Info Centre - Swine flu - your questions answered

This document provides pregnant women, their partners, and parents of babies and young children with information about how pandemic swine flu (the H1N1 virus) might affect their pregnancy, the health of their baby, or their own health; it also looks at how maternity and other services might be affected in the event of a pandemic swine flu outbreak.

There is now good information about swine flu specifically for pregnant women and those with small children. The latest information regarding the H1N1 virus is available at www.direct.gov.uk/swineflu.

The information in this fact sheet is drawn from a number of sources, including the Government’s Pandemic influenza: Guidance on preparing maternity services in England. This document is a general one developed to cover any pandemic flu outbreak. Where it is not relevant to this outbreak more specific information is being developed.

General information on pandemic swine flu

What is swine flu?
How infectious is swine flu?
How do I minimise my risk of catching flu
How do I minimise the risk of passing on infection to others
How can I be sure if I have swine flu?

About the Vaccine

Are the swine flu vaccines safe for pregnant women?
Have the vaccines been tested on pregnant women?
Can pregnant women be offered the vaccine at any stage of pregnancy?
There are two vaccines – which one will I be given?
Who can’t have the swine flu vaccine?
Is the swine flu vaccine the same as the seasonal flu vaccination?
Can the swine flu vaccine be given at the same time as other vaccines?
What is thiomersal?
Can the swine flu vaccine cause flu?
What is an adjuvanted vaccine and what is the Department of Health’s recommendation in the use of such vaccines by pregnant women?
Can the swine flu vaccine cause flu?
Are there any other side effects?
I’ve already had swine flu. Do I still need the vaccine?
Who can I talk to if I’m concerned

Pregnancy and birth and pandemic swine flu

What if I’m trying to conceive?
Am I more susceptible to pandemic swine flu if I’m pregnant?
What are the risks to my unborn baby if I catch pandemic swine flu?
What are the risks to me if I catch swine flu when I am pregnant?
Should I be vaccinated?
If I become ill how can I care for myself?
What medication can I take if I am pregnant and suffering from pandemic swine flu?
Can I take antiviral drugs if I am pregnant?
Can I use antibiotics when pregnant to treat complications arising from pandemic swine flu?
What is the normal course of flu in a pregnant woman?
If I am pregnant and become seriously ill with swine flu how will I be cared for?
Will having pandemic swine flu when I am in labour affect the birth of my baby?
Will having pandemic swine flu when I am in labour infect my baby?
What will happen if I am booked for a caesarean section and I become ill with swine flu?

Antenatal care during a swine flu pandemic

Will my antenatal appointments be affected by swine flu?
Will my antenatal classes be affected by swine flu?

Care during labour & birth and pandemic swine flu

Will my plans about place of birth be affected by swine flu?
Will it affect who I can have with me at the birth?
Will I be able to use a birth pool?
Will my discharge from hospital be affected by pandemic/swine flu?
Will it affect the visitors I can have

Babies and pandemic swine flu

Are newborn and young babies more susceptible to swine flu
Are newborn and young babies likely to be more seriously affected by swine flu
How do I minimise the risk of infection to my baby?
Should my baby be vaccinated?
What should I do if my baby becomes ill?
How do I care for my baby if she has swine flu?
Are there added risks for my baby if she is born prematurely during a pandemic swine flu outbreak?

New mothers and swine flu

If I am a new mother with swine flu how do I minimise the chance of my baby catching it?
If others in my close circle have swine flu how do I minimise the chance of my baby catching it?
If I am a new mother suffering from pandemic swine flu, how will I and my baby be cared for?

Breastfeeding and pandemic swine flu

Does breastfeeding protect babies from this new flu virus?
Is it ok to breastfeed my baby if I am sick?
If my baby is sick, is it ok to breastfeed?
I hadn’t planned to breastfeed are there any reasons to reconsider this because of pandemic flu?
I’m considering stopping breastfeeding – how might an outbreak affect my decision?
I’ve recently stopped breastfeeding – but would it be it a good idea to restart in the event of an outbreak?
What medication can I take if I am breastfeeding and suffering from pandemic swine flu?
Can I breastfeed if I am being vaccinated?

Formula feeding and pandemic swine flu

How do I minimise the risk of my formula fed baby catching swine flu?
Is any one formula better than another in a swine flu pandemic?

Swine flu and older babies or young children

Are older babies and young children more susceptible to swine flu
Are older babies and young children likely to be more seriously affected by swine flu
How do I minimise the risk of infection to my older baby or young children?
Should my child be vaccinated?
What should I do if my older baby or young children become ill?
How to care for an older baby or young children with swine flu?

How will a pandemic swine flu outbreak affect services for parents and babies?

What will happen if my child is in daycare or with child minders?
How will services from my local GP or health visitor be affected?

Where can I get further information?

General information on pandemic swine flu

The current outbreak of H1N1 influenza first identified earlier this year in Mexico and North America is caused by a new strain of flu virus.

The virus, which is commonly called swine flu, is now spreading from person to person across several continents, and is therefore classified as a 'pandemic flu outbreak'. A pandemic occurs when a new influenza virus, to which people have no immunity, emerges and starts spreading as easily as normal influenza.

This fact sheet provides information to address the concerns of pregnant women, their partners and parents with babies and small children. For general information about pandemic swine flu, please see: http://www.nhs.uk/ or ring the Swine Flu Information line on 0800 1 513 513.

What is swine flu?

