Heavy Breathing During Labor May Put Hospital Staff at Higher Risk of COVID-19

Doctor putting on gloves

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Key Takeaways

  • Vaginal labor and delivery is not considered an aerosol-generating procedure by the World Health Organization, but UCLA scientists say it should be.
  • Their study shows that respiratory emissions during labor and delivery can travel faster than a simple cough.
  • Labor and delivery staff need PPE to protect them from COVID-19 infection, the researchers conclude.

Due to their contact with people who are sick, healthcare providers are automatically at higher risk for contracting COVID-19, plus other respiratory diseases. However, some healthcare procedures are riskier than others. In those cases, access to personal protective equipment (PPE) is more important than ever. 

But not all procedures that appear to be high risk are officially designated as such, including vaginal delivery. Giving birth vaginally isn’t considered a high-risk or aerosol-generating (meaning healthcare workers are at a higher risk for contracting infection) procedure by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). As a result, PPE like N95 masks aren’t recommended for labor and delivery staff. 

A new study from UCLA, published in the journal Obstetrics & Gynecology, found that respiratory emissions during labor and delivery can travel faster—and potentially farther—than a simple cough, thereby increasing the risk of respiratory disease transmission (such as the COVID-19 virus).

“Prior to this study, there was no data regarding respiratory emissions during a vaginal delivery and thus recommendations regarding PPE use were limited to opinion,” says Rashmi Rao, MD, assistant clinical professor of obstetrics-gynecology at the David Geffen School of Medicine at UCLA and corresponding author of the study. 

What the Study Found

Colleagues in the UCLA Samueli Mechanical and Aerospace Engineering Department studied respiratory emissions using background-oriented schlieren imaging. This technique relies on measuring or visualizing shifts in focused images, and in this case, it made the flow of invisible warm gases and cooler surrounding air visible.

Researchers found that patient breath became progressively faster as the patient moved from the early stage to the second (active) stage of labor, which involved more forceful breathing. 

Labor and vaginal delivery also involves repeated use of the Valsalva breathing and pushing technique. This creates increased emission of respiratory particles, which move with great speed over a large distance and stay suspended in the air. 

Rashmi Rao, MD

With this study, we can begin to reevaluate the recommendation and support the use of full PPE with N95 masks for a vaginal delivery.

— Rashmi Rao, MD

The researchers found that during active labor, complex gas clouds (i.e. respiratory emissions made up of gases and particles) can travel at an average speed of 1.8 meters per second, which is about 30% faster than a gas cloud travels during normal breathing and at least 6% faster than gas clouds produced when coughing. 

Given the spread of these respiratory emissions, the speed and distance the particles travel, and the duration of time healthcare providers spend assisting in a vaginal delivery, the researchers believe that this is a healthcare setting at high risk for respiratory disease transmission.

“With this study, we can begin to reevaluate the recommendation and support the use of full PPE with N95 masks for a vaginal delivery,” Dr. Rao says. 

The Reality of the Labor Ward 

Iris Colon, MD, an OB/GYN with Santa Clara Valley Medical Center in San Jose, California, welcomes the findings for labor and delivery healthcare practitioners. 

“These findings are important, as they provide evidence from a dedicated study on respiratory emissions during labor. [It shows that] the process is one in which labor and delivery staff are exposed to respiratory emissions in a close contact situation and [for] a prolonged period of time,” she says.

Iris Colon, MD

The labor and delivery process is a high-contact and high-exposure event, and as such, practitioners need to protect themselves.

— Iris Colon, MD

Dr. Colon adds that the study highlights and provides evidence of what OBGYNs know from many years of taking care of patients in labor. “Namely, [we know] that the labor and delivery process is a high-contact and high-exposure event, and as such, practitioners need to protect themselves,” she explains. 

In fact, Dr. Colon and her colleagues used PPE during vaginal and cesarean deliveries even before the COVID-19 pandemic. It is for their safety and ability to remain healthy enough to provide care for their patients, she says.

Not providing full PPE to labor and delivery staff simply isn’t an option, Dr. Colon adds. “If there is a shortage of PPE, then we need to teach staff how to safely reuse [what is available],” she says.

What This Means For You

The study findings can be used to support providing full PPE to labor and delivery staff and designating vaginal birth as an aerosol-generating procedure. With COVID-19 still a very real risk, it's important to take precautions.

If you're pregnant and worried about giving birth during the COVID-19 pandemic, ask a healthcare provider to talk you through the process. You can opt to wear a mask, if it is not already required at your hospital, and/or request that the providers assisting in your labor and delivery also wear PPE.

Hospital staff will be able to answer your questions about the labor and delivery process and the steps the hospital takes to reduce the risk of COVID-19 transmission.

4 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. World Health Organization. Infection Prevention and Control During Health Care When Coronavirus Disease (‎COVID-19)‎ is Suspected or Confirmed.

  2. Centers for Disease Control and Prevention. Clinical Questions About COVID-19: Questions and Answers.

  3. Mok T, Harris E, Vargas A, et al. Evaluation of respiratory emissions during labor and delivery: potential implications for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Obstet Gynecol. 2021;138(4):616-621. doi:10.1097/AOG.0000000000004533

  4. The American College of Obstetricians and Gynecologists. Coronavirus (COVID-19), pregnancy, and breastfeeding: a message for patients.

By Claire Gillespie
Claire Gillespie is a freelance writer specializing in mental health. She’s written for The Washington Post, Vice, Health, Women’s Health, SELF, The Huffington Post, and many more. Claire is passionate about raising awareness for mental health issues and helping people experiencing them not feel so alone.