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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 17-_
November 4, 2020


TO:
People who are pregnant and breastfeeding

SUBJECT:
Guidance for Pregnant and Breastfeeding People During the COVID-19 Pandemic


Summary

This document provides guidance for people who are pregnant and breastfeeding during the COVID-19 pandemic. The California Department of Public Health will update this guidance as new information becomes available.

  • Pregnancy: Based on what is known at this time, pregnant people might be at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Pregnant people with COVID-19 are more likely to be hospitalized. (For more information, visit the CDC website.) Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19. Therefore, during pregnancy, it is important to reduce your risk of exposure to COVID-19.
  • Breastfeeding:  The Centers for Disease Control and Prevention (CDC) and the Academy of Pediatrics state that mothers with COVID-19 can breastfeed. When breastfeeding, precautions should be taken to reduce the risk of passing COVID-19 to their infant.

Questions and Answers

How can I prevent getting COVID-19? 

It is important that pregnant people protect themselves against COVID-19 by taking these actions: (For more information, visit the CDC website.)

  • Stay at home as much as possible when a statewide shelter-in-place order is in effect.  This includes restricting visitors to your home. To decrease the number of times you leave home, consider having family members or friends shop for you when possible.
  • When you leave your house, wear a facial covering. Practice physical distancing by maintaining at least 6 feet (2 meters) from others. When you return home, wash your hands. 
  • Wash your hands regularly with soap and water for at least 20 seconds. Or, use an alcohol-based hand sanitizer with at least 60 percent alcohol. 
  • Try not to touch your eyes, nose or mouth throughout the day. 
  • Clean and disinfect objects and surfaces you touch regularly.  Use a household cleaning spray or wipe that is bleach or alcohol based. Use hot soapy water or a dishwasher to wash dishes and utensils.
  • Take care of your body to maintain good health. Remember to eat healthy, exercising daily, and get plenty of sleep.
  • Make time to relax with activities you enjoy at home. Take deep breaths, stretch, or meditate at home.
  • Connect with others by phone or over the internet. Talk with people you trust about your concerns and how you are feeling.

Is it safe to go to my prenatal and postpartum office visits?

Take care of yourself and your baby during pregnancy and after delivery.

  • Do not skip your prenatal or postpartum care appointments. Your provider will do all they can to provide for a safe office visit or perhaps an online telehealth visit.
  • Talk to your health care provider about any concerns you have related to COVID-19.
  • Ask your health care provider about doing prenatal visits virtually.  
  • Ask your provider about who can attend your prenatal and postpartum appointments.
  • Consult with your provider about who can attend the birth.

What should I do if I feel sick? 

  • Call your health care provider if you have any of the following symptoms: fever, cough, shortness of breath, chills, headache, muscle aches, sore throat or loss of sense of smell or taste, congestion or runny nose, diarrhea, nausea or vomiting.
  •  Also, call your health care provider if stress gets in the way of your daily activities for several days in a row.

I am pregnant and I do not feel safe continuing to work. What can I do? 

Talk about your concerns with your employer as well as options to work from home. If working from home is not an option, consider the following:

  • If you have sick leave, you may use your sick leave to stay at home. 

If you do not have sick leave, you may be covered under the Family Medical Leave Act (FMLA). FMLA is unpaid leave that allows you to keep your job if you miss work to care for yourself or a sick family member. For further information on FMLA and COVID-19 please visit US Department of Labor.  For further information on paid family leave in California, please visit Employee Development Department and Employee Development Department Pregnancy FAQs.

  • You may be protected under the California Pregnancy Disability Leave law, if: 
    • Your employer has more than five employees and;
    • You can show proof from your health care provider that due to the condition of pregnancy you are not able to work without putting your health or the health of your baby at risk.
    • Check with your health care provider to see if your health situation qualifies.

Pregnant people who work in health care 

Pregnant people who work in health care should follow the CDC risk assessment and infection control guidelines for health care personnel exposed to patients with suspected or confirmed COVID-19. Following recommended infection prevention and control practices is an important part of protecting all health care personnel in health care settings.

