1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

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As the COVID-19 pandemic has progressed, more information has been published about the effects on childbearing women and their care during pregnancy and postpartum. In general, pregnant women with mild or moderate COVID-19 disease appear to have similar outcomes as the general population. The most common symptoms reported were fever, cough, and fatigue, consistent with nonpregnant patients with COVID-19 (Makvandi et al. 2021). In one study of 1,291 pregnant women with COVID-19 in the United States March 2020 to July 2020, approximately half were asymptomatic and ~40% had mild or moderate symptoms (Metz et al. 2021). Those with severe or critical symptoms were most at risk for adverse pregnancy outcomes including venous thromboembolism and death (Metz et al.). Women who developed more severe COVID-19 disease were older and had a higher body mass index and preexisting medical conditions such as hypertensive disorders of pregnancy, when compared to pregnant women with COVID-19 who did not become severely or critically ill. They were more likely to have indicated preterm births and cesareans (Metz et al.). Makvandi et al. reported one-third of pregnant women with COVID-19 had preterm labor. We will need more time and data to have a full picture of the clinical implications of COVID-19 on pregnancy.


Clinical practices have changed due to the pandemic. Many pregnant women experienced a virtual prenatal visit, lactation support visit, and postpartum check-in. Prenatal classes in many maternity services have been transitioned to a virtual format, at least until the pandemic is over. Limitations on support persons during labor and visitors during postpartum are common, as is an abbreviated inpatient length of stay. The usual time to establish breastfeeding in the hospital has been shortened. Nurses must consider the time and effort dressing in and applying personal protective gowns and equipment when they enter each patient's room. The second stage of labor looks quite different, with nurses, midwives, and physicians in protective gear including face masks, shields, goggles, and gowns. Masks preclude nurses and patients from seeing each other's faces during labor and birth, a useful indicator of how they are coping. The extra time spent by nurses in making sure patients are safe and protecting themselves during the pandemic has not been studied.


Nurse staffing is generally reported to be challenging during the pandemic based on media reports and online postings, although no studies have been published yet about the effects of COVID-19 on maternity nurse staffing. Listening to colleagues from around the country describe hospital and patient conditions when participating in various virtual committee meetings confirm social media accounts. Global reports validate the trauma nurses have experienced during the pandemic (International Council of Nurses, 2021). Nurses are exhausted, many are burned out, some have been infected with COVID-19, and some have died. Some are considering other fields or nursing roles in nonpatient contact positions. Posttraumatic stress is likely for some of the nurses who have seen death day after day in the intensive care units. We welcome your research manuscripts on these important issues.




International Council of Nurses. (2021). International Council of Nurses COVID-19 update: Mass trauma experienced by the global nursing workforce.[Context Link]


Makvandi S., Mahdavian M., Kazemi-Nia G., Vahedian-Azimi A., Guest P. C., Karimi L., Sahebkar A. (2021). The 2019 Novel Coronavirus Disease in pregnancy: A systematic review. In P. C. Guest (Ed.), Clinical, biological and molecular aspects of COVID-19 (pp. 299-307). Springer International Publishing. [Context Link]


Metz T. D., Clifton R. G., Hughes B. L., Sandoval G., Saade G. R., Grobman W. A., Manuck T. A., Miodovnik M., Sowles A., Clark K., Gyamfi-Bannerman C., Mendez-Figueroa H., Sehdev H. M., Rouse D. J., Tita A. T. N., Bailit J., Costantine M. M., Simhan H. N., Macones G. A.for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. (2021). Disease severity and perinatal outcomes of pregnant patients with Coronavirus disease 2019 (COVID-19). Obstetrics and Gynecology, Online ahead of print. [Context Link]