Swine flu is caused by a new virus called H1N1. This virus affects the upper respiratory tract and causes the symptoms of influenza (flu). Swine flu seems to be less risky to humans than was expected by those planning for an expected influenza pandemic.

How infectious is swine flu?

Swine flu does not seem to be very infectious, compared to other diseases. On average every infected person seems to be infecting 1.3 others. This is much fewer than chicken pox where one infected person on average infects 11 others or measles where one infected person infects 14 others.

How do I minimise my risk of catching flu?

Swine flu is spread from person to person in tiny droplets breathed, coughed or sneezed out by those who are already infected. If you stand several feel away from an infected person you reduce your risk of infection. Infected droplets fall onto the hands of those infected or onto hard surfaces and the virus can remain active in these for many hours. When you touch surfaces touched by many others or where droplets have fallen, you may pick up active virus on your hands which can be transferred to your mouth or other mucous membranes allowing the virus to infect you.

If you wash your hands regularly with soap and water and especially after being out in public you will reduce your risk. Washing your hands on returning to your home helps prevent the virus transferring at home to others in your family.

Vaccination is an effective way of preventing infection with swine flu. Those in groups defined as vulnerable are being offered the vaccine first this includes pregnant women.

Women in the second and third trimester of pregnancy will be offered the vaccine. Those in the first trimester may be offered it also.

How do I minimise the risk of passing on infection to others?

If you are infected you will be releasing infectious virus into the air when you breathe but particularly when you cough or sneeze. Using a tissue when you cough or sneeze reduces the spread of the virus into the atmosphere. The virus can remain infectious on a tissue for several hours so dispose of it in a bin.

The virus can remain infectious on hands and infects others when they touch you and then their mouth or eyes, or when they touch something you have recently touched and then their mouth or eyes. If you dispose of the tissue in a bin and wash your hands you will reduce the risk of spreading the virus on to hard surfaces where others may pick it up on their hands.

If you have a fever, staying at home will minimise your chance of passing it on to other people.

Even if you are not infected washing your hands regularly and on arriving or leaving your workplace or home helps to reduce the spread of infection to yourself and others.

How can I be sure if I have swine flu?

If you have swine flu you will have a fever. Your body temperature will rise to over 38oC or 100.4oF. To know your temperature exactly you will need a thermometer. Most people also have a cough which starts quite suddenly. This is because the virus affects the upper part of your lungs and breathing apparatus.

You may also have a headache, feel very tired, have chills, or experience aching muscles or pains in your limbs or joints. Some people have a runny nose and may sneeze a lot; you may get diarrhea or an upset stomach and not feel like eating.

To check your symptoms you can look at the swine flu symptom checker.

Babies and young children will have the high fever and some or all of the symptoms listed above but they may also appear drowsy, unresponsive and floppy.

About the Vaccine

Vaccines have been developed to protect against the virus that causes swine flu. There are two different brands of vaccine: Pandemrix and Celvapan. Most people given the Pandemrix vaccine will only need one dose. People who have the Celvapan vaccine will need two doses, at least three weeks apart.

Are these vaccines safe for pregnant women?

Both vaccines have been licensed for use by pregnant women. Licensed vaccines, including influenza vaccines, are held to a very high standard of safety and, according to Professor Salisbury, Director of Immunisation at the Department of Health, the vaccines would not be licensed if they were considered unsafe. In licensing the current swine flu vaccines for use in pregnancy, Professor Salisbury said (in a statement to GPs and practice nurses at the beginning of November 2009), that the European regulators gave careful consideration to the severe burden of illness caused by swine flu in pregnant women. They also considered the safety record of seasonal influenza vaccines and the nature of the adjuvants that were incorporated in the pandemic vaccines. There is an extensive safety record from seasonal influenza vaccination in all trimesters of pregnancy, since such vaccination has been recommended for several years in many countries. In the UK, vaccination against seasonal influenza is also recommended for pregnant women who are in the clinical at-risk groups, regardless of the stage of pregnancy.

No safety concerns have been raised after vaccination of millions of pregnant women with seasonal flu vaccines. There is no indication from reproductive toxicity studies that inclusion of adjuvants is associated with any risks in pregnancy. Similar vaccines containing another flu virus strain (H5N1) have been clinically tested in trials involving over 5,000 people. Women who are known to have become pregnant shortly after receiving Pandemrix have gone on to have normal pregnancies.

Have the vaccines been tested on pregnant women?

Women who are already pregnant are generally not enrolled into clinical trials. The safety of giving a particular vaccine to pregnant women is assessed from what is already known about the ingredients in the vaccine and the results of testing in reproductive toxicity studies. However, non-pregnant women who are enrolled into vaccine clinical trials sometimes become pregnant shortly after vaccination or are given vaccine before they know they are pregnant. These women are followed up and the outcome of the pregnancy is documented. The information gained adds to the assessment of any possible risks. Of the women who became pregnant during the clinical trials with H5N1 vaccine using the same adjuvant, there is no evidence of any specific risks to the mother or foetus due to the vaccine.

Clinical trials of the pandemic influenza vaccines provided good results in women of child-bearing age and based on experience from other influenza vaccines, it is assumed that the antibody response is similar in pregnant women and non-pregnant women. Reproductive toxicity studies, and experience from other types of vaccines, both non-adjuvanted and adjuvanted, do not raise concerns with respect to their use during pregnancy.

Can pregnant women be offered the vaccine at any stage of pregnancy?

Yes, according to the Department of Health, the vaccines are licensed for use at any stage of pregnancy.

