- Delayed umbilical cord clamping does not seem to increase pathogens transmission.
- Leaving vernix caseosa in place 24h after birth can be considered due to the presence of antimicrobial peptides.
- The majority of neonatal infections are caused by the environment and droplet transmission from the mother and other relatives.
- Physical separation at birth can be considered and needs to be discussed with family and the interdisciplinary team while considering local resources.
- Separating the infant from the mother can bring many consequences. Therefore, risks and benefits need to be evaluated carefully.
- There is no passage into maternal milk according to a small study.
- Breastfeeding, manual milk expression and skin-to-skin contact are not contraindicated but precautions must be taken (face mask, hand washing, dedicated pump) to avoid transmission by respiratory droplets.
- Some authors suggest discharging the mother earlier than usual if clinically stable, on day 1 for vaginal delivery and on day 2 for cesarean delivery.
- The prescription of long-acting reversible contraceptives at discharge should be considered.
- Follow-up postpartum visits should be done using telecommunication. The use of photos to evaluate wounds and breast infections can be considered where possible.
Care for the symptomatic COVID-19 positive mother :
- Close surveillance for respiratory decompensation should be practiced.
- In case of postpartum hemorrhage in a women at risk for bronchospasm, a small study suggests using second-line uterotonics such as oxytocin and methylergonovine instead of carboprost tromethamine.
- The consequences of the use of NSAIDs for ill patients have not yet been determined. It should still be considered for women experiencing uncontrolled pain in postpartum.
About milk donation and cuddler programs :
- Some milk banks have implemented verification methods using a rigorous questionnaire and body temperature.
- Infected women are generally not accepted as milk donors.
- Donation is more complex due to social distancing measures. It should be done at the hospital if possible.
- Milk banks worker should take precautions when receiving donation, such as wearing gloves and disinfecting the outside of the containers.
- Cuddler programs are often put on hold due visitor restriction in the hospital, reducing the skin-to-skin contact and holding for newborns in the NICU.
This data comes from multiple records. Baud & al. conducted a small literature review that is mainly based on data analysis from WHO and CDC about obstetrics and neonatal care for pregnant women infected with COVID-19. Bauer & al. provide recommendations and expert opinions regarding obstetric anesthesia and other obstetric topics in a review. Boelig RC & al. wrote an expert review regarding various steps of the labour and delivery process, including a section on the use of obstetric medications. Davanzo & al. conducted a literature review about the compatibility of COVID-19 infection with breastfeeding. The authors are part of the Italian Society on Neonatology. Narvey provided recommendations about breastfeeding and skin-to skin contact for infected mothers. He is part of the Canadian Paediatric Society. Panahi and al. wrote a narrative review that was conducted by a group of doctors and nurses in Iran, which includes 13 articles about vertical transmission and the risks of COVID-19 associated with pregnancy. A total of 37 pregnant women and 38 newborns were described in these studies. Stuebe conducted a small literature review to acknowledge the risks and benefits of separating the mother from the newborn in cases of COVID-19 infection.
The data on milk donation and cuddler programs comes from multiples records. The first is a feature article about NICU experiences, cuddler programs, breastfeeding and milk donation conducted by The Lancet Child & Adolescents. The second is an analysis of the current literature about the possible transmission through breast milk of COVID-19 and other coronaviruses. The author communicated with specialized doctors in China and Italy to understand the status of human milk banks during the pandemic. The third one an analysis of current literature about safety measures while handling donated milk conducted by the same author as the previous article.
Sources about postpartum and breastfeeding :
- Baud D., Giannoni E., Pomar L. et al. (March 17 2020). COVID-19 in pregnant women : Author’s reply. The Lancet Infectious Diseases.https://doi.org/10.1016/S1473-3099(20)30192-4
- Bauer M., Bernstein K. and al. (April 6 2020) Obstetric Anesthesia During the COVID-19 Pandemic. Anesthesia & Analgesia. https://doi.org/10.1213/ANE.0000000000004856
- Boelig RC., Manuck T. and al. (March 25 2020) Labor and Delivery Guidance for COVID-19. American Journal of Obstetrics & Gynecology MFM. https://doi.org/10.1016/j.ajogmf.2020.100110
- Davanzo R., Moro G. and al. (April 3 2020) Breastfeeding and Coronavirus Disease‐2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Maternal & Child Nutrition. https://doi.org/10.1111/mcn.13010
- Narvey, M. (April 6 2020) Breastfeeding when mothers have suspected or proven COVID-19. Canadian Paediatric Society. Retrieved from : https://www.cps.ca/en/documents/position/breastfeeding-when-mothers-have-suspected-or-proven-covid-19?fbclid=IwAR2iwfxV9eIn7sckiL_Y2PX2TwnSZiAiqVZOb-ooZCIsIAtlSxhKHzIgXLU
- Panahi L., Amiri M. et Pouy S. (March 23 2020) Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review. Archives of Academic Emergency Medicine. Retrieved from : http://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/595/752
- Stuebe, A. (April 7 2020) Should Infants Be Separated from Mothers with COVID-19? First, DO No Harm. Breastfeeding Medicine.https://doi.org/10.1089/bfm.2020.29153.ams
Source about milk donation and cuddler programs:
- Furlow B. (April 1 2020) US NICUs and donor milk banks brace for COVID-19. The Lancet Child & Adolescent Health. https://doi.org/10.1016/S2352-4642(20)30103-6
- Marinelli KA. (March 30 2020). International Perspectives Concerning Donor Milk Banking During the SARS-CoV-2 (COVID-19) Pandemic. Journal of Human Lactation. https://doi.org/10.1177/0890334420917661
- Marinelli KA and Lawrence RM. (April 3 2020) Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic. https://doi.org/10.1177/0890334420919083