Reflections of an Obstetrician on COVID-19 Recovery Phase
Our very first article about what was happening in maternity units Reflections of an Obstetrician during Coronavirus pandemic was in response to the suddenness of lockdown, the high levels of anxiety and fear amongst pregnant women, the sketchy information emerging.
There were mixed messages “pregnant women at no more risk than background population” yet “pregnant women isolate and work from home”.
That article was to help us make sense of the situation where suddenly the rug had been pulled from under our feet. One minute there was joy at being pregnant and expectancy regarding the new addition to the family and next minute……. It felt akin to suddenly being in the middle of a war zone (COVID-19 war zone) and running for shelter from enemy attacks.
Fast forward three months lock down is being gradually lifted. Life returning to a newish normal. We no longer need to be bunkered in our homes locking ourselves in a room anytime the doorbell rings or going out for walks at 6.30 in the morning when nobody else was around.
However, what are we allowed to do now? What about the next wave? What is the latest R number and will recent crowd gathering for protests change that? Who can I meet? Are there still pregnancy specific restrictions? etc etc.
In fact, it was so much clearer when the advice was simple. Stay At Home, Save Lives. Unambiguous message-difficult to argue with.
What can I say, all advice is a work in progress? We are on version 10.1 of Royal College of Obstetricians and Gynaecologist Guidance on COVID-19 Infection in Pregnancy.
Over this time, we (medics/scientists) have been collating information from all over the world, looking at studies, reports – I do not personally wish to see or hear of another webinar on COVID-19 in pregnancy.
The good news is information and intelligence gathered is now becoming reliable, there is consensus. We understand the beast that is the Coronavirus much more and what to do about it and who is at risk of it.
What has not changed is pregnant women are at no greater risk than background population. This is good news and we should always hold onto this statement.
As we approach the Recovery Phase -What is different now?
The hospitals are opening for clinic appointments now so it has more of the hospital normal hospital feel again.
You will be handed hand sanitisers at the entrance, given a mask if you have not got one. Everybody wears a mask on the premises now. It feels quite reassuring. Some hospitals are checking temperatures at the entrance.
Visitors are still restricted (i.e. partners), although some units are now relaxing this for pregnancy scans. Partners have been allowed to be present for births but had to leave after a few hours. Some of these restrictions around delivery are being lifted. Partners are expected to wear masks during labour, delivery or caesarean section. Some maternity units are additionally checking temperatures at the entrance to maternity.
As I explained in earlier post the maternity unit is quite separate from the rest of the hospital and ring fenced for pregnant women only. In many units it has been partitioned into birthing areas and in the infrequent instances where they may be COVID-19 positive pregnant women they are looked after in separate area, separate entrance, separate staff.
Women with planned admissions like for induction of labour or planned caesarean section are now screened a couple of days before with swabs to ensure they are not positive but without symptoms. If they are, they will be managed in a separate area.
You may still have your booking (first) appointment and other appointments as virtual appointment i.e. telephone or video.
This has worked well as the Midwife or Obstetrician can get all the information required by speaking with you. A record of the appointment discussion and agreed plan is usually then kept electronically on your hospital electronic file as you may still be carrying your own notes.
Your physical visit to the hospital can then just be for if you need examinations, scans or blood test. Always ensure your hospital visits are efficient i.e. do all you need to do at one visit. Change appointments if necessary, to try to rationalise your appointments.
There is no point having a scan on Tuesday, midwife appointment for your blood sugar test the following day and an obstetrician appointment 3 days later!
Some workshops like for VBAC (vaginal birth after caesarean), breech clinic or birth preparation classes can be held online in some units. Your midwife will advise.
Again, these have worked quite well.
COVID-19 in pregnancy
So, we know pregnant women are not at increased risk but like everybody else can get it. When they have had to be admitted to hospital this has almost invariably been after 28 weeks. This is therefore in keeping with the advice for pregnant women to isolate in the third trimester and work from home.
We know older women, women who are significantly overweight, women from BAME background and women with other medical conditions like diabetes are more likely to be among pregnant women who will need admission. If in any of those categories and you get COVID-19 symptoms (continuous cough, fever, shortness of breath, loss of smell or taste) then have a low threshold to report symptoms that are deteriorating.
