NOTE: Information and guidelines may change rapidly. Check in with listed references in ‘Learn More – Primary Sources’ to best keep up to date
Multiple societies and experts have weighed in on whether second stage of labor and delivery warrants respirators (e.g., N95 masks) vs surgical masks in the setting of a patient with confirmed or suspected COVID-19. The lack of clarity currently revolves around whether the second stage of labor should be considered an aerosol-generating event. ACOG, SMFM and multiple other ObGyn societies have sent a letter to the CDC requesting clarification (summarized under ‘Key Points’ below).
Based on limited data, forceful exhalation during the second stage of labor would not be expected to generate aerosols to the same extent as procedures more commonly considered to be aerosol generating (such as bronchoscopy, intubation, and open suctioning)
Forceful exhalation during the second stage of labor is not considered an aerosol-generating procedure for respirator prioritization during shortages over procedures more likely to generate higher concentrations of infectious respiratory aerosols
When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19
ACOG continues to review questions and data regarding the potential for aerosolization in the context of forceful exhalation during the second stage of labor
…consider N95 mask use for HCWs caring for patients with suspected or confirmed COVID-19 in the second stage of labor, including specifically HCWs with significant and prolonged exposure to such patients
As with all resource considerations and potential supply and demand imbalances, the ability to adhere to this suggestion will need to be evaluated on an institutional level. It is acknowledged that this suggestion is above and beyond current CDC recommendations
Universal use of hospital masks on Labor and Delivery, for staff, patients and visitors
Universal testing for Covid19 of all pregnant women and their chosen support person/s on Labor and Delivery, where available
Use of full PPE, including N95 masks and face shields, for the second stage of labor for all Covid positive women and persons under investigation or for all women, when universal testing is not available
Either an N95 respiratory mask and eye protection goggles or with an air-purifying respirator that provides eye protection
The protection is needed due to the likelihood of maternal virus aerosols and the potential need to perform newborn resuscitation that can generate aerosols
Healthcare personnel caring for women in the second stage of labor are in close contact for long periods of time to provide support for breathing and pushing
AWHONN recommends all healthcare personnel wear appropriate PPE during the second stage of labor, including use of N95 masks when caring for women who are known or suspected (PUI) COVID-19
Until universal testing is available, health care personnel should have the option to use N95 masks when caring for all women in the second stage of labor
…being interpreted as suggesting that obstetric care clinicians need not wear N95 masks and face shields when attending to patients with confirmed or suspected COVID-19 during the second stage of labor
We appreciate your clarification that the CDC recommends use of such PPE and look forward to working with you to amplify this message
Boelig et al. AJOG MFM, 2020
Palatnik and McIntosh. Am J Perinatol, 2020
CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
CDC: Clinical Questions about COVID-19: Questions and Answers
Society for Maternal-Fetal Medicine and Society for Obstetric and Anesthesia and Perinatology – Labor and Delivery COVID-19 Considerations
ACOG COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics
Labor and Delivery Guidance for COVID-19 (Boelig et al. AJOG MFM, 2020)
AAP issues guidance on infants born to mothers with suspected or confirmed COVID-19
AWHONN: COVID-19 Practice Guidance
Letter From Professional ObGyn Societies to the CDC
SOGH COVID-19 Position Statement
Protecting Labor and Delivery Personnel from COVID-19 during the Second Stage of Labor (Palatnik and McIntosh. Am J Perinatol, 2020)
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