COVID in Pregnancy

Where things stand now

COVID-19 in pregnancy is no longer the emergency it was, but it has not been reduced to an ordinary cold either. The NHS keeps dedicated pregnancy guidance, and the RCOG maintains a separate guidance paper on coronavirus infection in pregnancy for clinicians, which it describes as "regularly updated to reflect new research".

The RCOG's own framing is worth quoting because it is more measured than most: "While pregnant women are no more likely to contract COVID-19 than anybody else, the early uncertainty around vaccination and maternity care access shook women's confidence. Many pregnant women still feel vulnerable, although the NHS advises that pregnant women have only been placed in the moderate risk (clinically vulnerable) group as a precaution."

The symptoms that mean call now

This is the most useful part of the NHS pregnancy guidance, and it is more specific than general COVID advice. Call your midwife or maternity team immediately if:

• "your baby is moving less than usual", "you cannot feel your baby moving", or "there is a change to your baby's usual pattern of movements"
• "you have any bleeding from your vagina"
• "you have a headache that does not go away"
• "you get shortness of breath when resting or lying down"
• "your temperature is raised" or "you have severe tiredness"
• "you cannot cope with your COVID-19 symptoms at home"
• "you're feeling very anxious or worried" or "you feel unsafe at any time"

The NHS adds an instruction that people routinely ignore: "Do not wait until the next day or your next appointment — call immediately, even if it's the middle of the night."

Reduced fetal movement appearing at the top of a COVID advice list is deliberate. Fever and illness can affect the baby, and movements are the signal you can monitor yourself.

When to call 999

The NHS lists these as requiring an ambulance: feeling very unwell or thinking there is something seriously wrong, severe chest pain, coughing up blood, feeling cold and sweaty with pale or blotchy skin, collapsing or fainting, a rash that looks like small bruises or bleeding under the skin and does not fade when a glass is rolled over it, feeling agitated, confused or very drowsy, having stopped passing urine or passing much less than usual, being so breathless that you cannot say short sentences at rest, or breathing that has suddenly got worse.

Breathlessness deserves particular attention in pregnancy, because breathlessness on exertion is normal in later pregnancy and can mask something serious. Breathlessness at rest or lying down is not normal at any stage.

If you have COVID-19 and go into labour

The NHS is clear about what changes: "If you have symptoms of COVID-19 and go into labour, you'll be advised to give birth in a unit led by a doctor (obstetrician). This is so the team can look after you and your baby more closely. You'll be cared for in an area within the maternity unit that's just for pregnant women and people with COVID-19."

Two things do not change. "After your baby is born, you should be able to have skin-to-skin contact unless your baby is unwell and needs care in the neonatal unit." And on feeding: "You'll also be encouraged to breastfeed. There's no evidence COVID-19 can pass on to your baby in breast milk, so the benefits of breastfeeding and the protection it offers outweigh any risks."

The maternity team is also expected to "respect your birth choices as closely as possible". A COVID diagnosis narrows where you give birth; it does not delete your birth plan.

Vaccination, and the change most people have missed

This is where advice has moved furthest, and getting it wrong in either direction is unhelpful.

The NHS vaccinations in pregnancy page currently lists three vaccines offered as part of routine antenatal care: the flu vaccine, the whooping cough vaccine and the RSV vaccine. COVID-19 vaccination is not among them.

COVID-19 vaccination is instead offered through the seasonal eligibility groups. The NHS COVID-19 vaccine page describes eligibility as people aged 75 or over, people aged 6 months to 74 years with a weakened immune system due to a health condition or treatment, and residents of care homes for older adults. On pregnancy, it states: "Most people who are eligible for the COVID-19 vaccine can have it, including if you're pregnant or breastfeeding."

So pregnancy is no longer by itself a reason to be offered the vaccine on the NHS, and pregnancy is also not a reason to be refused it if you are eligible on other grounds. Eligibility is reviewed each season by the Joint Committee on Vaccination and Immunisation, and the UKHSA Green Book chapter on COVID-19 is the source clinicians work from. If you are in a clinical risk group, ask specifically.

Flu and whooping cough have not changed

It is worth separating the two conversations, because the retreat of routine COVID vaccination in pregnancy has led some people to assume all pregnancy vaccination has been deprioritised. It has not. The flu vaccine, whooping cough vaccine and RSV vaccine remain part of routine NHS antenatal care, and the NHS explains that whooping cough and RSV vaccination in pregnancy pass protection to the baby before birth.

If you have had COVID-19 in pregnancy and recovered, mention it at your next antenatal appointment so it is recorded. Illness with fever in pregnancy is worth having in your notes, and any concern about the baby's growth or movements afterwards should be raised rather than left to the next scheduled scan.