Providing necessary care and social support is critical during the perinatal time period to ensure the health and well-being of parents and children. Due to concerns related to COVID-19, hospitals have limited the number of people who can be present during and following birth. There are also fewer opportunities for face-to-face meetings at follow-up pediatrics and obstetrics appointments following birth. These structural changes are resulting in reduced social support and may result in higher maternal and infant mortality due to under-identification of perinatal complications.

Prenatal

• The American College of Obstetricians and Gynecologists (ACOG) recommends modifying or reducing prenatal visits during the COVID-19 crisis.
  • Among the general population, reducing the number of in-person visits and leveraging telehealth may reduce stress and does not adversely affect the mother or child.[1]
  • However, mothers at risk for negative pregnancy outcomes (e.g., mothers who use substances, smoke, or have a sexually transmitted infection) are generally less likely to receive adequate prenatal care and may be even less likely to receive care during the COVID-19 pandemic. The early identification of pregnancy among these mothers is important to reduce adverse birth outcomes.[2]
  • Alternative strategies should be used to identify pregnancy during COVID-19, especially for mothers with a higher likelihood of high-risk pregnancy. For instance, providing opportunities for screening at syringe exchange programs.
• Pregnancy loss during COVID-19 may be particularly challenging for parents. When possible, partners should be allowed to be present during a miscarriage, similar to provisions for birthing, to reduce mothers’ psychological distress.[3] Telehealth referrals to mental health care providers should be provided to mothers closely following pregnancy loss.

Birth

• Having a support person present during birth, such as partners and doulas, is associated with improved infant outcomes and decreased likelihood of maternal depression.[4]
• The CDC recommends allowing one essential support person during birth when possible; however, some hospitals cannot allow any support persons due to the risk of transmitting COVID-19.[5] Medical professionals could benefit from receiving additional guidance on providing mothers social support during this time. Receiving postpartum care from a consistent care giver improves patient perceived support.[4]
• ACOG recommends expediating hospital discharge and using telehealth for follow-up appointments after birth.[6] Physicians may need additional training to successfully use telehealth modalities.

Early Postnatal

• Special attention should be focused on providing social and medical support to women in the postpartum period to prevent additional complications.
• African American women [7] may be experiencing disproportionately heighted challenges due to COVID-19 and need additional support to promote their postnatal health and well-being. COVID-19 is disproportionately affecting African Americans [8] and African American women are already at greater risk for maternal mortality.[9]
• Electronic screeners for mental health concerns and physical concerns could be leveraged prior to visits to ensure the appointment is thorough.[10]