Andrea Dixon RN, CNM, instructor and creator of the BEST workshop, has studied midwifery since 1980. As a home birth midwife, she attended women in the largest geographical area of California while co-managing a busy birth center. More recently, she served as a full scope partner in a large, high risk, urban hospital practice coupled with home and birth center midwifery. In her birthing career she has attended over 1,000 births. She has a passion for education and offering workshops to a large scope of birth workers and practitioners. Currently, she offers neonatal resuscitation (NRP) training, Birth Emergency Skills Training (BEST). Live workshops are offered through Family Way Educational Services nationally and internationally and have inspired safer more prepared births.
"Blessed births are BEST prepared!"
Black Lives Matter: Put an End to State-Sponsored and Police Violence
A Statement from the American College of Nurse-Midwives
A Statement from the American College of Nurse-Midwives
Links to some timely podcasts and information for practice in the COVID 19 era
Regarding choice of birthplace
Late Transfer Agreement sample
Emerging Models of Midwifery
Breastfeeding and COVID19
What is new in this update? From the AAP June 4, 2021
The first AAP neonatal guidance was provided on April 2, 2020, shortly after the onset of the global pandemic, when it was apparent that SARS-CoV-2 was very contagious and infected individuals could suffer severe mortality and morbidity. Since that time, published evidence as well as data provided to the National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection has better informed the risks of perinatal disease, resulting in revisions to the guidance, most recently on February 11, 2021. In this current update posted on June 4, 2021, guidance on infection prevention measures for hospital personnel remains largely unchanged. Guidance on testing healthy newborns and on parent presence in the NICU has been updated. We have updated statistics from the Perinatal COVID-19 Registry, and include published evidence on neonatal SARS-CoV-2. We anticipate additional revision to this guidance as further evidence becomes available to inform newborn management.
What do we currently know about newborn risk for COVID-19?
The risk that a newborn tests positive for SARS-CoV-2 in the hours or days after birth to a mother with COVID-19 at the time of delivery is informed both by published case series and over 9,500 cases reported to date to the Perinatal COVID-19 Registry. Current Registry data suggest that approximately 2% of infants born to women who test positive for SARS-CoV-2 near the time of delivery have tested positive in the first 24-96 hours after birth. Case series from multiple centers in the US and abroad report infection rates ranging from 0-12% among infants born to women who test positive for COVID-19 at delivery.
Current evidence supports the highest risk of infection to newborns occurs when a mother has onset of COVID-19 near the time of delivery. A CDC surveillance report included 923 newborns born to women with COVID-19; among these newborns, 2.6% tested positive for SARS-CoV-2 after birth. However, among a subset of 328 infants born to women with documented onset of infection within 14 days before delivery, 4.3% of the infants tested positive for SARS-CoV-2. It should be noted that there is not a clear risk distinction between maternal symptomatic or asymptomatic infection; rather, that the timing of onset of maternal infection (and ability to transmit virus) can only be certain when accompanied by onset of symptoms.
Multiple national and international reports are now published describing outcomes of pregnant women who test positive for COVID-19 at the time of delivery. Newborn death directly attributable to perinatal infection with SARS-CoV-2 is extremely rare in the U.S. However, accumulating evidence suggests that maternal infection (primarily, but not exclusively, symptomatic infection at the time of delivery) is associated with increased risks of preterm birth and perinatal morbidity. In addition, clinicians and families should be aware that there are published reports of infants requiring hospitalization before one month of age due to severe COVID-19 infection.
What precautions should I take to attend a delivery from a mother with COVID-19?
Don a gown and gloves and use either an N95 respirator and eye protection (goggles or face shield) or an air-purifying respirator that provides eye protection. This equipment protects against both maternal virus aerosols and potential newborn virus aerosols that resuscitation procedures (bag-mask ventilation, intubation, suctioning, oxygen at a flow >2 liters per minute [LPM], continuous positive airway pressure and/or mechanical ventilation) can generate.
Should we continue delayed-cord clamping and skin-to skin care practices?
Delayed cord clamping practices and skin-to-skin care in the delivery room should continue per usual center practice. Mothers with COVID-19 should use a mask while holding their baby.
Can mother and well newborns room-in?
Yes. The evidence to date suggests that the risk of the newborn acquiring infection during the birth hospitalization is low when precautions are consistently taken to protect newborns from maternal infectious respiratory secretions. Mothers and well newborns should be cared for using usual center practice, including rooming-in (couplet care). A mother who is acutely ill with COVID-19 may not be able to care for her infant in a safe way. In this situation, it may be appropriate to temporarily separate mother and newborn or to have the newborn cared for by non-infected caregivers in mother’s room.
Currently we recommend the following for care of mothers with confirmed or suspected COVID-19 and their well newborns:
- Mothers and newborns may room-in according to usual center practice.
- During the birth hospitalization, the mother should maintain a reasonable distance from her infant when possible. When a mother provides hands-on care to her newborn, she should wear a mask and perform hand-hygiene.
- Healthcare workers should use gowns, gloves, N95 respirators and eye protection (or air-purifying respirators) when providing care for well infants, when this care is provided in the same room as a mother with COVID-19. When supplies are adequate, healthcare workers may use N95 respirators at all times when caring for well infants at risk for SARS-CoV-2 infection; standard procedural masks may be used if necessary.
- If non-infected partners or other family members are present during the birth hospitalization, they should use masks and hand hygiene when providing hands-on care to the infant.
Yes. The AAP strongly supports breastfeeding as the best choice for infant feeding. Several published studies have detected SARS-CoV-2 nucleic acid in breast milk. Currently, however, viable infectious virus has not been detected in breast milk. One study demonstrated that pasteurization methods (such as those used to prepare donor milk) inactivate SARS-CoV-2. Several recent studies have found antibody in human milk to specific SARS-CoV-2 antigens. Both IgA and IgG antibodies have been detected in breast milk after both maternal infection and maternal vaccination against SARS-CoV-2. Given these findings, direct breastfeeding is encouraged at this time.
- Infected mothers should perform hand hygiene before breastfeeding and wear a mask during breastfeeding.
- If an infected mother chooses not to nurse her newborn, she may express breast milk after appropriate hand hygiene, and this may be fed to the infant by other uninfected caregivers.
- Mothers of NICU infants may express breast milk for their infants during any time that their infection status prohibits their presence in the NICU. Centers should make arrangements to receive this milk from mothers until they are able to enter the NICU.