When a mother tests positive for COVID-19, a primary concern is whether the infection will pass to her baby before, during, or after birth. The current scientific consensus is reassuring: transmission of the SARS-CoV-2 virus from an infected mother to her newborn is generally uncommon, particularly the direct transfer to the fetus. While infection is possible, the risk is low, and most newborns who test positive experience mild or no symptoms. Understanding the routes of potential transmission and safety measures helps manage the risk effectively.
Transmission During Pregnancy and Birth
The transfer of the virus from the mother to the baby while the baby is still in the womb is known as vertical transmission, and it appears to be a rare event. The placenta acts as a protective barrier. Studies show that the virus’s primary entry receptor, Angiotensin-Converting Enzyme 2 (ACE2), is expressed at low levels in the placenta, limiting the virus’s ability to infect placental cells.
Even when the virus is detected in the placenta, it does not mean the fetus will become infected. The overall rate of vertical transmission is low, with most studies reporting rates under 5% of neonates born to infected mothers showing evidence of infection. The occurrence of in utero infection is likely tied to the mother experiencing severe illness. The mode of delivery, whether vaginal or Cesarean section, does not significantly affect this risk.
Risk of Infection After Delivery
The highest risk of infection for the newborn is not vertical transmission but horizontal transmission after birth. This postnatal spread occurs primarily through respiratory droplets from the mother or other infected caregivers during close contact, such as breathing, coughing, or sneezing.
The decision regarding whether the mother and baby should room-in together is a discussion between the parents and the healthcare team. While rooming-in facilitates bonding and breastfeeding, temporary separation can minimize the risk from the mother’s respiratory secretions. If rooming-in is chosen, the risk remains low if the mother consistently uses appropriate precautions.
If a healthy caregiver is available, they should provide most of the hands-on care to minimize the baby’s exposure. If the mother is the primary caregiver, she must strictly adhere to hygiene and masking protocols. Using a physical barrier, like an isolette, or keeping a distance of at least six feet when possible, also helps mitigate the risk of droplet spread.
Safety Protocols for Infected Mothers
Mothers who test positive for COVID-19 must implement specific, consistent hygiene and physical barrier protocols to protect their baby. The most important precaution is wearing a mask whenever the mother is within six feet of the newborn. The mask must cover both the nose and mouth completely to contain respiratory droplets.
Hand hygiene is essential. Hands must be washed thoroughly with soap and water for at least 20 seconds before touching the baby or any breast pump parts. If soap and water are unavailable, use an alcohol-based hand sanitizer containing at least 60% alcohol. These practices should be maintained until the mother meets the criteria for non-infectivity, including a specified period since symptoms started and resolution of fever.
A designated, healthy caregiver should handle the newborn as much as possible, especially if the mother’s symptoms are severe. If the mother is the primary caregiver, she should routinely clean and disinfect surfaces she touches. Masking, hand sanitation, and surface cleaning are the most effective steps to reduce postnatal infection.
Breastfeeding Considerations
Breastfeeding is generally encouraged even with confirmed or suspected COVID-19 infection, as the benefits of breast milk outweigh the potential risks. The SARS-CoV-2 virus is typically not found in breast milk, meaning the milk itself is not a source of infection.
Breast milk also contains antibodies against the virus, which may offer a protective effect for the infant. If the mother is well enough to breastfeed directly, she should wear a mask during feeding and practice hand hygiene before touching the baby. Skin-to-skin contact is still encouraged for stable newborns, provided the mother wears a mask.
If the mother is too unwell or prefers distance, she can express breast milk. Proper hygiene is necessary when pumping, including washing hands before touching the pump or bottle parts. All pump parts and feeding items must be cleaned and sanitized after each use before the expressed milk is fed to the baby by a healthy caregiver.