Pregnant clients according to the Canadian Centre for Disease Control and Prevention (CDC) appear to be at more risk of susceptibility of severe illness than the general population. Expert opinion at this time is that the fetus is unlikely to be exposed during pregnancy or congenital effects of the virus on fetal development. There is also currently no data suggesting an increased risk of miscarriage or early pregnancy loss.

Much is still unknown about the risks of COVID-19 to newborns born to mothers with COVID-19. The CDC experts know at this time that:

• Infections causing COVID-19 in newborns born to mothers with COVID-19 are uncommon.
• Some newborns have tested positive for the virus that causes COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth from close contact with an infected person.
• Most newborns who tested positive for the virus that causes COVID-19 had mild or no symptoms and recovered. However, there are a few reports of newborns with severe COVID-19 illness.
• Preterm (less than 37 completed weeks gestation) birth and other problems with pregnancy and birth have been reported among women who tested positive for COVID-19 during pregnancy. It is unknown whether these problems were related to the virus that causes COVID-19.

CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room (“rooming-in”). Current evidence suggests that the risk of a newborn getting COVID-19 from its mother is low, especially when she uses appropriate precautions before and during care of the newborn, such as wearing a mask and practicing hand hygiene.

If you are diagnosed with or test positive for the virus that causes COVID-19, you should discuss with your healthcare provider the risks and benefits of having your newborn stay in the same room with you. This conversation should begin during prenatal care if possible. Having your newborn stay with you in the same room has the benefit of facilitating breastfeeding and maternal-newborn bonding. Potential risks may include giving the virus to the newborn, although current evidence suggests the risk of a newborn getting COVID-19 from their mother is low if precautions are taken. After discussing, make an informed decision of whether your newborn is staying in the same room with you while in the hospital.

Take precautions when having your newborn stay in the same room with you, if you are in isolation for COVID-19.

If you are in isolation for COVID-19 and are sharing a room with your newborn, take the following precautions to reduce the risk of spreading the virus to your newborn:

• Wash your hands with soap and water for at least 20 seconds before holding or caring for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
• Wear a mask when within 6 feet of your newborn.
• Keep your newborn more than 6 feet away from you as much as possible.
• Discuss with your healthcare provider about using a physical barrier (for example, placing the newborn in an incubator) while in the hospital.

If your isolation period has ended, you should still wash your hands before caring for your newborn, but you don’t need to take the other precautions. You most likely won’t pass the virus to your newborn or any other close contacts after your isolation period has ended.

• If you had symptoms, your isolation period ends after
  • 10 days since symptoms first appeared, and
  • 24 hours with no fever without fever-reducing medications, and
  • Other symptoms of COVID-19 are improving
• If you never had symptoms, your isolation period ends after
  • 10 days since the date of your positive COVID-19 test

If you are still in isolation for COVID-19 and have returned home, take the following precautions until your isolation period has ended:

• Stay home to separate yourself from others outside your home.
• Isolate from other household members who are not infected and wear a mask in shared spaces.
• Have a healthy caregiver who is not at increased risk for severe illness provide care for your newborn.
  • Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • If the caregiver is living in the same home or has been in close contact with you, they should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation and for two weeks after you completed isolation.
• If a healthy caregiver is not available, you can care for your newborn if you are well enough.
  • Wash your hands with soap and water for at least 20 seconds before touching for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Take precautions at home if you are in isolation for COVID-19.

If you are still in isolation for COVID-19 and have returned home, take the following precautions until your isolation period has ended:

• Stay home to separate yourself from others outside your home.
• Isolate from other household members who are not infected and wear a mask in shared spaces.
• Have a healthy caregiver who is not at increased risk for severe illness provide care for your newborn.
  • Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • If the caregiver is living in the same home or has been in close contact with you, they should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation and for two weeks after you completed isolation.
• If a healthy caregiver is not available, you can care for your newborn if you are well enough.
  • Wash your hands with soap and water for at least 20 seconds before touching for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Others in your household and caregivers who have COVID-19 should isolate and avoid caring for the newborn as much as possible. If they have to care for the newborn, they should practice hand hygiene and wear a mask.

