During a period of lockdown where many of our basic freedoms have been limited, the autonomy and safety of pregnant women can easily be overlooked. In a blogpost last week, Anna Nelson and Chloe Romanis discussed concerns raised about the availability of home birthing during the COVID-19 lockdown. I spoke with Sarah Noble, Head of Midwifery at South Warwickshire NHS Foundation Trust (SWFT) about how maternity services at SWFT are creatively responding to the present challenges and how the team is taking innovative steps to support women’s choices.

Key Messages

• SWFT maternity has retained community services, trying to keep well women out of the hospital.
• So far, no COVID-19 symptomatic women have chosen homebirth against medical advice.
• SWFT maternity’s Facebook page, with support and information for pregnant women, gained over 1300 followers in 2 weeks.
• Innovative new approaches allow partners to stay with women for longer.
• Trusts with different policies are wary of being overloaded but continue to share good practice.

Choices and Advice

SWFT’s maternity team is committed to supporting all three birthing options: the obstetric unit, the birthing centre, and home birth. Unlike some other trusts, they have decided to promote home birth, basing their decision on safety data from the Birthplace Study, as well as the reduced infection risk from stopping women entering hospital. Although they had not actively promoted home birth previously, and had a home birth rate of 0.46%, they said this advice has been “really well received” by women.

Sarah told me the story of one pregnant woman in South Warwickshire whose midwife told her about the new advice. The pregnant woman explained this was, “never part of my plan” and the midwife said that was fine. But after 24 hours of reflecting on it, the pregnant woman changed her mind and is now booked for a homebirth.

The advice from RCOG is that, for women who are symptomatic with COVID-19 or self-isolating, giving birth in hospital is safer than home birth. Sarah explained that “we have really tried to get that balance right if there’s a medical need to come into hospital.” Although “supporting choice” was a priority, so far she knew of no cases where women had gone against this safety advice.

In order to keep pregnant women informed about provision and advice, the team “upped our comms”, both through central channels and through named midwives. “Relational-based care is more important than ever”, Sarah told me, and the team has risen to the challenge because almost 40% of the midwifery staff were already working in continuity of carer teams. Although “the fear is palpable across all the groups”, regardless of preferred place of birth, the midwifery team has set about “reassuring women we are here for them”.

Creative Solutions

Two weeks ago, the maternity team launched a Facebook page to update women about the service. This imaginative communications solution has accrued over 1300 members and includes regular posts on local charity provision during coronavirus covering topics as diverse as intimate partner violence, mental illness, and hypnobirthing. One of the midwives has uploaded a video where she dons the PPE which midwives are wearing, to reassure pregnant women who may be anxious about attending appointments.

Innovative digital solutions are also being embraced by the midwives. New guidelines from the RCOG have confirmed which appointments can be conducted online and many of the midwives are getting good results from virtual clinics using videocalls.

But not all the innovations are high-tech. During this time of high anxiety the maternity team acknowledges the particular importance of “keeping families together”. When pregnant women have to come into the hospital, the amount of time they can be accompanied by their birthing partners has been increased. “This reduces their comings and goings, so once they arrive, they have to stay otherwise will not be able to come back.” The maternity team has responded by widening bed spaces and expanding into a neighbouring closed ward to create more space for partners. For the first time, birthing partners are being fed by catering so they can stay together and reduce infection.

New Challenges

I asked Sarah about whether staff shortages had affected provision. Slightly more midwives on the team had been unavailable last week, but this week staffing is similar to the pre-crisis level. However other members of the team – obstetricians and sonographers – have had higher levels of unavailability. At the moment, Sarah says, “people are stepping up” and covering colleague’s shifts. “This will become more challenging the longer the pandemic” she suggests.

Compared with other nearby trusts, SWFT has placed a different emphasis on home birth encouraging suitable women to consider birthing at home, knowing that clinical outcomes are optimal and that it keeps well women at home in their own isolation bubble during this pandemic.  However, SWFT has had to state that it will not accept late bookers from neighbouring trusts because there is a risk that women from elsewhere in the region who would prefer homebirth will overwhelm the service and undermine SWFT’s duty to the women who are already booked in. At the same time, other trusts might be concerned that women seeking hospital deliveries will transfer to them.It seems likely that there will be a variance between services during this pandemic dependent upon what local services are able to offer safely.

What brings all these developments together is the pursuit of “safety and personalized care”. It’s clear that colleagues across the maternity team are enthusiastically tackling the remarkable challenges facing the service. “Our team-work is better than ever” Sarah tells me, “at times like these you realize that interdependence of all teams supporting maternity is critical”