General guidance for pregnant women, mothers, and their newborns during the pandemic

Protection against infection

The main route for transmission of pandemic (H1N1) 2009 influenza virus seems to

be similar to seasonal influenza; that is, via droplets that are expelled by speaking,
sneezing, or coughing. People can avoid infection by taking the following measures:

• avoid close contact with people who exhibit symptoms of influenza-like illness

(if possible, try to maintain a distance of at least 1 metre);

• avoid touching mouth and nose;

• wash hands thoroughly with soap and water or clean them with an alcohol based

hand sanitizer on a regular basis (especially if touching the mouth and
nose or surfaces that are potentially contaminated);

• if possible, reduce the time spent in crowded settings during epidemics in the

community; and

• improve airflow in living spaces by opening windows.

It is advisable to practise additional good health habits, including getting adequate
sleep, eating nutritious food, and staying physically active.

Special considerations for pregnant women and new mothers and their babies

• Pregnant women, new mothers, and newborn infants should avoid crowded

public places whenever possible.

• Pregnant women and new mothers should avoid providing care for those with

confirmed, probable, or suspected influenza infection, except for their own
newborns.

• Anyone with respiratory symptoms should not provide care for a pregnant

woman or a mother and newborn baby.

• Mothers should be encouraged to begin breastfeeding within one hour of

giving birth and to breastfeed frequently and exclusively including a period of

pandemic (H1N1) 2009 circulation. Infants who are not breastfed are more

vulnerable to infectious diseases, including severe respiratory tract infection.
 

• Inform parents and caretakers about how to protect infants from virus

infections that cause respiratory illnesses, including pandemic (H1N1) 2009, by:
 

o Washing hands frequently with soap and water and cleaning soiled

surfaces to keep the environment free from virus contamination,
especially since infants have a tendency to place their hands in their
mouths.
 

o Adhering to respiratory etiquette—that is, covering their mouth and nose,

when coughing or sneezing. If a tissue is used, it should be discarded in abin with a lid and then hands should be washed.10

o Keeping newborn infants close to their mothers. In general, this closeness

promotes infant survival from various threats.
 

Specific measures

 

• Antivirals for prophylaxis are generally not recommended. This includes

pregnant women and newborn infants exposed to pandemic (H1N1) 2009virus.11

• When pandemic (H1N1) 2009 vaccines become available in a country, pregnant

women should be immunized as a priority group given their increased risk ofcomplications and death.12,13

• From May 2010 the new seasonal influenza vaccines (e.g. those prepared for

the 2010 southern hemisphere influenza season) will include protection against

pandemic (H1N1) 2009 and can be given to pregnant women. Older seasonal
vaccines not containing a pandemic 2009 strain will not protect against the pandemic (H1N1) 2009 virus14.

• Pandemic (H1N1) 2009 and seasonal influenza vaccines are not recommended

for infants below 6 months of age.

Only inactivated influenza vaccine is suitable for pregnant women and children

less than 24 months of age. Live attenuated influenza vaccine should not be
used in this population.
 

• Vaccination is also recommended for all health care workers.13

Health care during and following pregnancy and childbirth in the pandemic
 

All pregnant women and their babies should be protected against influenza virus

infection.
Provide standard health care during and following pregnancy and childbirth as
recommended in national guidelines. In the context of pandemic (H1N1) 2009,
additional considerations include the following:
 

Antenatal care

 

• When pandemic (H1N1) influenza transmission is occurring in the community,

consider reducing antenatal clinic visits to the minimum required15 and advise
women with low-risk pregnancies to postpone clinic visits during early
pregnancy for a few weeks.
 

• Advise pregnant women to avoid crowded places, whenever possible, during

community outbreaks. This includes avoiding long waits in crowded clinic
waiting areas or using public transportation when coming for health services
and for any other travel.
 

• Organize care for asymptomatic pregnant women in separate areas from those

for ill women and apply triage criteria, i.e. check quickly for symptoms of
influenza, including fever and respiratory symptoms. If a woman has these
symptoms, she should be separated from those without symptoms.

Mechanisms should be in place (e.g. posters, signs) which would facilitate

women with symptoms to self-separate upon arrival at the health facility and
to not wait in an area with asymptomatic pregnant women.
 

• Provide adequate information on the prevention of influenza and steps to take

in case of symptoms that suggest influenza infection.
 

• Help pregnant women to develop their birth and emergency preparedness

plans and inform them about any relevant reorganization of health services in a
pandemic situation.
 

