Pandemic Maternity Care: How Can Birth Services Stay

Why should pandemic plans protect maternity services?

WHO's May 2024 announcement on pandemic-agreement negotiations emphasized stronger preparation for future outbreaks. Applying that objective to maternity services raises an immediate operational question: can someone still reach skilled care when labor begins or a complication develops? This is a practical implication of preparedness, rather than a maternity-specific finding from the negotiations. [WHO's May 2024 announcement](https://www.who.int/news/item/10-05-2024-governments-agree-to-continue-their-steady-progress-on-proposed-pandemic-agreement-ahead-of-the-world-health-assembly)

WHO reports that estimated global maternal deaths increased from approximately 282,000 in 2020 to 322,000 in 2021. It identifies both COVID-19 illness during pregnancy and disruption of maternity services as possible contributors. These estimates do not establish how many deaths resulted from each pathway, and the increase subsequently reversed. Nevertheless, they demonstrate why outbreak planning must consider the wider health system: preventing infection and preserving access to obstetric care are interconnected responsibilities. [WHO maternal mortality fact sheet](https://www.who.int/news-room/fact-sheets/detail/maternal-mortality/)

Which pregnancy and birth services need to remain available?

WHO recommends a minimum of eight antenatal contacts, creating repeated opportunities to identify problems and arrange treatment. Its guidance also recommends an ultrasound before 24 weeks to help establish gestational age and identify multiple pregnancies and some fetal abnormalities. These recommendations describe an ongoing relationship with maternity services, rather than appointments that can simply be removed when hospitals become busy. The appropriate schedule may require additional assessments when complications or other health needs arise. [WHO antenatal care recommendations](https://www.who.int/news-room/detail/07-11-2016-pregnant-women-must-be-able-to-access-the-right-care-at-the-right-time-says-who)

WHO's operational guidance for COVID-19 calls for maintaining essential pregnancy and postnatal care, skilled attendance at birth, and referral for complications. Supporting services matter too: laboratory testing, blood banks and safe transport help turn an assessment into effective treatment. A practical implication is that maternity continuity plans should identify alternative referral destinations and transport arrangements before disruption occurs. An open clinic cannot provide complete care if a patient needing urgent treatment has no functioning route to the appropriate facility. [WHO guidance on maintaining essential health services](https://iris.who.int/bitstream/handle/10665/332240/WHO-2019-nCoV-essential_health_services-2020.2-eng.pdf)

Why must pandemic maternity care continue after birth?

WHO's postnatal recommendations call for facility-based care for mothers and babies for at least 24 hours after birth, followed by at least three additional contacts during the first six weeks. Recommended follow-up points are 48–72 hours, seven–14 days and week six. Individual health needs can require longer observation or more frequent review. Follow-up includes recovery support, infant feeding assistance and assessment for maternal depression and anxiety, with access to treatment when needed. An outbreak does not remove these needs. [WHO postnatal care recommendations](https://www.who.int/news/item/30-03-2022-who-urges-quality-care-for-women-and-newborns-in-critical-first-weeks-after-childbirth)

Families also need clear instructions about symptoms that require immediate assessment. CDC identifies persistent or severe headache, vision changes, breathing difficulty, chest pain, heavy bleeding after pregnancy and reduced fetal movement during pregnancy among urgent maternal warning signs. Some serious pregnancy-related problems can occur during the year after delivery, so six weeks should not be treated as the end of all risk. During an outbreak, services should make urgent contact routes clear and tell patients where to seek care if their usual facility is unavailable. [CDC urgent maternal warning signs](https://www.cdc.gov/hearher/maternal-warning-signs/index.html)