Expecting? Due to deliver your baby soon? Sister Burgie Ireland explains the ins and outs of hospital policies and protocols during the coronavirus pandemic.

It’s understandable that many women are worried about what will happen when they’re ready to give birth. While hospitals and staff are gearing up to cope with the worst of the SARS-CoV-2 or COVID-19 crises, we’re told that maternity units will continue to function as usual.

The National Institute for Communicable Diseases (NICD) has issued guidelines for private and government hospitals. Please note that these could change depending on how COVID-19 develops in South Africa over the next few months.

Research has shown that pregnancy does not put women at a higher risk of contracting COVID-19 – providing they follow all the precautionary measures. Depending on circumstances and providing they’re not showing any symptoms, women will not be routinely tested on admission.

Symptomatic women and those who test positive for the virus will be nursed in isolation in separate facilities within the hospital. Certain government hospitals have been earmarked to accommodate COVID-19 patients.

Research has not found the coronavirus in amniotic fluid or breastmilk, but there is uncertainty when it comes to respiratory transmission of the virus to the baby. While women can safely have natural birth and breastfeed, those with the virus need to take extra precautions. It would be safest for the baby to be looked after by another family member if the mother is ill or unable to care for her baby. If this is not possible, or her symptoms are mild, the mother looking after her baby should always wear a clean mask and avoid breathing over her baby, wash her hands before and after touching her baby and regularly clean and disinfect surfaces that have been touched.

Hand washing should always be thorough, using soap and water, for at least 20 seconds, with friction to make sure that all surface microbes are removed. This should be continued for 14 days after symptoms have been resolved.

Women who don’t have COVID-19 can nurse their babies’ skin-to-skin immediately after birth.

Even though guidelines will be explained to you on admission, it helps to speak to a representative of the hospital where you will be having your baby, so that you know what to expect.  All hospitals are following a strict social distance and visiting protocol.

Government hospitals and clinics are open for antenatal tests and visits. It’s important that women don’t miss these appointments. Partners are not allowed into the delivery room in government hospitals, visiting is limited and the hospital stay – depending on circumstances – is minimised.

Verena Bolton, spokesperson on neonatal matters at Netcare, kindly answered the following frequently asked questions. These answers apply to women who are COVID-19 negative. Specifics for those who have symptoms of COVID-19 or who have tested positive are also answered.

Will elective C-sections be allowed or will women be encouraged to have natural birth?

In accordance with the World Health Organization, the event of COVID-19 is no reason to change how the delivery of the baby should happen. This remains a decision that the attending doctor will make with the mother-to-be in the best interests of the mother and baby.

What happens during labour – is your partner allowed to stay with you?

Netcare is following best practice for deliveries, in accordance with international guidelines. Thus, the expectant mother’s chosen birth partner is most welcome to attend the delivery, providing that the birth partner is not COVID-19 positive or a person under investigation (PUI) for COVID-19, has none of the symptoms of the infection, submits to risk-assessment and screening prior to entry to the hospital, and complies with all the infection prevention requirements as stipulated by Netcare.

The birthing partner may stay with the mother for the duration of the labour and delivery, until she is transferred to her ward. However, the mother-to-be will need to select another birthing partner if her chosen birthing partner is positive or symptomatic.

Where live-in facilities are available, (private room with mother and baby), the birthing partner will be allowed to stay for the delivery and thereafter on a continuous basis only. The birthing partner will not be able to leave and return to visit as this increases the risk of infection.

What happens if you go into premature labour?

The same restrictions and conditions apply if an expectant mother goes into premature labour.

A word of caution though: knowledge about COVID-19 is evolving. It would therefore be a good idea to phone the hospital prior to your arrival in order to check the accuracy of the information as it may have changed since this article was published.

If my baby is admitted to NICU can I practise kangaroo care?

Nursery and neonatal intensive care unit (NICU): only ONE parent is allowed to visit their newborn in the nursery or NICU at a time (i.e. either the mother visits for the duration of the nursery or NICU admission, or the partner visits for the duration of the nursery admission). This is on condition that the person(s) visiting has had no COVID-19 exposure and accepts that very strict infection prevention controls will be put in place to minimise the risks to their baby or another patient.

For long-stay neo-natal admissions, an exception can be granted by the hospital general manager, as authorised by the regional director. No grandparents and siblings will be allowed to visit. The parent visiting their newborn in the NICU for the duration of the baby’s admission will be required to wear personal protective equipment at all times while visiting.

Kangaroo care may be allowed in certain instances at the discretion of the manager of the NICU.

 

What about skin-to-skin and breastfeeding and keeping the baby with mom and not in the nursery?

Skin-to-skin contact in the first hour after birth, breastfeeding and rooming-in are encouraged in Netcare maternity units. These practices are aligned to the Mother and Baby Friendly Initiative of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), also during the COVID-19 pandemic.

 

Do you delay bathing the baby for the first 24 hours?

Generally speaking, bathing of babies in Netcare maternity facilities are delayed for the first 3 days in alignment with the South African Neonatal Skin Care Guidelines. Note, however, that there are exceptions.

How long will mom stay in hospital after natural birth (providing there are no complications) and how long can C-section moms stay in hospital?

There have been no changes as to how a maternity patient is treated in terms of her actual labour and discharge as a consequence of the incidence of COVID-19 in our country.

Any deviations from our usual practice would be as a consequence of the mother or newborn’s condition and would be medically indicated and thus, at the discretion of the attending doctor, who is responsible for the decision on the discharge of the mother. This is a clinical decision in which the hospital is not involved.

Mothers-to-be and mothers with newborns who are under investigation for, or confirmed with COVID-19

Netcare has identified separate zones in our hospitals for the care of persons under investigation (PUIs) and patients with confirmed COVID-19. If COVID-19 is suspected or confirmed in an expectant mother who is due to deliver her baby in a Netcare facility, she will be admitted to, and cared for in the appropriate zone.

All the guidelines of the National Institute for Communicable Diseases (NICD) in terms of maternity patients as well as their birth partners will be adhered to. This will be explained to the mother-to-be on admission.

 

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