwife present. There is more information about Freebirth on the following AIMS Birth information page Freebirth, Unassisted Childbirth and Unassisted Pregnancy which addresses rights and other things you need to know and where you can find support.

What are my birth choices if I tested positive or have symptoms of COVID-19?

The RCM/RCOG guidelines say that if you have tested positive at the time or within 10 days before going into labour, but have no symptoms and wish to give birth at home or in a birth centre it is recommended that you "should have an informed discussion around place of birth with {your} clinician." Note, however, that the decision whether to birth at home is yours - you do not need 'permission' to do this.

Offering continuous monitoring of your baby's heartrate "is not recommended" just because of a positive test though you should be offered a discussion of monitoring options (see our Birth Information page "Monitoring your baby's heartbeat during labour".) This is because there is no evidence that an infection without symptoms puts your baby at any increased risk of problems during labour. Consequently, you should not be denied access to a birth centre on the grounds that you need continuous monitoring if you would decline this anyway.

After the birth you should as normal be offered delayed cord clamping (waiting for the blood from the cord to finish passing to your baby before it is clamped and cut) and immediate skin-to-skin contact with your baby. There is no evidence that these practices increase the risk of a baby becoming infected.

If you have mild COVID-19 symptoms the guidelines say you should be encouraged to remain at home (self-isolating) in early labour, and if you do go to the maternity unit in early labour but all is well with you and your baby you should be encouraged to go home again until your labour is more established (assuming you have your own transport to do so). The guidelines recommend that if you have symptoms you should give birth in a hospital obstetric unit rather than at home or in a birth centre because "there may be an increased risk" of a baby becoming distressed in active labour (though they don't say how great the risk is) and because women with COVID symptoms are more likely to have a caesarean. You still have the right to birth at home if you choose.

The guidelines also say you should be offered continuous monitoring of your baby's heartrate, because "While further data is required in women with symptomatic confirmed or suspected COVID-19, it appears prudent to use" it. In other words, there isn't any evidence to say whether continuous monitoring helps in this situation, but the guideline authors feel it's better to be on the safe side. You still have the right to decline continuous monitoring if you do not want it.

There is no evidence to favour either a caesarean or a vaginal birth for people with COVID-19, unless their condition is worsening and they need urgent treatment and you should be free to choose which you want to plan for. You might be recommended to have an epidural put in during early labour, so that if you were to need a caesarean very urgently you would not need to be put under a general anaesthetic. However this is just being recommended as a precaution. So far there is no evidence to show whether women with suspected/confirmed COVID-19 are significantly more likely to need a very urgent caesarean where there would not be enough time to set up an epidural or spinal block. It is up to you whether you want to have an epidural for this reason, if you were not otherwise intending to use it to manage your labour, and your doctor or midwife should discuss the benefits and risks so that you can make an informed decision.

The guideline admits that there is no evidence on which to base recommendations about your care if you have recovered from COVID-19, so the following are "based on expert consensus" - which means what those writing the guideline thought made sense.

If you have recovered from COVID-19 but did not need to be admitted to hospital with it, "there should be no change to planned care during labour and birth."

If you were admitted to hospital with severe COVID-19 and have recovered "healthcare professionals should discuss and plan place of birth with the woman" taking into consideration your baby's growth and your choices. This does not affect your right to choose a homebirth, and if all is now well with you and your baby there would appear to be no reason for you not to go to a birth centre.

Will I be able to use Gas & Air during my birth?

At the start of the pandemic there were some concerns about the use of Entonox (Gas & Air) but now the RCM/RCOG guidance states "Entonox can be used with a single-patient microbiological filter. There is no evidence that the use of Entonox is an aerosol-generating procedure." The use of single-patient filters is standard practice. RCOG's information for women says "there is no reason you cannot use this in labour." This means you should not be denied access to Gas and Air because of concerns about you contracting Coronavirus or because you might pass it on to others.

Will I be able to have a waterbirth?