There are two vaccines – which one will I be given?

The Department of Health advises the use of Pandemrix for pregnant women, as only one dose is required. This means that you will be protected more quickly from the risk of flu than if you receive Celvapan, which requires two doses, at least three weeks apart.

Who can’t have the swine flu vaccine?

There are very few people who cannot have the swine flu vaccine but the vaccines should not be given to anyone who has had a severe allergic reaction to a previous dose of the vaccine or to any component of the vaccine. If you are worried that this may apply to you, talk to your GP or midwife.

In addition, the Pandemrix vaccine is prepared in hens’ eggs in the same way that seasonal flu vaccines are. It should not be given to people who have had a confirmed anaphylactic reaction (experiencing shock or difficulty breathing) after being exposed to egg products. The Celvapan vaccine is not prepared using eggs, so you should have this vaccine if you have a severe allergy to eggs.

Is the swine flu vaccine the same as the seasonal flu vaccination?

No. The swine flu vaccine is different from the seasonal flu vaccination that’s offered every year. The seasonal flu vaccine does not protect against swine flu. If you are usually advised by your GP to have the seasonal flu vaccination, you should have it as usual.

Can the swine flu vaccine be given at the same time as other vaccines?

Yes, the swine flu vaccine can be given at the same time as other vaccines, including the seasonal flu vaccine. But if two vaccinations are being administered on the same day, they should be given in different arms. There are two vaccines – which one will I be given? The Department of Health advises the use of Pandemrix for pregnant women, as only one dose is required. This means that you will be protected more quickly from the risk of flu than if you receive Celvapan, which requires two doses, at least three weeks apart.

What is thiomersal?

Pandemrix contains thiomersal, which is a preservative that contains a very small amount of mercury. There is no evidence of risk from thiomersal-containing vaccines for pregnant women and their babies.

Can the swine flu vaccine cause flu?

No. The flu vaccine cannot give you flu as it does not contain a live virus. Some people may experience mild flu-like symptoms (like fever, headache and muscle aches) for up to 48 hours after immunisation as their immune system responds to the vaccine, but this is not flu.

What is an adjuvanted vaccine and what is the Department of Health’s recommendation in the use of such vaccines by pregnant women?

An adjuvant is added to vaccines so that a lower dose of the vaccine is needed to produce the same level of protection. The adjuvant enhances the immune response seen following vaccination. The adjuvant used in Pandemrix includes squalene, which is extracted from fish oil and occurs naturally in plants, animals and humans. There is also a small amount of vitamin E (which we all have in our food and in our bodies) and polysorbate 80 (which is found in food and other medicines).

According to Professor Salisbury, the European Medicines Agency has licensed Pandemrix, which contains an adjuvant, for use in pregnancy. This followed a thorough evaluation of the safety of the vaccine, and its adjuvant, as well as the severe disease caused by swine flu in pregnant women. In early June, WHO reviewed the safety of adjuvants and no significant safety concerns were identified. The Joint Committee on Vaccination and Immunisation (JCVI) has advised that pregnant women receive the adjuvanted vaccine Pandemrix as this vaccine appears to give adequate levels of antibodies after a single dose thereby conferring protection more rapidly than would be afforded by Celvapan.

The vaccine is not live and cannot cause swine flu.

Are there any other side effects?
All vaccinations can produce side effects such as redness, soreness and swelling at the site of the injection. The vast majority of these side effects are not serious. If you think that you or someone you know has experienced a more serious side effect to Pandemrix or Celvapan, please speak to your GP or midwife or report it to the Medicines and Healthcare products Regulatory Agency at www.mhra.gov.uk/swineflu.

I’ve already had swine flu. Do I still need the vaccine?
Most people cannot be certain they have had swine flu unless it was confirmed by laboratory tests. There are several viruses which can cause flu-like symptoms and so, to be sure that we reduce the risk of infection, we are offering vaccination to all people in the priority groups. It is safe to be vaccinated even if you have already had swine flu and taken antivirals.

Who can I talk to if I’m concerned?
Contact your GP, practice nurse or midwife if you have any concerns.

Advice taken from the DoH leaflet "Swine Flu and Pregnancy" http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_108153

Pregnancy and birth and pandemic swine flu

What if I’m trying to conceive?

Advice from the Department of Health guidance says:

"We advise everybody to plan their pregnancy carefully - we are not advising women not to conceive. Mums-to-be are more vulnerable to any type of flu. It is particularly important that anyone who has existing health problems and is thinking about starting a family should talk to their GP first, as they normally would."

Am I more susceptible to pandemic swine flu if I’m pregnant?

During pregnancy, a woman’s immune system is slightly suppressed to help them cope with carrying a baby who doesn’t have an immune response. Although there is not much evidence-based information about this, it is generally thought that because of this fact, pregnant women may be more susceptible to infections than other women of reproductive age because of changes in their immune system. However, this does not appear to be the case with swine flu.

What is becoming clear is that the changes in a woman’s immune system to help her successfully carry her baby - and other adaptations her body makes - seem to make women more likely to develop complications from swine flu.

In later pregnancy, as the baby takes up more space, a woman’s lungs cannot expand as well. This seems to make respiratory complications more likely. Although only about 1% of those who have swine flu are admitted to hospital, pregnant women have a four-times higher risk of being admitted to hospital for complications than women who are not pregnant.

If a pregnant woman also has other risk factors, such as pre-existing lung or heart disease or diabetes, or if she is obese, she is more at risk that an otherwise healthy pregnant woman.