How does COVID-19 affect my baby? 

We do not know if the virus that causes COVID-19 can pass from the birthing parent to the fetus during pregnancy or at the time of delivery. However, the limited data available suggest it is not likely. (See CDC COVID-19 If you are Pregnant, Breastfeeding, or Caring for Young Children). Currently, there is not enough data on COVID-19 to provide guidance or information about the risk of miscarriage or birth defects. Data from another coronavirus epidemic, the Severe Acute Respiratory Syndrome (SARS-CoV), suggest no increased risk of fetal loss or birth defects associated with infection early in pregnancy. There may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.  

If you are diagnosed with COVID-19 and are preparing to give birth, talk to your health care provider. Follow their recommendations on how best to protect your newborn.

If I have COVID-19 when my baby is born, will my baby be allowed to room-in with me?

Early and close contact between the mother and infant has many well-established benefits. The ideal setting for care of a healthy, term newborn while in the hospital is in the mother's room. Mothers who room-in with their infants can more easily learn and respond to their feeding cues, which helps establish breastfeeding.  

Current evidence suggests the risk of an infant being infected with COVID-19 from their mother is low. Furthermore, data suggests that there is no difference in risk of COVID-19 infection to the infant whether an infant is cared for in a separate room or remains in the mother's room.

If you have suspected or confirmed COVID-19, you will need to take steps to minimize the risk of infecting the infant while rooming-in together. Steps include:

  • Wear a mask when feeding, holding or caring for your infant.
  • Wash your hands before touching your infant.
  • Place the infant at least 6 feet away when you are not caring for your infant.

    When the mother or the infant are severely ill, temporary separation may be considered. Temporary separation should be a shared decision between the mother, her family, and the health care provider. For more information, visit the CDC website.

If I am diagnosed with COVID-19, can I breastfeed my infant? 

Yes. Breastfeeding is encouraged unless the mother is too ill to breastfeed. Breastmilk protects your infant from numerous illnesses and provides all the nutrients your infant needs. At this time, there is no evidence that a mother passes COVID-19 to her infant through her breastmilk. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics say that breastfeeding parents with COVID-19 can successfully breastfeed.

The decision to start or continue breastfeeding should be a shared decision made between the breastfeeding parent, the family, and the health care provider. When parents have been either exposed to, have symptoms of, or have  COVID-19 decide to breastfeed, they should take precautions to avoid spreading the virus to their infant.  Precautions include washing hands before touching the infant and wearing a mask, if possible, while feeding at the breast. If a parent has been diagnosed with COVID-19 and chooses to temporarily express milk, they should wash their hands before expressing milk or touching any pump or bottle parts and wear a mask while pumping. They should follow recommendations for proper pump cleaning [English and Spanish] after each use. These recommendations should also be followed whether or not a parent has been diagnosed with COVID-19 and are important to protect the infant from all kinds of infections, not just COVID-19.  If possible, consider having someone who is not sick feed the expressed milk to the infant.

If I have COVID-19 and my baby is temporarily placed in the nursery, can my baby still have my breastmilk?

Yes, your breastmilk is the best food for your baby and will also help protect your baby from getting certain infections. If you are temporarily separated from your infant, frequent hand expression or pumping, ideally with a hospital-grade pump, is necessary to establish and build your milk supply. Pumping every 2-3 hours (including at night) signals the breasts to produce milk and prevents blocked milk ducts and breast infections. Mothers who are unable to establish milk production in the hospital, or who have to temporarily stop breastfeeding, can relactate with skilled assistance. Additional information on relactation is available. (See CDC guidance from 8/3/2020)

When I bring my newborn home, is it ok to have visitors over? 

During the COVID-19 pandemic, visitors should not be in your home. People can have COVID-19 and spread the disease even before they have any symptoms. Only those living in the household should be near or taking care of the newborn.

More information for California families:

COVID-19 Resources for Women & Families 

More information for California obstetrical providers:

COVID-19 Resources for Family & Reproductive Health Professionals

COVID-19 and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know


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