The availability of birth-pools varies. In some NHS Trusts there are one or more pool rooms within the main hospital obstetric unit, but in others they are only available in midwife-led units (birth centres). In that case, if the midwife-led units have been suspended, then there probably won’t be a birth-pool available unless the Trust has, for example, installed a portable birth-pool in the obstetric unit. Unfortunately, you do not have a right to insist on a water-birth so you may need to negotiate for this. If homebirth is an option for you then you can hire your own birth-pool.

Some Trusts have decided to suspend the use of birth-pools even though these are available in an obstetric unit and/or in a midwife-led unit which remains open. The RCM/RCOG guidance guidance recognises that labour and birth in water "may confer benefits" and makes it clear that those who have no symptoms or who have tested negative for COVID-19 should be able to use a birth-pool "providing adequate PPE can be worn by those providing care." AIMS hopes that this will mean that Trusts cease to impose blanket bans on waterbirths.

The guidelines note that for those who have tested positive but have no symptoms there is a lack of evidence to show whether the virus can be transmitted in water, so they make no recommendation for or against the use of birthpools in this case. In fact, while there is evidence that coronavirus may be present in faeces (poo) there is no direct evidence that it can be caught from a birthpool, so there seems no good reason to prevent someone without symptoms from using one, even if they have tested positive. However, hospitals may decide against it in order to protect staff.

The guidelines note that it is not usually recommended for those with fever to labour in water, and that those with symptoms such as coughing or breathing difficulties, or who feel unwell, need careful monitoring so their care is better managed on land.

This briefing from the Royal College of Midwives (RCM) concludes that “The current evidence does not suggest that there should be a blanket cessation on the use of water in labour or waterbirth for all women.” It does go on to say that “Individualised risk assessment about the appropriateness of providing labour or birth care in the pool room should be undertaken for each woman by the midwifery team providing care, based on the woman’s individual presentation and the pool environment within the labour setting.” This would still allow a Trust to say that their pool room is not suitable.

A paper from Oxford Brookes University water immersion during labour and waterbirth - COVID-19 context makes the case for waterbirth being a potentially safer option for women who do not have suspected or confirmed symptoms of COVID-19 “because it promotes the use of social distancing without interrupting normal midwifery care” and that the water should dilute any potential contamination from respiratory droplets or faeces.

Will I still be offered an induction or planned caesarean?

The RCM/RCOG guidelines suggest having a discussion with your doctor about the timing and mode of birth but it is (as always) up to you whether to accept an offer of induction or a caesarean, and you should also be able to request a caesarean if that is what you want and it is not being offered.

If you are self-isolating because you or someone in your household has suspected COVID-19 the suggest "personalised assessment should take place" to decide whether it is better overall to delay a planned caesarean or induction. This should include consideration of how urgent it is for your baby to be born, and the risks of infection to others and to your baby after birth. You can ask for a second opinion if you are unhappy with the decision.

Can my baby stay with me after birth if I have suspected or confirmed COVID-19?

There is little evidence about the risk of a baby catching COVID-19 from an infected mother but according to Advice from the British Association of Perinatal Medicine (BAPM) "it now appears unlikely" that a baby will become infected around the time of birth "if correct hygiene precautions are undertaken." The recommended approach differs according to whether the baby is well at birth, or needs to spend time in a neonatal unit.

The RCM/RCOG guidance says that, as long as your baby is healthy they should remain with you and you should be supported to breastfeed and to practice skin-to-skin/kangaroo care if you wish, even if you have a suspected or confirmed COVID-19 infection. However, if your baby needs to be cared for in a neonatal unit then you will probably not be admitted to the unit, in order to protect the other babies and adults in there, except in some specific circumstances. The guidance confirms that parents should still be involved in decisions about their baby's care and that those who wish to breastfeed should be supported to do so. (See "Will I be able to be with my baby if s/he is being cared for in a neonatal unit (NNU)?" for more about this situation.)

Will I be able to be with my baby if s/he is being cared for in a neonatal unit (NNU)?