Do not put a face shield or mask on your baby.

A face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation. Babies move frequently. Their movement may cause the plastic face shield to block their nose and mouth, or cause the strap to strangle them.

There are also no data supporting the use of face shields among babies for protection against COVID-19 or other respiratory illnesses.

CDC recommends all people 2 years of age and older wear a mask in public settings and when around people who don’t live in their household. CDC does not recommend use of face shields as a substitute for masks for the general public, including pregnant or breastfeeding mothers.

Ensure safe sleep for your baby.

Safe sleep is an important part of keeping babies healthy.

During the COVID-19 pandemic, parents of babies may experience increased stress and fatigue that could affect their ability to ensure that their baby is sleeping safely. Help reduce your baby’s risk of sudden infant death syndrome (SIDS) and other sleep-related deaths by doing the following:

• Place your baby on his or her back for all sleep times – naps and at night.
• Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.
• Have the baby share your room but not your bed. Your baby shouldn’t sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.
• Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby’s sleep area.
• Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.
• Don’t smoke or allow anyone to smoke around your baby.

(Information from CDC)

The CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth hospitalization is within the mother’s room (“rooming-in”). Current evidence suggests that the risk of a newborn getting COVID-19 from its mother is low, especially when she uses appropriate precautions before and during care of the newborn, such as wearing a mask and practicing hand hygiene.

If you are diagnosed with or test positive for the virus that causes COVID-19, you should discuss with your midwife the risks and benefits of having your newborn stay in the same room with you. This conversation should begin during prenatal care if possible. Having your newborn stay with you in the same room has the benefit of facilitating breastfeeding and maternal-newborn bonding. Potential risks may include giving the virus to the newborn, although current evidence suggests the risk of a newborn getting COVID-19 from their mother is low if precautions are taken. After discussing, make an informed decision of whether your newborn is staying in the same room with you while in the hospital.

Take precautions when having your newborn stay in the same room with you, if you are in isolation for COVID-19.

If you are in isolation for COVID-19 and are sharing a room with your newborn, take the following precautions to reduce the risk of spreading the virus to your newborn:

• Wash your hands with soap and water for at least 20 seconds before holding or caring for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
• Wear a mask when within 6 feet of your newborn.
• Keep your newborn more than 6 feet away from you as much as possible.
• Discuss with your midwife about using a physical barrier (for example, placing the newborn in an incubator) while in the hospital.

If your isolation period has ended, you should still wash your hands before caring for your newborn, but you don’t need to take the other precautions. You most likely won’t pass the virus to your newborn or any other close contacts after your isolation period has ended.

• If you had symptoms, your isolation period ends after
  • 10 days since symptoms first appeared, and
  • 24 hours with no fever without fever-reducing medications, and
  • Other symptoms of COVID-19 are improving
• If you never had symptoms, your isolation period ends after
  • 10 days since the date of your positive COVID-19 test

If you are still in isolation for COVID-19 and have returned home, take the following precautions until your isolation period has ended:

• Stay home to separate yourself from others outside your home.
• Isolate from other household members who are not infected and wear a mask in shared spaces.
• Have a healthy caregiver who is not at increased risk for severe illness provide care for your newborn.
  • Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • If the caregiver is living in the same home or has been in close contact with you, they should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation and for two weeks after you completed isolation.
• If a healthy caregiver is not available, you can care for your newborn if you are well enough.
  • Wash your hands with soap and water for at least 20 seconds before touching for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Take precautions at home if you are in isolation for COVID-19.

