TCHMB Position Statement on Care for Pregnant Women and Infants During COVID-19

Pregnant women and their infants are critical populations for consideration during public health crises. Delivery is not an elective procedure and Labor and Delivery (L&D) units are essential clinical areas that require specific attention and focus during times of crises. Prenatal care and L&D providers have prolonged face-to-face exposure to pregnant women during the course of their care. Additionally, every laboring patient has a risk of requiring unplanned intubation for cesarean delivery or delivery complications, placing the health care team at risk for exposure to an aerosol generating procedure. Each pregnant woman is expected to have several in-person visits during her prenatal period and postpartum. While some of the visits may be performed by telehealth, there are many that require in-person visits in order to do ultrasound, fetal testing, blood pressure measurement, and pelvic examination. In-hospital portions of care for women and infants’ services occur in several locations such as emergency rooms, labor units, operating rooms, inpatient and neonatal units. Therefore, many of the activities in obstetrical and neonatal care require COVID-19 related resources, such as testing kits, personal protective equipment (PPE), disinfecting solution/wipes, and isolation rooms. There is also a significant need to allow patients to have an accompanying person to provide emotional and psychological support. 

It is essential that we protect the equipment and personnel required to care for the vulnerable population of women and infants of Texas. Global PPE shortages have resulted in resource limitations. There is concern that, as scheduled surgeries and procedures ramp-up inside hospitals, there will be greater competition for the limited available PPEs leading to potential diversion of the available PPEs away from obstetrical and neonatal services.

While many rural hospitals have historically utilized cross-trained personnel for postpartum/mother-baby units thoughtfully to balance the healthcare needs across their systems, specific efforts should be made to preserve an appropriately trained workforce available to care for women and infants during crises, including pandemics, and to minimize diverting staffing towards other areas. While obstetrical and neonatal staff can cross-cover other areas, the reverse is not always appropriate.

The Texas Collaborative for Healthy Mothers and Babies (TCHMB), the statewide perinatal quality collaborative, encourages hospitals to prioritize planning for pregnant women and infants during crises and to prioritize their care. For COVID-19, we recommend:

  1. Pregnant women admitted with suspected COVID-19 or who develop symptoms suggestive of COVID-19 during admission should be prioritized for testing. In addition, with hospital systems with access to universal testing capacity, we recommend prioritizing pregnant women particularly in high prevalence areas.

  2. Maximize access to PPE for labor nurses, obstetricians, midwives, anesthesiologists, and neonatal providers on women and infant units due to the prolonged personal exposure that occurs in these populations.

  3. Maximize and preserve the specialized women and infants’ workforce, and avoid deployment of L&D and NICU nurses and providers to other areas of the hospital if possible;

  4. Determine the resources needed for optimal obstetric and neonatal practice based on prior usage (e.g. testing kits, PPEs, disinfecting wipes and solutions) and ensure that these will be available in the future before committing these resources to other services that are more elective in nature; and

  5. Include plans specific for obstetric and pediatric populations in surge planning.