Advice from the British Association of Perinatal Medicine (BAPM) makes it clear that there should be no restriction on parents being with their baby in a neonatal unit unless they have tested positive or are required to self-isolate. They state that "it is essential that the mother and her partner are never considered to be visitors within the neonatal unit – they are partners in their baby’s care, and their presence should be encouraged." NNUs are advised to identify how to admit parents safely at all times of day, including during ward rounds, so that they can be properly involved in discussions of their baby's care. It notes that "The benefits of extended parental contact, including skin to skin care and active involvement in their baby’s care are well documented, as are the long established advantages of breast feeding. At such a stressful time it is important for both parents to be able to be present together, at least for part of the day, unless such practice would be clearly detrimental to other babies and/or staff in the NNU or TCU." BAPM also encourages hospitals to offer testing to parents on the same basis as to staff, in order to minimise unnecessary separation from their baby.

Most Trusts/Boards appear to be allowing both parents to visit together, for all or a large part of the day, but some still have restrictions e.g. only allowing one parent to visit at a time, or limiting visiting to daytime. AIMS has a template letter which parents can use to request access to a baby in a neonatal unit, if this is being restricted without good reason.

BAPM recognises that "It would generally not be appropriate" for parents who have tested positive or are self-isolating to visit a neonatal unit but every effort should be made to facilitate remote contact by use of video technology and/or social media. If a baby is critically ill or receiving palliative or end-of-life care then "everything possible should be done to achieve parental presence and participation in cares" even if the parents have tested positive.

If parents are not able to visit their baby, it remains their right to receive information and be supported to make decisions about their baby's care, and mothers should be supported to express breastmilk if they wish (see "Can I breastfeed my baby if I have suspected or confirmed COVID-19?")

All four nations of the UK have issued their own , which in most cases is in line with the BAPM advice.

NHS England reaffirms that "Parents of babies in neonatal critical care also need to be involved in their baby’s care as much as possible. Integral to this is ensuring parents have access to their baby, while complying with legislation and government guidance on managing transmission risks." It is therefore asking neonatal critical care providers "to maximise opportunities for parents to be with their babies and to identify how to facilitate parental presence at all times of day" by carrying out a risk assessment and implementing changes to reduce the risk. In particular it recommends routinely testing parents of babies in the NNU, using rapid testing where available, and that if parents test positive they "should be offered video access to their baby for the duration of their self-isolation."

The Wales Maternity and Neonatal Network says that "If you are both well, one parent at a time can visit your baby." However, visiting is not allowed if either parent has a confirmed infection, or if anyone in the household has a suspected infection until they have been confirmed negative. It confirms that "will still be able to give you updates on your baby and involve you in decisions and may be able to arrange video contact for you." It provides guidance on expressing and delivering breastmilk if a mother is positive. suspected positive or self-isolating. Welsh Government guidance is for "Up to two parents, guardians, or carers at the bedside at a time for paediatric inpatients and neonates subject to local determination, and following a risk assessment including the ability to maintain social distancing."

In Scotland the Government's minimum standards for visiting say that even at the highest prtection levels (3 & 4) both parents should be able to be with their baby in neonatal care "subject to local risk assessments and physical distancing." At level 2 one additional designated visitor is allowed, and at level 1 two additional visitors (though they may hsve to visit separately). If the baby is having a prolonged stay siblings can be permitted at levels 1 & 2 "subject to local risk assessment."

In Northern Ireland the guidance states that any child admitted to a neonatal unit "can be accompanied by two persons (either/both parents or two nominated caregivers from up to two households) at all times for the duration of the stay."

Can I breastfeed my baby if I have suspected or confirmed COVID-19?

The best way to protect your baby from infection is to breastfeed and maintain close contact/skin to skin contact with your baby even if you are ill. You may choose to wear a mask when you are in close contact with your baby, or when you are feeding them.

The latest Advice from the British Association of Perinatal Medicine (BAPM) confirms that even a woman with a suspected or confirmed COVID-19 infection should be enabled to have skin-to-skin contact and breastfeed her baby if that is her choice and the baby is well. They say " To date viral RNA has been reported only very rarely in fresh breast milk of COVID-19 confirmed mothers" and so, though the sample is small, the current advice for "well babies of COVID-19 suspected or confirmed mothers is that the benefits of breast feeding outweigh any theoretical risks."

