COVID-19: If I test positive or have symptoms, will I be separated from my baby after birth?

Updated 6/22/2020

When you arrive at the hospital in labor, you will most likely be screened for COVID-19. If you test positive, or if you have symptoms that suggest you might be infected, then you and your clinical team will have to decide together:

Is it better overall for you and your newborn to room together, or is it better for you to be in separate rooms?

This decision is ultimately up to you. As the American College of Obstetricians and Gynecologists (“ACOG”) describes the decision-making process in their publication, “Coronavirus (COVID-19), Pregnancy, and Breastfeeding: A Message for Patients”:

Where will my baby stay after delivery if I have COVID-19?

You and your health care team should discuss the risks and benefits of the different rooming options at your hospital or birth center. Things to consider include the best way to reduce the risk of infection for the baby, your health, the baby’s health, if you would like to breastfeed, and what you think is right for you and your baby.

The organization Evidence Based Birth has put together a legal form that you can use if you want to assert a legal right to remain with your baby even though your clinical team is recommending separation. You can access the Evidence Based Birth “Sample Informed Consent Form for Refusal to Separate Birthing Parent and Infant” here.

To help you think about what you might do if you are faced with this decision, here is guidance from the Illinois Department of Public Health (“IDPH), from the Centers for Disease Control (“CDC”) and from the World Health Organization (“WHO”).

IDPH: “Children & Pregnant Women Guidance”

Guidance from the Illinois Department of Public Health unequivocally supports women who are positive for COVID-19 and who want to keep their babies with them, touch and hold them, and breastfeed:

Can women with COVID-19 breastfeed?

Yes. Women with COVID-19 can breastfeed if they wish to do so. They should:

  • Practice respiratory hygiene during feeding, wearing a mask where available;
  • Wash hands before and after touching the baby; and
  • Routinely clean and disinfect surfaces they have touched.

Can women touch and hold their newborn baby if they have COVID-19?

Yes. Close contact and early, exclusive breastfeeding help a baby to thrive. You should be supported to:

  • Breastfeed safely, with good respiratory hygiene;
  • Hold your newborn skin-to-skin, and
  • Share a room with your baby

You should wash your hands before and after touching your baby and keep all surfaces clean.

On May 20, the CDC updated its guidance on whether to separate a COVID positive mother and her newborn in a new publication called “Evaluation and Management Considerations for Neonates At Risk for COVID-19”. The CDC now more strongly recommends “temporary separation”. Temporary separation can include keeping the baby in the mother’s room at a physical distance of at least 6 feet, or having the baby in an isolette located in the mother’s room, in addition to having the baby and mother in separate rooms:

Although it is well recognized that the ideal setting for care of a healthy term newborn while in the hospital is within the mother’s room, temporary separation of the newborn from a mother with confirmed or suspected COVID-19 should be strongly considered to reduce the risk of transmission to the neonate. . . .

Temporary separation in the clinical setting can be achieved in many ways, including a separate room, maintaining a physical distance of ≥6 feet between the mother and neonate, and placing the neonate in a temperature-controlled isolette if the neonate remains in the mother’s room. For mothers whose test results are negative, separation precautions may be discontinued.

Although temporary separation of a neonate from a mother with confirmed or suspected COVID-19 should be strongly considered in healthcare settings, it may not always be feasible. For these situations, the risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team, and decisions about temporary separation should be made in accordance with the mother’s wishes. Considerations include:

  • Clinical conditions of the mother and neonate
    • Separation may be necessary for infants at higher risk for severe illness (e.g., preterm infants and infants with medical conditions)
  • Availability of testing, staffing, space, and PPE in the healthcare facility
  • Results of neonatal testing
    • If the neonate tests positive for SARS-CoV-2, separation is not necessary

The CDC guidance also addresses measures that can be taken to minimize the risk of transmission from mother to baby in the event that separation is not undertaken. These include:

  • Mother uses cloth face covering and practices hand hygiene during all contact with the neonate. Cloth face coverings should not be placed on neonates or any children younger than 2 years of age.
  • Engineering controls like physical barriers are used (e.g., placing the neonate in a temperature-controlled isolette), and the neonate is kept ≥6 feet away from the mother as much as possible.

Importantly, the CDC offers additional, specific guidance for COVID positive mothers who are considering breastfeeding. The “key points” from that guidance as summarized by the CDC are:

  • Breast milk is the best source of nutrition for most infants. We do not know whether mothers with COVID-19 can transmit the virus via breast milk, but the limited data available suggest this is not likely to be a source of transmission.
  • Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.
  • A mother with confirmed COVID-19 should be counseled to take all possible precautions to avoid spreading the virus to her infant, including hand hygiene and wearing a cloth face covering.

[emphasis added]

The WHO Guidance: Q&A on COVID-19, pregnancy, childbirth and breastfeeding

The WHO has not directly addressed the question of whether you should room in with your baby if you have or might have COVID-19. However, the WHO has strongly advocated in favor of mothers who wish to breastfeed or have skin-to-skin contact with their babies, even if positive for the virus. 

The World Health Organization’s Q & A on COVID-19, pregnancy, childbirth, and breastfeeding (dated March 18, 2020) states:

Can I touch and hold my newborn baby if I have COVID-19?

Yes. Close contact and early, exclusive breastfeeding helps a baby to thrive. You should be supported to

  • Breastfeed safely, with good respiratory hygiene
  • Hold your newborn skin-to-skin, and
  • Share a room with your baby

You should wash your hands before and after touching your baby, and keep all surfaces clean.

Summing it up

The IDPH and the WHO do not recommend separation. The CDC does recommend separation, but also supports your decision to breastfeed.

These varying recommendations among experts reflect that fact that we don’t know how likely the newborn is to be infected as a result of exposure to an infected mother; and we don’t know how sick the newborn is likely to get if infected.  That means that you are balancing known benefits against unknown risks. Making a decision under these circumstances is obviously very difficult, and different families will balance risks and benefits differently. That is why it is essential that you are fully included in the discussion of benefits and risks so that you can come to a decision that feels right to you, as recommended by ACOG.

Your clinical team should share with you the medical evidence about risks and benefits of rooming in with your baby if you are COVID-19 positive in light of all the specifics of your particular situation.  You should share with them your preferences and priorities as a family for the care of your baby. By pooling information, you and your clinical team can make the best decision about what is right in your case. The shared goal should be to reach a decision that feels right to you in light of all considerations, medical and personal.