See: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/QA.aspx#Specialrisks

What are the risks to my unborn baby if I catch pandemic swine flu?

The swine flu virus so far seems to cause a mild form of flu for most people and the risk to your unborn baby appears to be low. The risk depends on the strength of the flu virus and the stage of your pregnancy.

In the first three months of pregnancy, there is a small theoretical possibility that the flu virus might damage developing tissues or organs, possibly leading to the death of the baby in the womb or birth defects, although the risk is believed to be very low.

There may be a risk – though a very small one – that uncontrolled high fever in early pregnancy may increase the risk of miscarriage or congenital anomalies in the baby. High fever can sometimes cause a baby to be born early. Please see information below about caring for yourself.

It is also possible that an increased heart rate can be caused in your unborn baby if you have a high fever. If you have a fever when you are in labour, doctors may suggest delivering your baby more quickly.

Infection near the end of pregnancy does not seem to be transmitted to the baby.

What are the risks to me if I catch swine flu when I am pregnant?

If you contract pandemic swine flu, it is likely that you will experience the usual symptoms of flu (e.g. cough, sore throat, fever). However, there is a chance that the illness might progress more rapidly than usual and be more severe. According to the ‘Pandemic Influenza, Weekly Situation Report’, issued by Sir Liam Donaldson, Chief Medical Officer (CMO) on 15 October 2009, seasonal influenza in pregnancy increases the risk of hospitalisation between four and seven-fold. In pandemics and in seasonal flu, complications and deaths can increase progressively through pregnancy.

Forexample, your illness might be complicated by secondary viral pneumonia or a bacterial infection. If you experience a sudden and rapid worsening in your ability to breathe you will need urgent medical help. If you are pregnant and have an underlying illness such as asthma or you are diabetic or overweight, there is an increased risk of complications if you catch swine flu.

Should I be vaccinated?

According to the UK’s CMP, Sir Liam Donaldson, immune responses to seasonal flu vaccines are the same in pregnant and non-pregnant women as well as the adverse reactions. Maternal vaccination reduced influenza in both mothers and their infants. “We routinely recommend vaccines (inactivated) for pregnant women when indicated – polio, tetanus, influenza. [The vaccine] produces extremely good immune responses in healthy adults after one dose, which is important for rapid protection in pregnancy,” he said in a statement on 15 October 2009.

Now that the flu vaccine has become available those who are pregnant will be offered vaccination as soon as possible. The vaccination is an effective way of preventing infection with swine flu and has a similar low level of mild adverse effects as the seasonal flu vaccination. The vaccine will be offered to you, and the Department of Health’s advice is to accept it. In addition, The World Health Organization (WHO) issued the following statement on 15 October 2009: ‘The WHO supports the use of vaccines as recommended by functional regulatory authorities’. As with all treatments, the final decision is yours

If I become ill how can I care for myself?

If you are pregnant you are at a slightly greater risk of complications. If you are pregnant and have an underlying illness, especially if you are diabetic or overweight, at the risk is slightly greater again. Call your family doctor to say you think you have the virus. You are likely to be offered anti-viral treatment. Starting anti-viral treatment within 48 hours of the start of symptoms seems to shorten the length of the illness.

To help you feel better, most people find going to bed and resting makes a difference. Keeping your temperature down helps your baby and paracetamol can be used for this. Drinking water helps keep you hydrated and this is important because you will be losing water by sweating. If you are pregnant, you are using more energy than usual to enable your baby to develop. As a result, eating little and often will help to keep you and your baby supplied with energy and nutrients. If you can’t eat for a few days, your body will give your baby priority and your stores will be used to support the baby.

Depending on how you feel, you may find using a hot water bottle or wheat heat-pack helps with flu symptoms. Some people find drinking boiled water, cooled to drinking temperature, helps settle their stomach. Lemon juice in warm water with a teaspoon of honey is also comforting.

If you experience a sudden and rapid worsening in your ability to breathe you will need urgent medical help.

What medication can I take if I am pregnant and suffering from pandemic swine flu?

Paracetamol is thought to be safe for women during pregnancy and can be used to control fever. Follow-up studies have found a greater risk of asthma in children whose mothers took paracetamol frequently during pregnancy, but a high temperature can damage an unborn baby.

Over-the-counter flu treatments may contain decongestants and/or sedatives in addition to paracetamol and are not recommended for pregnant women.

Non-steroidal anti-inflammatory drugs should not be taken for the treatment of flu symptoms, because they may interfere with the baby’s pulmonary blood flow. Contact your pharmacist or doctor for further information.

Can I take antiviral drugs if I am pregnant?

Yes, if these are obtained on prescription, following the advice of a doctor. Both anti-virals are suitable for use in pregnancy. The inhaled product is likely to be given to pregnant women because less of it reaches the baby. However, either drug can be used and if a pregnant woman has pre-existing lung problems or has difficulty taking an inhaler or develops severe respiratory problems, then the tablet form of anti-viral will be given because it can reach the site of infection without needing good lung function.

It may be possible to obtain these drugs after phone diagnosis. Contact the pandemic flu service: http://www.direct.gov.uk/en/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_178842.htm.Detailed

Information about the drugs is on the DH website at: http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Treatment.aspx.

Talk to your pharmacist, GP, pediatrician, midwife or nurse practitioner if you need information about the correct dose of drugs.

There is up to date information on this possibility at http://www.nhs.uk/Conditions/Pandemic-flu/Pages/QA.aspx#Whatshould.

