This week I have had many, many women contacting me because of concern about pregnancy and Covid-19 and how they can access safe care. I understand how extremely worried many of you will be feeling. The social distancing and self isolation measures are having a huge impact – but we must remember that the reason for this is to slow down the spread of infection, which ultimately will help us all.
The government’s inclusion of pregnant women in the “at risk” group advised to be particularly careful has caused extra concern. It has been somewhat misreported in much of the media. The actual advice recommends social distancing, not self isolation. That means reducing unnecessary contacts with others, rather than having to shut yourself away and cut off all contacts. There is no evidence at present that pregnant women are more susceptible to Covid-19 or that it is a particular problem if they are infected. This is quite different to seasonal flu which we know is a significantly greater problem for pregnant women than others.
Expert advice from the RCOG and the RCM about pregnancy and Covid-19 was released after the governments “stay home” advice.
Many NHS providers are cutting back on services and cancelling appointments. In part this is to avoid groups of people gathering in hospital or GP waiting room where exposure risks exist. This is the reason why they are restricting visitors etc. Mainly however, cancelling appointments is because of the huge problem of having many staff unavailable due to whole families having to self isolate because one member has symptoms which could possibly be Covid 19 infection. It is to be hoped that an antibody test will become available quickly, as it may well be that many of us are already immune and could therefore be working normally.
I believe that antenatal care is essential and not therefore a “social contact”. The reasons for antenatal care are to safeguard you and your baby from real issues which we know can be seriously harmful. What we need to do is to minimise your exposure to infection.
What I am doing to stay safe?
The symptoms of Covid-19 are a new dry cough and high temperature. I am therefore checking and recording my temperature every morning. If it goes up, I will not work that day and monitor closely. Obviously I will follow the government advice if I become symptomatic. I am in frequent contact with fellow private midwives and we will provide cover for one another if necessary.
At this time we all need to think about our physical contacts, reducing anything unnecessary. This means that I will have to try to remember not to shake hands, hug, or have other physical contact with you, unless I am actually performing an examination. We will need to remind each other as we relearn our social behaviours.
It is the most important tool in preventing the spread of infection. Hot water and soap are what is needed rather than anti-bacterial rubs (this is a virus, not a bacteria). I would ask that you have a freshly laundered towel for me to use when I visit you. Normal laundry with normal laundry products (through ideally at 60 degrees) will kill the virus.
As soap and water are effective to inactivate the virus, I am cleaning all equipment between clients with hot water and washing up liquid, in addition to my usual cleaning protocols. I will be limiting the number of physical visits I do each day to allow time for the cleaning & drying of kit.
Prior to every visit I will be asking clients to confirm that their household are symptom free. It may be worth considering if, like me, you could monitor your temperature every morning as soon as you wake up. It is important to do it at that time, before you are physically active, to get a reliable assessment. Remember that all the usual coughs and colds will still occur and so a rising temperature does not automatically mean that you have got Covid-19. It should be used as an early warning sign that your body is working hard to deal with something.
Routine midwifery care and Covid-19
Urine testing, checking blood pressure and checking your baby obviously cannot really be done remotely. During the non-contact part of our consultation, I will be suggesting that we sit as far apart as is reasonably possible. Rooms should be well ventilated.
If you and your household are well, I am happy to see you face to face, but we should consider options for non-clinical consultations.
I am not very technically minded, but have this week successfully started virtual consultations, using a variety of tools, and obviously the option exists for phone consultations. Reducing face to face consultations can benefit everyone by reducing the number of households I visit.
Birth- home or hospital?
All the usual issues about place of birth and mode of delivery remain relevant in the face of Covid-19, but there are now extra issues to consider. Many hospitals are restricting you to one birthing partner to reduce the number of people entering the hospital. As the situation is changing very quickly, we need to make decisions once birth is imminent.
There are discussions underway about whether suitably insured private midwives like me might be allowed to provide full clinical care for our private clients in hospital, as this would reduce the pressure on NHS staff. Currently we can only offer support and advocacy. Such a change would allow you to employ a private midwife who would just be caring for you, in an individual birthing room, rather than a midwife who is caring for several women simultaneously. You could then, if all is well with you and baby, go straight home – again with your private midwife caring for you. Whilst homebirth may be a good option, as always this needs to be considered carefully. It is predictable that back up services such as ambulance transfer to hospital if needed could be very difficult to arrange.
Questions or concerns?
If you are concerned about pregnancy and Covid-19, please get in touch by phone or email. My normal visiting area is Sussex and Surrey, but I have contacts all over the UK. I offer one-off consultations or complete packages of care. Both pregnancy and Covid-19 present risks. I am here to help you work out what is best in your particular situation. Together we can work out a plan.