If you are still in isolation for COVID-19 and have returned home, take the following precautions until your isolation period has ended:

• Stay home to separate yourself from others outside your home.
• Isolate from other household members who are not infected and wear a mask in shared spaces.
• Have a healthy caregiver who is not at increased risk for severe illness provide care for your newborn.
  • Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • If the caregiver is living in the same home or has been in close contact with you, they should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation and for two weeks after you completed isolation.
• If a healthy caregiver is not available, you can care for your newborn if you are well enough.
  • Wash your hands with soap and water for at least 20 seconds before touching for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
  • Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Others in your household and caregivers who have COVID-19 should isolate and avoid caring for the newborn as much as possible. If they have to care for the newborn, they should practice hand hygiene and wear a mask.

Do not put a face shield or mask on your baby.

A face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation. Babies move frequently. Their movement may cause the plastic face shield to block their nose and mouth, or cause the strap to strangle them.

There are also no data supporting the use of face shields among babies for protection against COVID-19 or other respiratory illnesses.

CDC recommends all people 2 years of age and older wear a mask in public settings and when around people who don’t live in their household. CDC does not recommend use of face shields as a substitute for masks for the general public, including pregnant or breastfeeding mothers.

Ensure safe sleep for your baby.

Safe sleep is an important part of keeping babies healthy.

During the COVID-19 pandemic, parents of babies may experience increased stress and fatigue that could affect their ability to ensure that their baby is sleeping safely. Help reduce your baby’s risk of sudden infant death syndrome (SIDS) and other sleep-related deaths by doing the following:

• Place your baby on his or her back for all sleep times – naps and at night.
• Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.
• Have the baby share your room but not your bed. Your baby shouldn’t sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.
• Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby’s sleep area.
• Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.
• Don’t smoke or allow anyone to smoke around your baby.

(Information from CDC)

Current evidence suggests that breast milk isn’t likely to spread the virus to babies.

You, along with your family and midwives, should decide whether and how to start or continue breastfeeding. Breast milk provides protection against many illnesses and is the best source of nutrition for most babies. The CDC doesn’t know for sure if mothers with COVID-19 can spread the virus to babies in breast milk, but the current evidence suggests that this isn’t likely.

Helpful tips for breastfeeding

You may find it harder to start or continue breastfeeding if you are not sharing a room with your newborn in the hospital. Here are some helpful tips:

• Frequent hand expression or pumping, ideally with a hospital-grade pump, will help you establish and build milk supply if you are separated from your newborn.
• Pump or feed every 2-3 hours (at least 8-10 times in 24 hours, including at night), especially in the first few days. This signals the breasts to produce milk and prevents blocked milk ducts and breast infections.
• If you are unable to establish milk production in the hospital after birth, or have to temporarily stop breastfeeding during your COVID-19 illness because you do not feel well enough, get help from your midwife or a lactation support provider. Learn more about relactation.
• You should always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk even if you don’t have COVID-19. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

If you have COVID-19 and choose to breastfeed

• Wash your hands beforehand
• Wear a mask while breastfeeding

If you have COVID-19 and choose to express breast milk

• Use a dedicated breast pump (not shared).
• Wear a mask during expression and wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts and before expressing breast milk.
• Follow recommendations for proper pump cleaning after each use, cleaning all parts that come into contact with breast milk.
• Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby. Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and for two weeks after you completed isolation.

(Information from CDC)

We advise pregnant clients avoid traveling during the coronavirus pandemic. You can check the Government of Canada’s website for the latest travel advisories. 

If you have recently traveled outside of Canada, please reschedule your midwife appointment until you have been symptom free for 14 days after your arrival into Canada. If you are 37 weeks or more, please contact our office phone line and ask to speak with your midwife. Your midwife will be able to do a phone triage assessment and/or set up a home visit if necessary. Please note, we will not be providing letters to travel outside of Canada during the pandemic until we have been instructed it is safe to do so.

If you have traveled to Hubei province, China, Iran or Italy in the last 14 days, you must limit your contact with others for 14 days, starting the day you began your journey to Canada. This means self-isolation at home. If you develop any symptoms, contact your midwife by pager for advise on the next steps.

If you or your family member(s) have symptoms of coronavirus, you should contact the Health Unit at 519-663-5317 and ask to speak to the Infectious Disease Control team to facilitate assessment and testing. 