Can I use antibiotics when pregnant to treat complications arising from pandemic swine flu?

Antibiotics are not effective against flu (as flu is a virus and they are effective only on bacteria) but most can be taken by pregnant women to treat the bacterial infections arising as complications from pandemic swine flu. Your pharmacist or doctor will be able to tell you which antibiotics are appropriate and safe if you need a prescription for these.

Viral pneumonia seems to be a secondary infection following flu for some people and antibiotics are not effective for this.

What is the normal course of flu in a pregnant woman?

Most pregnant women who have had swine flu seem to be ill for a few days. Three quarters are fully recovered within 10 days.

If I am pregnant and become seriously ill with swine flu how will I be cared for?

Pregnant women with pandemic swine flu will mostly be cared for at home, with support from community midwifery and other services.

Pregnant women requiring hospital treatment for flu or its complications may be cared for in acute medical facilities with input from maternity specialists.

The risk of complications is higher for pregnant women who are substantially overweight, as they are more vulnerable to respiratory problems. Those with pre-existing lung or heart problems or diabetes are also more at risk. Any woman in this group, who believes she has flu, and experiences breathing difficulties, should contact a doctor without delay.

Will having pandemic swine flu when I am in labour affect the birth of my baby?

Giving birth when you are unwell can be a stressful experience. However, the maternity service should support you to have a straightforward birth because in most cases it is both the safest way for a baby to be born and safer for the mother even if you have flu. There are lots of things you can do to make a straightforward birth more likely.

If you have pandemic swine flu during your labour, then there is a risk that your fever will raise your baby’s heart rate. A high heart rate can be a sign of oxygen deprivation. Under some circumstances, this might mean doctors suggest delivering your baby more quickly. They may suggest a caesarean section. Before making a decision, it may be helpful to have a sample of your baby’s blood taken from her scalp so a proper assessment of whether the baby is distressed or short of oxygen can be made.

Having a caesarean section while suffering from swine flu is likely to make your recovery from the operation more difficult. It will be harder to care for and breastfeed your baby. The blood test will help you and the doctors decide if, under the circumstances, a caesarean section is necessary.

Sometimes a doctor may suggest inducing your labour early if you are close to going into labour and have a fever. Induction itself carries the risk of further interventions. (Find out more about induction.) You might decide to be induced or wait until you go into labour naturally. If you wait, this may give you a chance to recover from the flu before your baby is born.

If a woman is seriously ill with swine flu, under some circumstances, earlier delivery of her baby may be needed to create more space for her lungs and help her clear the infection.

Will having pandemic swine flu when I am in labour infect my baby?

If you have pandemic swine flu when you give birth, your baby will be at risk of becoming infected with flu and may also be at risk of bacterial infection or later meningitis.

You and your baby may be kept in isolation if you are in hospital for the birth and postnatal period.

Maternity services should arrange close follow-up and/or rapid access to neonatal care in the event of your baby developing a fever when you are at home.

What will happen if I am booked for a caesarean section and I become ill with swine flu?

If you have a planned caesarean section booked and have flu symptoms at the time, it is very likely your caesarean section will be delayed by a few days for you to recover before you have surgery, in order to minimise risk to you. Recovering from a caesarean section is often painful and difficult and it will help your recovery and your ability to look after and breastfeed your baby if you do not have the operation until after you have recovered from the flu. The closer you plan your planned caesarean section to the estimated date of birth, the safer it will be for your baby. Breathing difficulties are less common in babies if they are born closer to full term. If you go into labour while suffering flu symptoms then please contact the hospital maternity unit where you are due to give birth.

Antenatal care during a swine flu pandemic

Will my antenatal appointments be affected by swine flu?

At this stage it is very difficult to estimate, although it seems highly likely that there will be some impact on aspects of maternity care if large numbers of staff are infected and off work.

Maternity services may well suffer from staff shortages and may need to take action to reduce the chance of women infecting each other and midwives or health visitors.

For example, services may target women who require urgent or emergency help; check-ups of healthy women may need to be done over the phone rather than face-to-face. Some screening tests may need to be delayed or combined, or intervals may need to be increased between some tests. This is more likely if you are expecting a second or subsequent baby and have had a normal pregnancy with a healthy baby before. These mothers may be able to participate in some aspects of self-monitoring, such as taking their blood pressure and possibly urine testing, using test kits provided by a midwife, or through a clinic or maternity support group such as the NCT.

In addition, some non-urgent outpatient services and elective procedures in fertility and gynecology services may have to be postponed where this does not impact on the health of the pregnant woman or her baby.

The Department of Health in England has issued guidance for maternity services, which is being also given out by the Scottish Government and the Welsh Assembly: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091737

Will my antenatal classes be affected?

It is possible that if there are staff shortages within the NHS that antenatal classes may be affected.

The NCT will continue to run antenatal and postnatal classes and has issued guidance to its workers about how we intend to cope. (See bottom of page for this guidance).

Care during labour & birth and pandemic swine flu

Will my plans about place of birth be affected by swine flu?

If there are staff shortages as a result of the flu pandemic, then this may mean that midwives will have to care for more women in labour than is usual practice. Where there are shortages women may be encouraged to come into hospital for their births so that they can share midwife time.

In all areas, the hospital will encourage you to let them know if you think you are in labour but will ask you to stay at home if you are healthy with a normal pregnancy until your contractions are coming at around five or so minutes apart and you find it hard to talk during a contraction. Managing the early part of your labour at home is usually more comfortable for you and minimises your contact with other people.

