• Women with severe illness should be isolated from their newborns.
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There is currently no evidence of pregnant women transmitting Covid-19 to their babies while in the womb or after delivery during breastfeeding.
Speaking to the Star on the phone, Dr Mukaindo Mwaniki, Consultant Obstetrician and Gynecologist, Aga Khan University Hospital Nairobi, said further testing has not shown the presence of the virus in amniotic fluid or the placenta.
Women with Covid-19 are encouraged to breastfeed if they wish to do so provided they are observing hygiene measures. The doctor, however, added it is an area of active on-going research.
"Pregnant women who test positive for Covid-19 should notify and discuss with their maternity care provider about the level of care they need as well as delivery arrangements.
To determine the level of care needed the obstetrician will asses their illness severity and recommend either inpatient care or remain under self-isolation at home," the doctor adds.
Pregnant women who are either very sick or have other risk factors such as hypertension, diabetes, asthma, HIV, chronic heart disease, chronic liver disease, chronic lung disease, chronic kidney disease will be required to report to the hospital.
If the mother tests positive for coronavirus, the doctor adds delivery route will depend on the presence of any pregnancy complication and severity of Covid-19 illness.
"Women with severe Covid-19 illness require a Cesarean delivery. Plans for delivery should proceed as usual in women without severe illness. In these women Covid-19 infection alone is not a reason to perform a Cesarean delivery,” he said.
He advised expectant women to deliver in a facility with capacity for isolation, adequate baby monitoring in labour and after delivery as well as practiced routines and protocols for managing Covid-19 positive women during delivery.
"After delivery, Covid-19 positive women with mild symptoms may opt to be isolated or stay with their newborns but take full hygiene precautions such as handwashing, wearing masks and keeping a physical distance when handling the baby is not required," he said.
Women with severe illness will be isolated from their newborns. They can assign a person of their choice to care for the newborns during the period of illness.
The gynecologist, however, adds that some professions may put expectant women at risk of exposure to the virus. These include health care workers and other public-facing roles such as manning front offices and customer care desks.
"Women in the first and second trimesters, that is less than 28 weeks pregnant, with no underlying conditions can continue to work in public-facing roles provided they take necessary precautions and the work environment is modified to minimize their exposure," he said.
However, women who are in their third trimester, that is more than 28 weeks pregnant, or have an underlying health condition such as heart or lung disease should work from home where possible and avoid people who have symptoms of Covid-19.
"They should also significantly reduce unnecessary social contact and discuss with their obstetrician measures their facility are taking to prevent exposure of expectant women during antenatal clinic visits and delivery," he said.
Women who feel uncomfortable going to a hospital for antenatal care should be offered alternative options to continue their care.
"At Aga Khan, we are offering teleconsultation services through telephone calls, zoom and other electronic platforms. This allows our doctors to interact with the client from a distance.
This option is especially suitable for routine visits to discuss results or offer advice. We are also offering mobile pharmacy and laboratory services from the comfort of your home," he said.
When it comes to nurturing their babies, women without coronavirus are encouraged to remain in close contact with their newborns and breastfeed them exclusively for the first six months while maintaining universal hygiene measures.
A woman with Covid-19 may be too unwell to breastfeed their baby due to Covid-19 or other complications. They should be supported to safely provide the baby with breast milk in a way possible, available, and acceptable to them.
"This could include expressing milk and donor human milk. Formula feeding should be reserved only as a last resort when it is impossible to get breast milk.
"Relactation, the process of resuming breastfeeding after a period of little or no breastfeeding, should be started as soon as they are able to breastfeed again," the doctor said.