Guidance for maternity and newborn care

Queensland Health has published COVID-19 guidance for maternity care for mothers and babies during the COVID-19 pandemic at Queensland Clinical Guidelines. NSW Health recommends that sections 2 (Maternity care during COVID-19 pandemic) and 4 (In-hospital maternity care if suspected or confirmed COVID-19) of this guidance is used by maternity services in NSW.

Guidance for Neonatal Services in NSW is available on the NSW Health website. The guidance is relevant to postnatal wards, special care baby units and neonatal intensive care units.

Districts and networks are expected to follow the Tiered Perinatal Networks Local Network Operational Plans outlined in the NSW Health Policy Directive (PD2020_014) Tiered Networking Arrangements for Perinatal Care in NSW when escalation of care is required.

For pregnant women with suspected or confirmed COVID-19, continued access to woman-centred, respectful skilled care is essential. This includes mental health and psychosocial support as well as obstetric, medicine and neonatal readiness to care for maternal and neonatal complications.

Essential elements of maternity care

During a pandemic, health services will be required to review their usual service provision and models of care to respond to the local disaster planning. Service redesign or changes to models of care need to be accompanied by a robust risk assessment process to ensure there are no unintended adverse consequences of such changes.

The following elements for maternity care are considered essential:

• First contact/Booking in
• Alternate plans should be considered to provide required booking in paperwork via postage or secure email systems prior to booking process
• The booking in and risk stratification process for pregnant women must be done with a clinician (e.g. midwife), even if the process is completed over the phone
• Psychosocial screening must be completed; domestic violence screening should be deferred to a face to face visit
• Venous thromboembolism (VTE) screening must be completed
• Test results should be given over the phone or by secure messaging
• Abnormal results should be given face to face or via secure video
• Women with particular vulnerabilities or who are at risk (e.g. CALD, Aboriginal, those with mental health or drug and alcohol issues) should not be disadvantaged and all effort should be made to ensure that services are enhanced to support these populations
• Care planning needs to take into consideration the risk factors identified, the context and the woman’s preferences
• Encourage women to have their flu vaccination.
• 20 weeks
• This visit could take place over a secure video call or by phone, however if significant risk factors have been identified it should be a face to face visit. There should be an appropriate revision of the care plan if risk factors have been identified
• Consider offering pertussis vaccinations at this visit for women at risk of preterm birth.
• 28 weeks
• Face to face visit
• Comprehensive assessment of maternal and fetal wellbeing (including weight, BP and urinalysis)
• Review care plan
• Review and discuss usual screening investigations e.g. Full Blood Count, Oral Glucose Tolerance Test (if fasting blood glucose is between 4.7 and 5.0 mmol/L, Oral Glucose Tolerance Test is required. Further guidance is in: Notice of update during Covid-19 pandemic: Recommendations for GDM screening and oral glucose tolerance test (OGTT)
• Review and discuss usual vaccinations: seasonal flu and pertussis
• Offer Anti-D for Rhesus negative women.
• 36 weeks
• Comprehensive assessment of maternal and fetal wellbeing (including weight, BP and urinalysis)
• Check fetal presentation (using point of care ultrasound if available)
• Review care plan
• Review and discuss usual screening tests e.g. FBC, GBS swab
• Review Anti-D prophylaxis for Rhesus negative women (if not received at 34 weeks, then offer at 36 weeks).
• 40 – 41 weeks
• Comprehensive assessment of maternal and fetal wellbeing (including weight, BP and urinalysis)
• Check fetal presentation (using point of care ultrasound if available)
• Review care plan.

• Postnatal
• Following birth, a postnatal risk assessment should be performed including VTE assessment and the specific care needs for women with vulnerabilities (e.g. mental health, substance use etc.)
• Risk assessment should be attended daily for women receiving postnatal care in the community; the usual Covid-19 screening approach should be adopted and management planning adapted depending on responses
• The following are essentials of care:
• Immunisation for both mother and baby
• Anti D
• Vitamin K
• Physical assessment of well neonate
• Newborn blood spot screening
• SWISH screen
• Newborn cardiac screen
• Maternal physical and mental health assessment
• Extended length of stay in hospital is still appropriate for women with complex needs
• Comprehensive advice around breastfeeding and postnatal care.

Infant feeding

For women with suspected or confirmed COVID-19, the main risk for infants is the close contact with the mother, who is likely to have infective airborne droplets. In the light of the current evidence, the benefits of breastfeeding outweigh any potential risks of transmission of the virus through breastmilk. There is further information in the Queensland Queensland Health guidance document for clinicians. Guidance for parents about breastfeeding with COVID-19 is available on the NSW Health website

Document information

Developed by: Health and Social Policy Branch (HSPB)

Consultation: Maternity, Child and Family, HSPB

Reviewed

• Version 2 - 20/04/2020
• Clinical Lead, Community of Practice, Maternity
• Representatives from the Community of Practice: Maternity Risk Network, Tiered Perinatal Networks’ Obstetric Leads and Redesign Leads.

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