In some areas, birth at home may be encouraged to reduce the number of women in contact with each other and therefore reduce the risk of spreading infection.

For a healthy woman having a straightforward (low-risk) pregnancy, research shows that home birth is as safe as hospital birth. For more information about home birth, see http://www.nct.org.uk/info-centre/information/view-45.

Birth at home will minimise the number of people you come into contact with which could help reduce your own risk of infection.

If others in your household are infected the health service may ask you to go to hospital or may take the view that you are better cared for in your own home rather than risk you taking the infection into hospital.

Will it affect who I can have with me at the birth?

When efforts are being made to reduce the spread of flu it is likely you will be asked to have only one partner or supporter present during the birth of your baby. This person will probably be required to be free of flu symptoms and to comply with all infection control protocols.

Will I be able to use a birth pool?

To prevent cross infection, birth pools need to be cleaned or a new liner put in between births. For the same reason, birth rooms also need to be cleaned and linen changed between births.

There is no health reason to avoid a birth pool during a flu epidemic, however, the Department of Health’s original pandemic guidance states that ’birthing pools should not be used during a pandemic owing to the time and staff needed to clean and refill them. This is being reviewed. Standard infection control procedures and following local policies can be used to clean birthing balls and birthing mats.’

In practice, however, the availability of water births will probably depend on how much of a strain staff shortage is putting on the system. If you give birth at home, it may be easier for you to choose a land or water birth, whichever you prefer.

Will my discharge from hospital be affected by pandemic/swine flu?

Possibly, since early discharge from hospital of both uninfected and infected mothers may help minimise contact between them.

The health service will want to minimise the number of women in contact with each other; they may be short of staff so you may be asked to go home as soon as you feel able.

At home you may have fewer visits from the midwife than is normal. Regular telephone contact between new mothers and midwives may be used to supplement a reduced face-to-face visit schedule. Your first visit from a health visitor, normally between 10 and 14 days post birth, may be delayed. Your six-week postnatal review may be deferred if you report that you are experiencing no postnatal problems.

You might find it helpful to have contact details of other new mothers and helpline numbers such as the NCT’s. You can call if you have a query about the care of yourself or your new baby.

NCT Enquiries line: 0300 330 0770.

Will it affect the visitors I can have?

Visitors to maternity wards before and during birth may be restricted to one person who does not have symptoms of flu. Personal birth companions or doulas may be asked to show that they understand and are able to carry out their responsibilities in terms of hygiene and infection control. Your health service should still be able to provide you with an interpreter if you need one.

Mothers concerned about infection could consider reducing their risk of exposure to pandemic swine flu by limiting visitors to new babies for the first two months of life. Excluding visitors if they are symptomatic for pandemic swine flu or have recently recovered from it, or have been in contact with flu recently, will reduce the likelihood of infection.

Babies and pandemic swine flu

Are newborn and young babies more susceptible to swine flu?

Newborns, babies and children do not have a fully developed immune system. However all babies do benefit from some immunity to common infections passed on from the time when they were in the mother’s uterus. Your baby will have some protection as a result of infections that you have been exposed to while you were pregnant or before.

Babies who are breastfed are partially or fully protected from some infections by antibodies and many other components in breastmilk. If the mother and baby stay together then the mother is likely to be exposed to the same infections as her baby. Her mature immune system is more able to produce an immune response to fight off the infection. For many diseases she is also able to support her babies’ immune system by passing on elements of this immune response to her baby.

With a new infection, like swine flu, that you have not been exposed to, your baby will be born with no immunity. Swine flu seems so far to be a mild disease which is not very infectious.

Are newborn and young babies likely to be more seriously affected by swine flu?

There are as yet not enough data to know how much more likely babies are to catch swine flu if they are exposed to it. Premature babies are likely to be more at risk from swine flu but, because they are less likely to be exposed to infected people, are less likely to be infected. There are as yet not enough data to know if healthy full-term babies will be more severely affected than other children or adults.

How to minimise the risk of infection to your baby

To minimise transfer of infection wash your hands regularly and wash your baby’s hands. Also ask others to wash their hands before handling your baby. Encourage your other children and family members to wash their hands on returning home and after sneezing or blowing their nose.

If you are breastfeeding, keep your baby with you as much as possible. Any infection she is then exposed to you will also be exposed to and your body will, in developing a reaction to the infection, pass some protection to your baby.

If you are using formula milk to feed your baby, and you or others you have been in close contact with develop flu you might consider asking someone else to take day to day care of your baby. However, because people are infectious before they get symptoms of flu, you might want to take the view that it would be more distressing for you and the baby to be separated when it is quite likely she has already been infected.

Should my baby be vaccinated?

When the new vaccine becomes available the Government will identify which groups will be offered the vaccine first. It is not yet clear if all babies or only some that are at high risk will be offered the vaccine.

What should I do if my baby becomes ill?

If your baby develops symptoms that may be swine flu, call your family doctor to let them know. Depending on the age of your baby, the doctor may suggest antiviral treatment.

How do I care for my baby if she is ill with swine flu?

Babies will need you to be with them most of the time when they are ill. Some parents find having the baby in a sling helps keep them calm and comforted. At night the safest place for your baby to sleep is in the same room as you. If you are breastfeeding - or can return to breastfeeding - this will help your baby get the nutrition and fluid needed and provide support for the immune system. Breastfed babies may want to feed more often. Babies on formula may refuse the formula and may need more water than usual. Babies can have paracetamol to help bring their temperature down but it is important to follow the dosage instructions very carefully. Your pharmacist is the expert in dosage and use of medicines.

