State of California—Health and Human Services Agency
California Department of Public Health

AFL 17-_

July 19, 2021

TO:

People who are pregnant and breastfeeding

SUBJECT:

Guidance for Pregnant and Breastfeeding People During the COVID-19 Pandemic

Summary

This document provides guidance for people who are pregnant and breastfeeding during the COVID-19 pandemic. The California Department of Public Health will update this guidance as new information becomes available.

Pregnancy: Based on what we know at this time, the Centers for Disease Control and Prevention (CDC) state "pregnant people are at an increased risk for severe illness from COVID-19 and death, compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth (delivering the baby earlier than 37 weeks). It is especially important for pregnant people, and those who live with them, to protect themselves from getting COVID-19."
Breastfeeding: The Centers for Disease Control and Prevention (CDC) and the Academy of Pediatrics state that parents with COVID-19 can breastfeed. When breastfeeding, precautions should be taken to reduce the risk of passing COVID-19 to their baby.

For more information, visit Breastfeeding and Caring for Newborns.

Questions and Answers

How can I prevent getting COVID-19?

It is important that you protect yourself against COVID-19 by taking the actions below:

Get vaccinated. The Center for Disease Control and Prevention (CDC) states that pregnant and lactating individuals can receive a COVID-19 vaccine. Experts have not identified any safety concerns for pregnant or lactating people who were vaccinated or their breastfeeding babies. The COVID-19 vaccines do not contain the live virus, so they cannot cause COVID-19. Pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people. Getting a COVID-19 vaccine during pregnancy can protect you from severe illness if you get COVID-19. Talk to your healthcare provider if you have questions about getting a COVID-19 vaccine. For more information, refer to CDC Vaccines while Pregnant or Breastfeeding or CDPH Guidance for Vaccination during Pregnancy.
If you are not vaccinated, wear a face covering when you leave your house; practice physical distancing by maintaining at least 6 feet (2 meters) from others and avoid enclosed spaces; and when you return home, wash your hands.
Wash your hands regularly with soap and water for at least 20 seconds. Or, use an alcohol-based hand sanitizer with at least 60 percent alcohol.
Take care of your body to maintain good health. Remember to eat healthy, exercise daily and get plenty of sleep.
Make time to relax with activities you enjoy at home. Take deep breaths, stretch, or meditate.
Connect with others. Talk with people you trust about your concerns and how you are feeling.

Is it safe to go to my prenatal and postpartum office visits?

Take care of yourself and your baby during pregnancy and after delivery by taking the actions below:

Do not skip your prenatal or postpartum care appointments. Wear a mask during visits to health care facilities.
Talk to your health care provider about any concerns you have related to COVID-19.
Ask your provider about who can attend your prenatal and postpartum appointments.
Consult with your provider about who can attend the birth.
Discuss when to get the Covid-19 vaccine (see below).

What should I do if I feel sick?

Call your health care provider if you have any of the following symptoms: fever, cough, shortness of breath, chills, headache, muscle aches, sore throat or loss of sense of smell or taste, congestion or runny nose, diarrhea, nausea or vomiting.

I am pregnant and I do not feel safe continuing to work. What can I do?

Talk about your concerns with your employer

If you have sick leave, you may use your sick leave to stay at home.
If you do not have sick leave, you may be covered under the Family Medical Leave Act (FMLA). FMLA is unpaid leave that allows you to keep your job if you miss work to care for yourself or a sick family member. For more information on FMLA and COVID-19, visit U.S. Department of Labor. For more information on paid family leave in California, please visit Employee Development Department and Employee Development Department Pregnancy FAQs.
You may be protected under the California Pregnancy Disability Leave law, if:

Your employer has more than five employees, and
You can show proof from your health care provider that due to the condition of pregnancy you are not able to work without putting your health or the health of your baby at risk.

I'm pregnant and work in health care. What should I do?

You should follow the CDC Potential Exposure at Work and Infection Control Guidance for health care personnel exposed to patients with suspected or confirmed COVID-19. Following recommended infection prevention and control practices is an important part of protecting all health care personnel in health care settings. Additionally, vaccination against Covid-19 is extremely important if you work in health care.

How does COVID-19 affect my baby?

While much is still unknown about the risks of COVID-19 to newborns, we do know that COVID-19 is uncommon in newborns born to people who had COVID-19 during pregnancy.

Some newborns have tested positive for COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during or after birth. Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered. However, there are rare reports of newborns with severe COVID-19 illness. If you are diagnosed with COVID-19 and are preparing to give birth, talk to your health care provider. Follow their recommendations on how best to protect your newborn.