For a baby being cared for in a neonatal unit (NNU) it suggests that carers and parents should discuss the pros and cons of a mother with a suspected or confirmed infection expressing breastmilk for her baby, taking into account the baby's age and state of health, and whether donor breastmilk is available as an alternative. However, it would be the mother's right to provide expressed breastmilk if she wishes, and the RCM/RCOG guidance says that if you are unwell or otherwise unable to breastfeed your baby directly, you should be supported to express your breastmilk, or be offered donor milk for your baby.

If your baby is receiving donor breastmilk, you may wish to continue expressing and discarding your own milk until you are no longer infectious, in order to maintain your supply.

Getting breastfeeding support may be more difficult right now due to the closures of face to face breastfeeding drop ins, however, most of those groups will have moved online and be offering video call support to parents. Search Facebook for your local group.

Breastfeeding Counsellors, Lactation Consultants and doulas are making themselves available for video consultations so do reach out if you need support.

All the breastfeeding helplines are still open:

  • National Breastfeeding Helpline: 0300 100 0212
    www.nationalbreastfeedinghelpline.org.uk
  • NCT Helpline: 0300 330 0700 (Choose option 1 for NCT infant feeding line)
  • La Leche League GB Helpline: 0345 120 2918
  • Association of Breastfeeding Mothers: 0300 330 5453

Breastfeeding Support organisations

What if you are giving your baby formula?

If you are formula feeding your baby it is even more important than usual to make sure you are carefully sterilising all the equipment you use and minimising the number of people who hold and feed the baby.

Should you encounter any issues obtaining formula for your baby please do not ring the ‘careline’ number on the packaging - the rumour that the companies are sending out free supplies to mothers is not true. If you are running short of formula and unable to find any in the shops, please inform your pharmacy or GP surgery, who can order in stocks for you.

Many parents worry about their baby not taking the recommended amount of milk, and during this time where they may be a lack of support you may be concerned about this. In which case you may find the ‘Paced Bottle-Feeding’ method may be useful and information can be found here https://feedsleepbond.com/lactation-consultants-guide-bottle-feeding.

Written by: Nadia Higson
Reviewed by: AIMS Helpline Team
Reviewed on: 31/08/2021
Next review needed: 31/03/2021


AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Latest Content

Journal

« »

What has the AIMS campaigns team be…

AIMS Journal, 2021, Vol 33, No 4 By the AIMS Campaigns Team Covid-19: With other members of the But Not Maternity Alliance [1] we wrote to all Trusts and boards that were…

Read more

Aims Editorial December 2021: What…

AIMS Journal, 2021, Vol 33, No 4 Alex Smith The title of the editorial for this issue of the journal is, ‘What just happened?’ I feel a little bit like ‘baby bear’ from G…

Read more

How does BMI influence maternity ca…

AIMS Journal, 2021, Vol 33, No 4 [ All charts are taken from or adapted from the report ] By the AIMS Campaigns Team The National Maternity and Perinatal Audit (NMPA) is…

Read more

Events

« »

AIMS 60th Anniversary Event - Confe…

POSTPONED FROM JUNE 2020 Making a difference past and future The purpose of the day is to celebrate what Birth Activists in general and AIMS in particular have achieved,…

Read more

Latest Campaigns

« »

AIMS Campaigns Update, December 202…

AIMS supports the Government's ongoing commitment to the implementation of relational care - the Continuity of Carer model of care - in the maternity services across Engl…

Read more

Response to the RCOG Consent Advice…

The draft document can be found here General comments: The comments form is online only and cannot be downloaded. This makes it very difficult for considered responses to…

Read more

AIMS Position Papers

AIMS is pleased to announce the publication of the first of our new position papers. Over the years, AIMS has developed a reputation for taking a position on a wide range…

Read more