• When attending pregnant women, use all preventive measures to avoid

transmission of infection. Vaccination is recommended for all healthcare
workers.
 

Childbirth and postnatal care for the mother

 

• On admission, check for any symptoms and signs suggesting influenza infection.

• Apply infection control measures and ensure that during and following

childbirth, pregnant women and their newborn infants are not exposed to

symptomatic individuals with acute respiratory illness. Have separate areas for

labour and delivery for women with pandemic (H1N1) 2009 virus infection (see

section on "Infection control and prevention" below).

 

• Allow birth companions, but screen them for infection (i.e. take their history,

measure body temperature, and look for signs of influenza infection). If

infection is a possibility, arrange for an alternative, healthy birth companion.

Emphasize to the companion the importance of preventive measures during

the mother's and newborn's stay.

 

• Develop discharge criteria; reduce the length of stay in the postnatal ward to

the minimum required by maternal and newborn conditions, and inform

community services of any change.

 

• Provide women and their families with adequate information on prevention of

infection with pandemic (H1N1) 2009 virus and the steps to take if symptoms

suggestive of virus infection develop after discharge.

 

Newborn care and breastfeeding

 

• Do not separate the baby from the mother. Institute rooming-in.

• Ensure adherence to WHO recommendations on protecting, promoting, and

supporting breastfeeding,16 which includes initiating breastfeeding within the

first hour of life to establish exclusive breastfeeding.

 

• Minimize contact between health-care workers and the mother-baby dyad and

minimize the time spent in hospital by mother and baby as much as possible.

 

• Implement screening procedures and limit the number of visitors to

maternities and newborn care units.

 

Considerations for pregnant women in the workplace

• Pregnant women working in professions that involve interaction with large

numbers of people or groups or where they may come into contact with

infected persons should follow the same guidelines as all other persons and

should carefully follow recommended infection prevention and control

measures (see section on "Infection control and prevention" below).

 

• Pregnant women working in high-risk professions involving direct contact with

people with suspected, probable or confirmed influenza (e.g. nurses or doctors

caring for hospitalized patients) should be familiar with infection prevention

and control measures and advised to strictly adhere to Standard and Droplet

 

Transmission Precautions.17 It is recommended, where available, that pregnant

women working in health care should be vaccinated. Upon request, and if the

situation allows, reassignment may be considered to duties where they are less
likely to be in close contact with people who may have pandemic (H1N1) 2009
virus infection.
 

Pregnant women who have suspected or confirmed pandemic (H1N1)

2009 virus infection

In addition to appropriate care related to pregnancy, childbirth, and the postnatal

period, care for pregnant women or mothers with newborn infants who have
suspected or confirmed pandemic (H1N1) 2009 virus infection includes interventions
for infection prevention and control and clinical management of pandemic (H1N1)2009 virus infection.10,11,18

Infection prevention and control

• Services for pregnant women and new mothers and babies with acute

respiratory infection (ARI) should be separated from services for other
pregnant women and other hospitalized patients.

• A separate area for childbirth should be maintained for women with influenza.

• Rooms should be adequately ventilated.

• Newborn babies should be roomed-in with mothers even if the mother has

pandemic (H1N1) 2009 virus infection. The benefits for the baby of not
separating it from its mother in the early newborn period are well documented;
keeping the baby with the mother provides protective effects for child survival,
in general, and early initiation of breastfeeding allows passive transfer of
antibodies that protect the newborn infant from infections, including
respiratory infections. This is especially important in developing countries.
Currently, there is no evidence that the potential risk of newborn infection with
pandemic (H1N1) 2009 outweighs the risk that would result from separating
the baby from the mother and from not being breastfed.

• An ill mother should practise cough or sneeze etiquette, perform hand hygiene

regularly, and keep her room well-ventilated.

• Health-care workers should follow recommended infection prevention

practices, including those for cleaning surfaces, change linens, and handling
waste disposal.
 

• Health-care providers should wear face masks properly whenever they are in

contact with infected individuals.

 

• Additionally, personal protection equipment should be used during childbirth

since splashes are common.

 

• Patients with respiratory symptoms, including pregnant women or mothers

should be asked to:

o wear face masks when being transported within health-care facilities;

o cover their mouth and nose, when coughing or sneezing;

o practice hand hygiene, washing often with soap; and

o dispose of infected waste (e.g. soiled tissue) in a bin with a lid.