Most people who contract COVID-19 will recover; however, some people are at higher risk of complications. If you think you may have COVID-19, or if you have been in contact with someone who has COVID-19, you should get tested.

Knowing if you are infected is important for protecting:

• yourself
• your family
• people you encounter

Testing for the presence of the virus is the only way we can confirm if someone currently has COVID-19. Testing helps reduce the spread of the virus. When people are confirmed to have COVID-19, they can be isolated at home, or if needed, in a hospital.

Testing tells us:

• who has the infection
• where in our communities the virus is spreading
• how much the virus may be circulating in our communities

Testing is a key tool to:

• detect and isolate people who have COVID-19
• follow up with close contacts
• help us to better understand this virus
• inform the public health actions we take
• stop the spread of the virus and prevent outbreaks

Update November 2020 – Please visit this website to book your online appointment here for a COVID test. These tests are currently being run at Carling and Oakridge assessment centres. 

For Woodstock Test Centre click here. This is by appointment only.

For Tillsonburg Memorial Hospital Assessment Centre – call to book an appointment 1-855-905-6148

• Open Monday through Friday from 8am to 4pm.

St Thomas Elgin General Hospital Assessment Centre – call to book an appointment 519-631-2030 ext. 6210 or email assessmentcentre@stegh.on.ca 

You should NOT visit the Emergency department, your midwife clinic or your family doctor. If you are experiencing a medical emergency, you should dial 911 and page your midwife.

There is no specific treatment for coronavirus. You should self-isolate at home indoors and avoid contact with others for 14 days or until advised otherwise. Click here for what to do if you are sick.

Advise for people who are self-isolating – click here for further information.

Advise for people who are self-isolating and live in the same house – click here for further information.

You can find your results at the Government of Ontario COVID-19 Test Results page.

Currently in Canada, there are 3 ways of testing for COVID-19. 

1. Molecular PCR – MOST COMMON – PERFORMED AT LHSC HOSPITAL
   • uses swabs to collect samples from the nose or throat which are sent to a laboratory for testing
   • results are ready in 1-3 days
2. Point-of-care test
   • involves a rapid test done at the time and place of care, such as a hospital or doctor’s office
   • uses swabs to collect samples from the nose or throat which are then tested on-site
   • results are ready in 30-60 minutes
   • Since point-of-care technology can only test a limited number of samples in a single machine, it’s used in places where it’s needed most, including: rural, remote and isolated communities and specific high-risk settings where it’s important to have fast results without having to send samples to a laboratory.
3. Antibody testing (serology)
   • Health care providers may have access to blood tests, called serological tests, which are used to see who may have already had the virus. These detect the presence of antibodies produced by your immune system in response to an infection. A positive serological test means that someone has been exposed to the virus in the past, but cannot reliably indicate how long ago that exposure occurred. As a result, they are not used to diagnose a case of COVID-19 in early stages of infection, since they don’t detect the virus itself.
   • Serological tests can help us: estimate how many people have had COVID-19, determine which public health measures need to be in place, better understand how much the virus has been circulating in the community.

All tests must be performed by a health care professional. At-home sample collection test kits or home test kits have not been authorized for sale. 

Watch how health care professionals test for COVID-19.

Test accuracy can vary during the course of your illness. For example, depending on when a test is conducted, it could result in false negative results if there’s not enough virus in your body at the time of the test. False positive results are also possible. Health care professionals make their diagnosis decisions based on a number of factors, including test results.

• A positive test means that you have COVID-19 and must follow public health measures.
• A negative test can indicate that a person is not infected, but it doesn’t always mean you’re COVID-19-free. If you’re tested too soon after exposure, the virus may not be detected because the person is still incubating the virus and it is not detectable at the time of the test and will ultimately become infectious.
• Sometimes tests are inconclusive. In this case, your health care provider may re-test you.

