Recommendations for Postpartum Management
The authors believe that there is a need to reduce the risk of
transmission to the baby after delivery. Steps to reduce this risk of
transmission may include avoiding delayed cord clamping, skin-to-skin
contact and breastfeeding. In addition, in our protocol, the newborn
will be transferred to a separate room or to the ante-chamber for
neonatal management to reduce the risk of droplet transmission. However,
the evidence to support these measures is lacking and it is important to
discuss them with the mother.
Direct breastfeeding has been discouraged in preference to
formula-feeding. Wang et al reported an advisory panel from the
Department of Neonatology, National Clinical Research Center for Child
Health and Disorders and Ministry of Education Key Laboratory of Child
Development and Disorders in China, advising avoiding breastfeeding from
mothers with probable or laboratory-confirmed 2019-nCoV infection until
the recovery of confirmed mothers or rejection of probable
infection.(26) Although breastmilk tested in six cases of mothers with
COVID-19 were found to be negative for the virus (6), the close
proximity of breastfeeding exposes the infant to respiratory droplets
which risks transmission. In contrast, other organisations such as the
RCOG, ACOG, CDC are far less draconian and permit breastfeeding with
precautions such as good hand hygiene and wearing a facemask (10,14,15).
Another controversial area concerns the practice of separating mother
and baby to prevent the risk of neonatal transmission until the mother
is fully recovered or is found to be negative for the COVID-19 virus.
Again, evidence for this is limited. RCOG has cautioned against routine
separation of mother and baby given the detrimental effects on feeding
and bonding. (10) Efforts should be made to discuss these issues with
the mother and her perinatal management individualised to her wishes.
The strengths of our paper include the meticulous and detailed nature of
our protocols which encompasses the principles of detection,
containment, intrapartum care and training. In addition, these protocols
were developed after rigorous literature review and multidisciplinary
discussion. While our centre has not yet managed a patient with
suspected or diagnosed COVID-19, our multiple simulation runs have
identified deficiencies in the protocols which we have addressed in this
paper.