As an internal medicine and pediatric hospitalist in the home stretch of my third pregnancy, my daily focus is on squeezing into scrubs, following strict infection control procedures, and keeping up a good pace and extra hydration on rounds. But third trimester brings some broader concerns during this first coronavirus disease 2019 (COVID-19) season, and as I follow the medical literature, I find myself wondering what would happen if I were to be infected when I deliver my baby? How would I weigh the risk of transmitting the virus against the known costs of separation from my infant during the first days of life? And in a rapidly evolving clinical landscape, how should I as a physician counsel families asking similar questions?
Numbers from New York suggest that nearly 90% of women positive for COVID-10 who deliver in the hospital setting are asymptomatic at the time of presentation.1 Given this and the fact that masks are not tolerable for most women during the second stage of labor, many hospitals around the country are moving toward universal COVID-19 screening on labor and delivery units to protect health care workers and patients alike. For women who test positive for COVID-19, current American Academy of Pediatrics guidelines recommend physical separation from their infant when space allows, unless they choose rooming-in despite being counseled on risk.2 On the other hand, the World Health Organization’s recommendations for women positive for COVID-19 encourage breastfeeding initiation within an hour of birth and routine newborn care with added emphasis on respiratory and hand hygiene.3 As clinicians, we are tasked with understanding the data behind these guidelines and translating them into family-centered practice.