Giving birth during Covid-19 pandemic and what to expect in the immediate postnatal period

Due to the evolving nature of the coronavirus pandemic, clinical guidance is under constant review and change. This information was taken from RCM (Royal College of Midwives) RCOG (Royal College of Obstetricians & Gynaecologists) Version 8: Friday 17^th April 2020.

The health and safety of pregnant, labouring and postnatal women and their babies is of absolute paramount importance.

It is vital to keep updated with Coronavirus information given by your health providers. If you are unsure about your maternity care, please contact your community midwife or maternity unit. The midwives will be more than happy to help. We want you to be well informed, which will hopefully reduce anxiety and stress.

Leeds Teaching Hospitals NHS Trust Pregnancy Support Links

www.leedsth.nhs.uk/a-z-of-services/leeds-maternity-care/contact-us/ (Includes details of specific pregnancy cornovirus support number)

www.leedsth.nhs.uk/patients-visitors/patient-and-visitor-information/patient-information-leaflets/coronovirus-advice

Harrogate Teaching Hospitals NHS Pregnancy Support Links

https://www.hdft.nhs.uk/services/maternity-services/coronavirus/ (includes Coronavirus/COVID-19 Maternity-specific information)

Airedale Trust Hospitals NHS Pregnancy Support Links

http://www.airedale-trust.nhs.uk/services/maternity-services/ (includes Coronavirus/COVID-19 Maternity-specific information)

NHS Support

www.england.nhs.uk/coronavirus/wp-content/

The advice is continually being updated as new evidence emerges. Maternity units everywhere are working to manage additional pressures and facilitate women’s choices to the best of their abilities.

Some services such as homebirth provision can be dependent on their current staffing levels. The most common reasons for the homebirth service to stop are due to staffing and concerns about capacity in the ambulance service to provide transfers should an emergency arise during the labour or birth.

As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour are being advised to go to obstetric units for birth, where the baby can be monitored using continuous electronic fetal monitoring, and your oxygen levels can be monitored hourly.

There is currently no evidence to suggest you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus, so your birth choices should be respected and followed as closely as possible based on your wishes.

However, if you are unwell and your team feel that this suggests that your baby needs to be born urgently, a caesarean birth may be recommended.

It is not recommended that you give birth in a birthing pool in hospital if you have suspected or confirmed coronavirus, as the virus can sometimes be found in faeces. This means it could contaminate the water, causing infection to pass to the baby. It may also be more difficult for healthcare staff to use adequate personal protective equipment (PPE) during a water birth.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. After further review there is also no evidence that Entonox cannot be used in labour.

There has been a lot of concern regarding birth partners attending births. The maternity team know that having a trusted birth partner present throughout labour is known to make a significant difference to the safety and well-being of women in childbirth. At times like this, when coronavirus is heightening anxiety, that reassurance is more important than ever. However, it is necessary to restrict access to birth partners who have or are suspecting of having coronavirus in order to safeguard the health of the woman and the maternity staff supporting her. At this point an alternative, well, birth partner can attend.

Birth partners cannot be present on Antenatal or Postnatal wards.

Most caesareans and instrumental births in theatre are carried out under spinal or epidural anaesthetic. In this situation, everything should be done by the clinical staff to enable the birth partner to stay with the woman in theatre. If a woman requires a general anaesthetic, the birth partner will not be able to be present for the birth.

The RCM, RCOG and RCOA (Royal College of Anaesthetists) have developed the following guidance for birth partners below which you might find helpful to adapt for local use to hand to partners when they attend the labour ward:

1. If you are unwell, protect your family and our NHS staff and stay at home. To prepare for this, women and their current birth partner are being encouraged to think about an alternative birth partner.
2. Birth partners will be advised to wash their hands regularly with soap and water and use hand sanitiser gel in clinical areas as available. If they cough or sneeze, they should cover their mouth with a tissue and dispose of this in a bin immediately.
3. A Midwife will be allocated to support you; please carefully follow their instructions and approach them if you have any questions.
4. You will be advised to stay in the labour room with the woman you are supporting. Do not move/walk around the Labour Ward unaccompanied.
5. If you are asked to wear a mask or any PPE during the labour or birth, it is very important that you do so. Please follow the instructions carefully, and to take it off before you leave the clinical area.
6. The maternity team will do everything they can to enable you to be present for the birth. However, if there is a particular safety concern, they may ask that you are not present in the operating theatre. If this is the case, the team should discuss this with you and explain their reasons.

We do understand this is a stressful and anxious time for pregnant women and their families. Please be assured that the maternity team will do all it can to provide information, guidance and support you and your partner.

Postnatal Care:

Postnatal care will be individualised according to you and your baby’s needs. Postnatal midwifery care is from birth until 28 days. Midwives will then coordinate further postnatal care with local health visitors to ensure a smooth transfer of care

The minimum recommended number of contacts is three: at day 1, day 5 and day 10. LTHT (Leeds Teaching Hospital Trust) also contact on day 3 for breastfeeding mums to support breastfeeding. These postnatal appointments are a combination of face to face and telephone consultations according to the woman and baby’s needs. Midwives have a duty of care, so it may be necessary to arrange a face to face appointments in a clinic setting or in your homes if required. During a face to face contact, midwives will be wearing PPE, but need to be informed if you or any of your family are showing any signs or symptoms of coronavirus.

Please see below testimonials from parents who have recently given birth:

I just had my second baby at St James. It was a very different experience to my first but no less special! The staff were all in PPE. My husband was only allowed to stay an hour after birth, however the midwives couldn’t have helped me more and all went above and beyond to look after me and Isaac.

The community midwives and Harrogate hospital were amazing – both in advance and on the day – then I have needed the support of midwives afterwards with feeding and they have been equally brilliant. Despite everything going on, they are still creating a sense of calm and giving amazing support.

I have just had my second baby, had no issues in hospital and hubby was there for the birth. On a positive we’ve had plenty of bonding time!

Wishing you a very positive birth experience and look forward to hearing your birth story.

Best wishes and stay safe.

Annie

Blooming Babies is owned and managed by Annie Robinson, a registered midwife, fully qualified nurse and mother of two.  Blooming Babies provide Antenatal, Aquanantal, Baby Massage and Paediatric First Aid courses, for more details visit the Blooming Babies website.

Tel: 07580 004021

Email: yorkshirebloomingbabies@gmail.com

www.bloomingbabiesyorkshire.co.uk

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