Babies with a high temperature can be helped to cool down by removing a layer of their clothing. You can also sponge their forehead gently with a sponge or flannel that has been dipped in lukewarm water. The evaporation of the water will help cool the child’s skin.

It is very worrying looking after a sick baby and you may find it helpful to talk to other parents who have experienced looking after a baby with a fever. If you become more concerned about your baby then call your GP or NHS Direct.

Are there added risks to my baby if she is born prematurely during a pandemic swine flu outbreak?

The respiratory system of premature babies is not as robust as that of full-term babies. As well as the normal risks faced by premature babies, they are more likely than full-term babies to suffer complications if they catch pandemic swine flu. In addition, for approximately the first two months of life, babies cannot benefit from Tamiflu (oseltamivir) treatment.

Babies in incubators are protected from droplet transmission and are also unlikely to transmit respiratory infections provided that carers use good hand hygiene measures.

Providing your baby with your own breastmilk is the one way you can provide her with support for her immune system that is tailored to the infections she is exposed to. Breastmilk contains antibodies and many other factors to fight infections but it is not yet clear what effect it has on the flu virus.

New mothers and swine flu

If I am a new mother with swine flu how do I minimise the chance of my baby catching swine flu?

As babies are usually in close contact with their mothers, it is likely that if you catch flu your baby will also be infected before you have symptoms. It is most likely that the baby will be infected from the virus in droplets emitted as you breathe, cough or sneeze.

Although the risk of transmission of the pandemic swine flu virus through breastmilk is unknown, transmission of other flu viruses through breastmilk is extremely rare.

Although an infected mother is likely to pass flu to her baby there are advantages to them remaining together wherever possible. Skin-to-skin cuddles help mothers to develop antibodies to germs that the baby is exposed to, improves health, bonding, breastfeeding and long-term mental health of the baby. However if the mother is feels too unwell to do this she may need others to step in.

If a mother has flu and her baby is formula-fed, but has no sign of infection, she might want to consider asking someone else to care for her baby. This separation may reduce the risk of infection passing to the baby.

If others in my close circle have swine flu how do I minimise the chance of my baby catching it?

You can reduce the risks by washing your hands and your baby’s. The same applies to others in contact with the baby and the baby’s toys. If those infected can stay several feet away from the baby and be diligent about tissue use and hand washing for themselves you will reduce the risk. The fewer different people your baby is in close contact with the smaller the risk that they will catch swine flu.

If I am a new mother suffering from pandemic swine flu, how will I and my baby be cared for?

Mothers with pandemic swine flu will mostly be cared for at home, with support from community midwifery and other services.

Mothers requiring hospital treatment for flu or its complications may be cared for in acute medical facilities with input from maternity specialists. Some hospitals may have the facilities for you to have your baby with you. If a mother is ill, continuing breastfeeding and increased feeding frequency will help her baby. If she becomes too ill to feed then expressing milk may still be possible. It the baby becomes too ill to breastfeed then expressed milk could be used.

Babies who become ill with pandemic swine flu may be considered and assessed for neonatal high dependency care. Breastfed babies will benefit if you can continue to breastfeed or provide expressed milk during your illness.

Breastfeeding and pandemic swine flu

Does breastfeeding protect babies from this new flu virus?

Breastfeeding and breastmilk protect babies in many different ways that affect health. So far, it is not clear how much breastfeeding helps with this new virus. However, it is clear that mothers pass on protective antibodies and other factors to their baby during breastfeeding. Antibodies are made by the immune system in the body to help fight infections to which the mother and baby are exposed. For more information, see: http://www.dh.gov.uk/en/Healthcare/Children/Maternity/Maternalandinfantnutrition/DH_099965

Flu can be very serious in young babies. Babies who are not breastfed get sick from infections including diarrhoea and chest infections more often and more severely than babies who are breastfed

Is it ok to breastfeed my baby if I am sick?

Yes, it’s important to keep breastfeeding if you can when you are ill. Frequent breastfeeding helps to protect your baby. Government recommendations are that 'if a mother is ill, she should continue breastfeeding and increase feeding frequency'. They state that, 'where possible, additional formula should not be used so that the infant receives as much of the maternal antibodies as possible.' If you are too ill to breastfeed but can use a breast pump, expressed breastmilk could be fed to your baby.

If my baby is sick, is it ok to breastfeed?

One of the best things you can do for your sick baby is keep breastfeeding (babies who are sick often go off food, but are more likely to keep on breastfeeding). Babies who are sick need more fluids than when they are well and breastfeeding is comforting as well. Breastmilk is easily absorbed and has the benefit of helping to protect your baby’s immune system as well. Breastfeeding is also better at helping babies maintain their weight through illness than formula milk.

Babies who are too sick to breastfeed may be able to drink your milk from a cup, bottle, or teaspoon.

I hadn’t planned to breastfeed are there any reasons to reconsider this because of pandemic flu?

If you had not planned to breastfeed but your baby is born during a pandemic, starting breastfeeding and continuing until risk of infection is clear will provide some protection to your baby.

I’m considering stopping breastfeeding – how might an outbreak affect my decision?

If you were considering stopping breastfeeding, you can provide some protection by continuing until the risk of infection is over. If you want to talk to someone please call the NCT Breastfeeding Line on 0300 330 0771

I’ve recently stopped breastfeeding – but would it be it a good idea to restart in the event of an outbreak?