If you are in labour or require a hospital assessment urgently for your pregnancy, and are self-isolating, your midwife will meet you in the car park of the hospital to provide a mask for you to wear and then admit you to our specialist isolation rooms for assessment. If you require an ambulance transfer, you should inform the dispatcher that you are self-isolating for coronavirus.

Your midwives will wear special masks, gowns and gloves to prevent the transmission of coronavirus. You and your birthing partner must keep masks on at all times as per hospital policy and to keep our staff safe. Visitors will not be allowed and therefore only one birthing partners will be able to be present with absolutely NO switching.

Currently the recommendation from the Royal College of Gynaecologists UK suggests continuous fetal monitoring is implemented to ensure your baby’s wellbeing due to the increased risk of fetal compromise, although this guidance may change as more evidence becomes available.

It is reassuring that in six Chinese cases tested, breastmilk was negative for COVID-19; however, given the small number of cases, this evidence should be interpreted with caution. Your midwife will discuss precautions to take while breastfeeding.

Information adapted from: Centers for Disease Control and Prevention website, Middlesex Public Health Unit, World Health Organization, and Royal College of Obstetricians and Gynaecologists in U.K. Last modified March 2020.

If you are in crisis or immediate danger please contact your midwife or dial 911.

If you are experiencing gender-based violence, you can access a crisis line or request a video appointment from your midwife where you can use the signal for help.

You may also access support workers, social workers, psychologists and other professionals for confidential chat sessions or phone calls by texting WELLNESS to:

• 686868 for youth
• 741741 for adults

The COVID-19 pandemic has resulted in many changes. You might feel like you’re no longer in control of things. It is normal to feel sad, stressed, confused, scared or worried. People react in different ways. Some common feelings include:

• a sense of being socially excluded or judged
• concern about your children’s education and well-being
• fear of getting sick with COVID-19 or of making others sick
• worry about losing your job, not being able to work or finances
• fear of being apart from loved ones due to isolation or physical distancing
• helplessness, boredom, loneliness and depression due to isolation or physical distancing

• Stay informed but take breaks from social media and the news.
• Practise physical distancing, but stay socially connected to friends and family through:
  • email
  • phone calls
  • video chats
  • social media
• Practise mindfulness by:
  • stretching
  • meditating
  • taking deep breaths
• Try to:
  • eat healthy meals
  • exercise regularly
  • get plenty of sleep
• Follow safe food handling and cooking practices to keep you and your family safe by killing the virus and lowering your risk of infection.
• Think about how to use any unexpected flexibility in your daily routine.
• Focus on the positive aspects of your life and things you can control.
• Be kind and compassionate to yourself and others.

What do we know about the safety of the COVID-19 vaccine in pregnancy?

Research trials did not include pregnant persons, which makes information limited. However, based on what we know about how these vaccines work, there is no theoretical reason to think they would be unsafe, or less safe in pregnancy. The COVID-19 vaccines do not contain live virus. Normally, we like to wait until more information is available, however we have to consider the very real risks of COVID-19 in pregnancy. (SOGC 2021)

Should anyone who is pregnant get vaccinated?

Anyone who is pregnant should discuss the vaccine with their prenatal care provider. Some will decide their risks of getting a serious COVID-19 infection are very low, and choose not to be vaccinated. Others will decide their very real risks support vaccination. This decision should be based on the client’s personal values and an understanding that the risks of COVID-19 outweigh the theorized and undescribed risk of being vaccinated during pregnancy or while breastfeeding. It’s important for pregnant clients to be up to date on all recommended vaccinations during pregnancy. Speak with your health care provider to make sure your vaccinations are up to date. (SOGC 2021)

Additional Resources –

SOGC COVID-19 Resources Handout

SOGC Statement on pregnant workers during the COVID-19 pandemic

SOGC Statement on COVID-19 vaccination in pregnancy

SOGC FAQ

SOGC Statement on pregnant people in the ICU’s with COVID-19

O’Mama: COVID-19 Pregnancy, birth and newborn

Provincial Council for Maternal and Child Health – I am pregnant or breastfeeding, should I get the COVID-19 vaccine – flowchart