It is important that all pregnant women continue to contact their maternity unit regarding non-COVID-19 concerns. There have been unfortunate reports of women choosing not to come into hospital because of concerns about COVID-19 and ending up not getting timely care they required to keep them and their babies safe.
Remember the risk of COVID-19 infection in pregnancy is not greater overall for pregnant women than background.
Government approved Antibody testing is also available. This is now available to all staff in the NHS and available privately for you and family members. This can help with peace of mind if you find you are antibody positive or a member of your household who has had symptoms has antibodies. People can have antibodies because they may have been asymptomatic carriers.
Even if antibody positive it is still important to maintain social distancing, regular hand washing and follow government guidance.
We know water births; home births are all resuming.
We know partners or one accompanying adult can be present for birth and units are now relaxing the restrictions on how long they can be around after birth. (All precautions still apply hand sanitisers, masks, minimum movement around the unit).
If women develop symptoms whilst in hospital or pre-admission there are rapid 2-hour COVID-19 tests that can be taken. This allows the clinical team to treat women and separate them as suspected COVID-19 till the results come back. This is precautionary and it just means staff wear full PPE and women are looked after in a separate area or room. This is for their benefit, to protect staff and other women.
There are ongoing discussions on when Doulas can resume supporting women in labour.
All these measures are being implemented at different rates into the different units. So, you will need to ask about your maternity unit.
Remember that the situation is changing daily so do not be worried about asking the same question again later.
As we come out of cervical cancer screening awareness week, please ensure you have your smear test if this is due from 6 weeks onwards postnatally. Do not delay because of concerns of visiting clinics. GPs are re-opening now for smear tests or alternatively this can be arranged privately with your Gynaecologists. Regular smear tests prevent the majority of cervical cancers.
Also, during the pandemic, mothers delayed bringing babies into accident and emergency because of worry about Coronavirus. This led to a spike in babies and children arriving in hospital very sick because of delay. There are separate areas in the accident and emergency for babies and children to be seen by the paediatric nurses and doctors.
Remember thankfully children are less affected by COVID-19 but are susceptible to many other more common illnesses, some of which can be serious. So do call and seek clinical advice and follow this if your baby is unwell.
Contraception is another area that it is important, and women need take seriously.
Please attend to have implant, coils, mini-pill, vaginal rings etc prescribed or fitted so you have effective contraception. Breastfeeding is not a contraceptive and you can conceive whilst exclusively breastfeeding and before your periods ever return. As there may be a second wave of the COVID-19 infection it would be less than ideal to find yourself inadvertently pregnant again.
Of course if the intention is to conceive then, then we will simply ensure all the measures and advice acquired with this first wave is available and in place to look after you.
We all are in the recovery phase from the pandemic.
Shops are reopening, People returning to work, London traffic building up again, children (some) returning to school and hospitals resuming clinics and operating and managing backlog. Maternity never closed but adapted.
There will still be ongoing changes within maternity units that will improve efficiency, patient experience but underpinning all of this will be you and your baby’s safety.
These are indeed curious times for us all.
So, let us all continue to be careful out there.
This article has been written by Miss Gubby Ayida Consultant Obstetrician at The Women’s Wellness Centre.
Our Consultants and Specialists at The Women’s Wellness Centre offer care and reassurance from conception to birth, providing everything you need to have a healthy and happy pregnancy. If you wish to know more about our Private Pregnancy Care please contact us on 020 7751 4488 or book an appointment online here.
Consultant Obstetrician and Gynaecologist MA FRCOG DM (Oxon)
Gubby’s guiding philosophy is based on a respect for pregnancy as a state of health, and childbirth as a normal, healthy physiological process. Her obstetric care respects the diversity of women’s needs and the variety of personal and cultural values that women bring to pregnancy and birthing. Gubby Ayida is also Founder/CEO of the Women’s Wellness Centre over the years has grown, developing a strong established brand. Miss Ayida was listed in (2007/2013) Tatlers Guide to Britains ‘s 250 best private Doctors.