The good news is that getting vaccinated against COVID-19 during pregnancy appears to transfer some antibody protection to the developing baby so the newborn baby has some degree of protection at birth.

If I have COVID-19 when my baby is born, will my baby be allowed to room-in with me?

There are many benefits of having early and close contact between you and your baby. The ideal setting for care of a healthy, full term newborn while in the hospital is in your room. Parents who room-in with their babies can more easily learn and respond to their babies' feeding cues, which helps establish breastfeeding.

Current evidence suggests the risk of a baby being infected with COVID-19 from their parent is low. Furthermore, data suggests that there is no difference in risk of COVID-19 infection to the baby whether a baby is cared for in a separate room or remains in the parent's room.

If you have suspected or confirmed COVID-19, you will need to take steps to minimize the risk of infecting the baby while rooming-in together. Steps include:

Wearing a mask when feeding, holding, or caring for your baby.
Washing your hands before touching your baby.
Placing the baby at least 6 feet away when you are not caring for your baby.

When the parent or the baby is severely ill, temporary separation may be considered. Temporary separation should be a shared decision between parents, family, and the health care provider. For more information, visit the Care for Newborns.

If I am diagnosed with COVID-19, can I breastfeed my baby?

Yes. Breastfeeding is encouraged unless you are too ill to breastfeed or are on certain medications that could be dangerous to your baby. Breastmilk protects your baby from numerous illnesses and provides all the nutrients your baby needs.

Currently, there is no evidence that a breastfeeding parent passes COVID-19 to their baby through their breastmilk. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics say that breastfeeding individuals with COVID-19 can successfully breastfeed.

The decision to start or continue breastfeeding should be a shared decision made between the breastfeeding parent, the family, and the health care provider. When parents have been either exposed to or have symptoms of COVID-19, and decide to breastfeed, they should take precautions to avoid spreading the virus to their baby. Precautions include washing hands before touching the baby and wearing a mask, if possible, while feeding at the breast. If a parent has been diagnosed with COVID-19 and chooses to temporarily express milk, they should wash their hands before expressing milk or touching any pump or bottle parts and wear a mask while pumping. They should follow recommendations for proper pump cleaning (also available in Spanish) after each use. These recommendations should also be followed whether a parent has been diagnosed with COVID-19 and are important to protect the baby from all kinds of infections, not just COVID-19. If possible, consider having someone who is not sick feed the expressed milk to the baby. For more information, visit Breastfeeding & Caring for Newborns.

If I have COVID-19 and my baby is temporarily placed in the nursery, can my baby still have my breastmilk?

Yes, your breastmilk is the best food for your baby and will also help protect your baby from getting certain infections. If you are temporarily separated from your baby, frequent hand expression or pumping, ideally with a hospital-grade pump, is necessary to establish and build your milk supply. Pumping every 2-3 hours (including at night) signals the breasts to produce milk and prevents blocked milk ducts and breast infections. Breastfeeding individuals who are unable to establish milk production in the hospital, or who have to temporarily stop breastfeeding, can often resume lactation with skilled assistance from a Lactation Consultant. Additional information on relactation is available. For more information, visit Breastfeeding & Caring for Newborns.

When I bring my newborn home, is it ok to have visitors over?

People can have COVID-19 and spread the disease even before they have any symptoms. Only vaccinated individuals or those living in the household should be near or taking care of the newborn.

What precautions should I take while expressing breastmilk in the workplace?

You should wash your hands before touching any pump or bottle parts and follow CDC information on how to properly clean and sanitize breast pumps. If possible, a single-user pump should be used.

Breastfeeding individuals who work in settings with a higher risk of exposure to the virus, such as healthcare providers and first responders, should wear a mask while breastfeeding or expressing milk in the workplace if unvaccinated.

If a workplace has a multi-user lactation room, efforts should be made to physically distance (e.g., spacing lactation stations at least 6 feet apart, installing physical shields between lactation stations, staggering lactation schedules or encouraging telework). There is evidence that the virus may remain on surfaces for several hours to days. However, there is no evidence on whether cleansing the breast (e.g., using soap and water) prior to breastfeeding or milk expression reduces the risks of getting COVID-19. Additional information on ways to disinfect workplace lactation rooms can be found at disinfecting facilities. For more information, visit CDC Care for Breastfeeding People.

For more information, visit CDC Vaccines while Pregnant or Breastfeeding or CDPH Guidance for Vaccination during Pregnancy.