If you have stopped breastfeeding recently it is possible to re-start. The NCT Breastfeeding Line on 0300 330 0771 can let you know how to do this. Breastfeeding helps to limit the severity of respiratory infections in babies but information about this flu is not available at present

What medication can I take if I am breastfeeding and suffering from pandemic swine flu?

The Department of Health advises that aspirin should not be given to children under the age of 16 because there is a small risk of Reye’s disease. Similarly, breastfeeding mothers are advised not to take aspirin. It is suggested that paracetamol is safe for women during breastfeeding and for small children, and can be used to control fever. Recent studies have found an increased risk of asthma in children who have taken paracetamol frequently in the first year of life, but a high temperature carries its own risks. Discuss any medicines with your pharmacist or doctor.

Cough medicines containing decongestants or sedatives such as phenylephrine, pseudo ephedrine or phenothiazines can cause severe side-effects in young babies and should not be used in this age group. Simple syrups containing lemon or honey are usually safe and can be given to small children.

Tamiflu and Relenza

See above in ‘Can I take antiviral drugs if I am pregnant? Or see Department of Health advice at http://www.nhs.uk/Conditions/Pandemic-flu/Pages/Treatment.aspx

Antibiotics are not effective against flu (as flu is a virus) but can be used by pregnant women, breastfeeding mothers or babies to treat bacterial infections arising as the complications from pandemic swine flu. Some antibiotics can affect breastfeeding babies however, so you should always check with your pharmacist or doctor that the antibiotic you are taking is appropriate.

Can I breastfeed if I am being vaccinated?

Once the vaccination becomes available information will be provided on this. With the type of vaccine being developed there is unlikely to be any problem and continuing breastfeeding is likely to be recommended for mothers being vaccinated.

Formula feeding and pandemic swine flu

How do I minimise the risk of my formula fed baby catching swine flu?

If you are formula feeding, it is always important you wash your hands and sterilise all equipment before preparing feeds. See ‘Using infant formula: your questions answered’ for more information. If you are infected extra care is needed to make sure virus does not get into the bottles you are making. Although it is likely you have already infected your baby by contact before you developed symptoms you might want to ask a non infected person to make up bottles to reduce the risk of infection if it has not already taken place.

Although an infected mother is likely to pass flu to her baby there are advantages to them remaining together wherever possible. Skin-to-skin cuddles improve health, bonding and long-term mental health of the baby. However if the mother feels too unwell to do this she may need others to step in.

Is any one formula better than another in a swine flu pandemic?

All infant formula is similar in its constituents. There is no clear published evidence that any one formula has any advantage over another in relation to infection. Formula milks provide the nutrients a baby needs but do not contain the anti-infective factors and do not have the same properties as breastmilk.

Swine flu and older babies or young children

Are older babies and young children more susceptible to swine flu?

Babies and young children do not have a fully developed immune system and are probably slightly more at risk of catching swine flu if exposed to it.

Are older babies and young children likely to be more seriously affected by swine flu?

There is very limited information at present but because they have immature immune systems they are likely to be slightly more at risk of having the disease more severely.

How do I minimise the risk of infection to myolder baby or young children?

Hand hygiene and tissue use by you, the child and all in contact with you help reduce the risk. The more people you are in contact with the more likely that one of them has swine flu and could cause infection. However you and your children need to be able to carry out daily activities so it will be a personal decision on what you do about going out and about

What should I do if my older baby or young children become ill?

If your child develops swine flu symptoms, especially if she is under five, call your family doctor to let them know you think she has the virus. You may be offered antivirals for your child.

If your GP confirms that your child has swine flu, keeping them at home prevents them infecting others.

If your child develops swine flu symptoms, especially if she is under 5, call your family doctor to let them know you think you have the virus. You may be offered antivirals for your child.

How do I care for an older baby or young children with swine flu?

Children are likely to stop wanting to eat but it is important they continue to drink, so offer them small amounts of water or, in an older child, squash regularly. Children can have paracetamol to help bring their temperature down but it is important to follow the dosage instructions very carefully. Most parents find offering small amounts of temping food cut into small pieces may encourage a child to eat at least a little.

If you are still breastfeeding or can breastfeed, even an older baby or child may welcome a return to breastfeeding and will benefit from an increased frequency of breastfeeds. If your child has a very high temperature you can help cool her by removing a layer of clothing and sponging her with a damp sponge or flannel that has been dipped in lukewarm water. The evaporation of the water from your child's skin will cool her down.

Children will often need you to be with them when they are ill and may like to be in your room with you at night. Some parents find having an older baby or toddler with you in a sling helps keep the child calm and comforted.

How will a pandemic swine flu outbreak affect services for parents and babies?

What will happen if my child is in daycare or with child minders?

The Department for Education and Skills has published guidance on this: http://www.teachernet.gov.uk/_doc/13525/Shortversionofguidanceforchildcare.pdf

How will services from my local GP or health visitor be affected?

Individual GP surgeries will let you know what they can offer depending on the availability of staff.

Where can I get further information?

Visit www.direct.gov.uk/swineflu.

Talk to your midwife, health visitor or GP if you need further information.

Consult your pharmacist before taking any medication.

Alternatively, go to http://www.nhs.uk/ or the Health Protection Agency at http://www.hpa.org.uk/, or ring the Swine Flu Information line on 0800 1 513 513.