Table 1.

recommendations for restoring and maintaining essential maternity services during the COVID-19 pandemic

Component of service	Measures to ensure safe service delivery
Antenatal care	⦁ Stratify pregnancy risk:
	‣ More frequent visits for high-risk pregnancies.
	‣ Third trimester visits for low-risk pregnancies
	⦁ Offer extended doses of ferrous sulphate/folate of three-four months.
	⦁ ; Provide all relevant client care in a single visit to avoid unnecessary repeat visits
	⦁ Promote the use of telemedicine and digital platforms wherever possible. Advocacy for internet subsidies for maternity care is needed.
	⦁ Utilise the first contact fully for any missed opportunities including vaccinations and laboratory evaluations, and where possible, provide laboratory results over the phone.
	⦁ Restrict antenatal admissions to only those unavoidable, and limit the allowable number of visitors in the antenatal wards to only one appropriately screened individual.
Labour and delivery	⦁ Universal infection prevention and control measures throughout labour and delivery
	⦁ Allow only birth companion, preferably the partner, who should be appropriately screened for COVID-19.
	⦁ Caesarean sections must be performed for obstetric indications, regardless of the COVID-19 status of the patient.
	⦁ All patients requiring emergency surgery must be offered, with or without COVID-19 test results, observing universal IPC measures persistently, consistently and correctly.
	⦁ Minimise waiting times, operation and recovery times to the best possible, ensuring that the most skilled manpower is available.
	⦁ Work closely with paediatricians to urgently resuscitate babies, and shorten the time to transfer them to neonatal units.
	⦁ Whenever possible, utilise maternal waiting shelters, ensuring the most possible IPC standards are observed.
Postnatal care	⦁ Shorten the hospital duration as much as possible for patients who deliver both normally and vaginally.
	⦁ Educate patients on danger signs, and offer telephone numbers for teleconsultations.
	⦁ Where physical postnatal visits are unavoidable, offer the maximum possible care in one visit to avoid all avoidable repeat visits.