This weeks blog is written for My Expert Midwife by Dr Emma Ferriman, MBChB, FRCOG, who is a consultant in Obstetrics and Fetal Medicine, Sheffield Teaching Hospitals NHS Trust.
Pregnancy can often be a daunting time for mothers but particularly first-time mums. Never was there such a difficult time as now in the face of a global pandemic. As a Consultant Obstetrician I am seeing a lot of scared and anxious women who are concerned, understandably, for the health of their unborn baby. This blog will give you some helpful advice on how many maternity services may be operating, however always check with your own local hospital for their guidance.
General pregnancy advice
Firstly, there is no evidence that COVID-19 is particularly dangerous for pregnant women. Pregnant women have a distinct advantage in that the majority are young fit and healthy. During the pandemic I have seen very few COVID positive pregnant women and those that I have seen have been on the whole asymptomatic making a good recovery. This may be because our population have a low incidence of co-morbidity or it may be that pregnant women have very sensibly stayed at home and really adhered to the social distancing advice.
Pregnant women still require appropriate levels of antenatal care. For most this will be under the care of their own midwife at the GP surgery, but for others they may require more specialist input in the hospital setting. The take home message is that all women should attend scheduled appointments if they are asymptomatic. If women have a cough, temperature, flu-like symptoms or loss of sense of taste they should self-isolate for seven days and if there is a member of their household who is symptomatic, they should stay at home for fourteen days.
Appointments for scans
There has been a reduction in the number of scheduled appointments for pregnant women in an attempt to limit hospital admissions and thus potential exposure. This reduction still allows safe care for pregnant women whilst limiting hospital attendances. Women will continue to have dating scans at around 11-14 weeks and will still be offered screening for chromosomal abnormalities, they will also be offered an anomaly scan between 19-22 weeks. For women requiring serial scans for previous pregnancy history, lifestyles that increase the risk of growth restriction or medical conditions such as diabetes, these will continue to be scheduled and it is really important for these women to attend. Where scans are indicated, for example, in women who their midwives identify as smaller than expected, scans will continue to be booked and managed accordingly. Staff providing care will be wearing personal protective equipment (PPE) to reduce the risk of infection.
Care for high risk pregnancies
Some pregnancy pathways have changed in an effort to reduce the number of hospital visits and these include screening for gestational diabetes, monitoring of obstetric cholestasis and pre-eclampsia (high blood pressure in pregnancy). Strategies such as home blood pressure monitoring are being employed in some units and these are working well to provide appropriate monitoring just at home and away from the hospital. These strategies are all to attempt to reduce the infection risk.
Partners and appointments
One very difficult challenge for pregnant women is that their partners or family members are no longer able to attend for routine appointments and these include ultrasound scans. This is really difficult because the scan is an important event in any pregnancy, which is routinely shared with partners or close family members. Remember that the reasons for limiting hospital consultations to the patient only, is to reduce the spread of infection for both the patient and the health care worker.
For ultrasound scans there are some ways to help with this. In some hospitals using Facetime or other video messaging modalities is permitted, which enables partners to be “virtually” present for the scan and in other hospitals sonographers may take a video clip for mothers to share at home with their families. The most difficult time occurs for women who may have been referred for a specialist fetal medicine opinion when there are concerns about the health of the baby or a higher chance of chromosomal abnormality. These consultations are particularly challenging because women will still need to attend alone. In my own practice I am using Facetime or video messaging to allow partners access to the scan. Where parents require counselling, I will call the partner with the mother and we will have a conversation together to allow the partner to hear the counselling as it happens, and to give all parents a chance to ask questions and clarify any issues.
Emergency hospital appointments
For women who need to attend the hospital for an unscheduled visit or as an emergency they should do so as usual. It is important to let health care workers know if either you or a family member has symptoms, so that the appropriate measures can be taken. You should attend as advised for all pregnant women even in the event of the current pandemic. That means always make sure you’re happy with baby’s movements, always get checked out if you have pain, bleeding, loss of fluid or headaches. These are all important symptoms that need appropriate hospital investigation. For women being admitted to hospital they will be tested for COVID-19. This allows appropriate precautions to be taken for positive, asymptomatic women in the hospital environment.
Labour and birth
Women with early signs of labour may be asked to stay at home for longer until they establish in labour, but if you are concerned or struggling with pain you should attend. Currently no visitors are allowed in all hospitals in the UK and the ROI. The exception is labour when one birth partner is able to attend, as long as they are asymptomatic (you may need to think about a back-up plan i.e. have someone on standby in the event that your birth partner becomes ill). Women undergoing elective caesarean section will also be allowed a birthing partner. Once baby has been born partners will be asked to go home, and this can be a difficult time. Try and be patient, the midwives and medical staff will get you and your baby home as soon as it is safe to do so.
The take home message is that pregnant women should attend for all necessary appointments because it is imperative that women have the appropriate pregnancy care. The exception is if you are symptomatic or self-isolating, in which case you should inform your health care provider and non-urgent appointments will be rescheduled. For urgent attendances you should still attend but the appropriate precautions will be taken to reduce the risk of infection. Please continue to follow government advice so that we can continue to protect you and your families.