Martínez-Perez O, Vouga M, Melguizo SC, et al. - Births to women with COVID-19 were assessed by mode of delivery via assessing 82 women with singleton pregnancies and a positive reverse transcriptase–polymerase chain reaction (RT-PCR) test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 12 and April 6, 2020 and who delivered within the next 14 days at 96 level 2 or level 3 maternity hospitals throughout Spain. Of these women, 11% (9/82) had severe adverse maternal outcomes, 4 of whom presented with severe and 5 with mild COVID-19 symptoms. Among patients with mild symptoms at presentation, excellent outcomes were reported in all patients with a vaginal birth whereas severe maternal outcomes were reported in 13.5% of women undergoing cesarean delivery and clinical deterioration in 21.6%. Risk of adverse outcomes were higher among women undergoing cesarean delivery, but after adjusting for confounding factors, cesarean birth remained independently linked with an elevated risk of clinical deterioration. Surgery induced physiological stress is identified to enhance postpartum maternal complications.