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Coronavirus COVID-19 - With Mother and Child Services

(Updated 20/07/2020)

Please note that this is an evolving situation and wherever possible I will try to update this page accordingly.

About the Virus

Corona Virus infections include the common cold. A new strain of Corona Virus:- Novel coronavirus(SARS-COV-2) which seems to have originated in Hubei Province in China in 2019 causes Corona Virus Disease. This disease can cause sudden onset of severe breathing problems ( sudden acute respiratory distress syndrome) requiring hospital treatment and in some cases intensive care with oxygen and or ventilation support.

Current data from the World Health Organisation suggest that the majority of pregnant mothers with no underlying health problems who come into contact with COVID-19 will only experience mild to moderate cold or flu like symptoms and fully recover without needing hospital treatment.  Findings from the UK Obstetric Surveillance System UKOSS show that a small proportion of mothers, mainly in the third trimester of pregnancy, 28 weeks onwards, have become seriously ill with the virus. This is why social distancing is particularly important from 28 weeks of pregnancy. Data from UKOSS also showed that the chances of being admitted to hospital with COVID-19 infection in pregnancy are increased for mothers who are over the age of 35,overweight or obese, have underlying health problems such as high blood pressure and diabetes. The data also suggests that statistically mothers from black, asian and other ethnic minority backgrounds are at increased risk, though the reasons for this are not clear. It is important to note that having a black, asian or ethnic minority heritage does not mean you should be treated as high risk in labour, so long as you are healthy and do not have any symptoms of COVID-19, nor do any member of your household. You can still have the choice of giving birth at home, in water or in a midwife led setting. The Midwife led care principle applies to all women regardless of heritage who are healthy and without symptoms and I will be offering these services to you accordingly with the added benefits of having your own continuity of carer Midwife who is able to liase and share your care with medical and specialist teams if required.

Services

I am still in the early days of my Independent Midwife career and so work is relatively quiet. I continue to work part time for our NHS with additional shifts where needed on the labour ward, antenatal hospital and community clinics.

Antenatal and postnatal care are extremely important to ensure the health and wellbeing of both you and your baby. I will still be providing Private Independent Midwifery Services, which will include home visits where telephone/video conferencing is not appropriate. For home visits I will complete a simple risk assessment prior to each visit to ensure we both continue to be symptom free and have the necessary protective safeguards in place to avoid contracting the virus.The Royal College of Midwives have published a simple guide drawn from Public Health England for families about what to expect from a Midwife Home visit.  https://www.rcm.org.uk/media/3915/guidance-for-women-on-home-visits-4.jpg

With the current changing situation and circumstances I feel it will be  easier to have an initial consultation free of charge over the phone to discuss your individual needs and how best I can taylor services to support you. If you  decide to have me as your named midwife  responsible for your maternity care, charges will be reduced  by 10% to reflect the following:- reduced number and duration of home visits, the additon of telephone consultations to replace some home visits where it is safe to do so. 

If you would like general advice over the phone about your pregnancy, birth or afterwards I will be happy to offer this free of charge  within 24hrs of your query via email sarahj@withmotherandchild.co.uk or by telephone 07453081777. Please note that this would not be a replacement for your NHS care but an additional support should you need it.

Should you require urgent help if you are ill or suspect you may have the virus, please contact the maternity unit where you have booked for your pregnancy and speak to them over the phone about what to do next. If you are not booked in a maternity unit dial the NHS 111 service for advice and if you feel you need emergency medical treatment call 999.

Infection risk concerns

I appreciate that you may be concerned about possible infection coming into your home either from myself, having worked in the hospital environment and with other clients.

You may equally be concerned about catching the virus when you go to a clinic appointment, come into hospital to have your baby.

Precautions I am taking, and precautions being taken in the maternity unit where I work (this is not an exhaustive list, please feel free to contact me to ask further questions about this).

  • For obvious safety reasons, I will not be able to provide home visits for consultations if either you or a member of your family are self isolating, or if I myself come into contact with the virus and is having to self isolate/ receive treatment. I am obviously taking all precautions necessary to avoid this and I am sure you are as well.

 

  • To limit potential exposure from the public, family and friends, I had been self isolating apart from going to and from work and household shopping in my own car. From the 4th of July, some restrictions were lifted and as a result I have started to see friends and family but with social distancing and meeting outside in lovely gardens :) My camping deckchairs and coolbox have prooven extremely useful! I live alone with my husband who has also adopted the same behaviour and being a key worker also managed successfully to date to continue to adopt all the necessary safeguards to prevent coming into contact with the virus. We both practice scrupulous hand hygiene in accordance with NHS guidance on how to stop infection spreading https://www.nhs.uk/coronavirus and also wear facemasks where this has been advised ie at work, shops or enclosed spaces where social distancing is not possible.

 

  •  I limit my trip to the shops to buy essential groceries and practice social distancing and hand hygene, including the wearing of facemasks where this has been advised.

 

  • For visiting you at home to provide midwifery care I have purchased a supply of additional Personal Protective Equipment mainly masks and overshoe covers. Aprons, gloves etc are already routinely used because of the nature of certain aspects of the job. With regards to my equipment, where it is not disposable single use I will wash or wipe down with disinfectant as appropriate after each use. I also regularly wipe down surfaces within my car and home with disinfectant.

Reducing the risk of infection further

Midwives are in close contact with mothers we care for, including bodily fluids etc. The maternity unit where I work have always adopted a Universal policy protection against infections.This means that for every mother and baby basic protection e.g. disposable gloves, apron, hand hygiene and waste disposal practices have always been part of everyday practice. I have followed these practices including barrier Nursing when a mother has required this, very stringently for over two decades both in the hospital and community settings. Thankfully I have never yet contracted or inadvertently passed on an infectious disease or hospital acquired infection to anyone.

I am fully aware that the Corona COVID-19 Virus is highly contagious and like other NHS staff and myself as a part time employee, I have been provided with the necessary protective equipment for Corona Virus in addition to the other protective measures we take on a daily basis .I have kept up to date with all the training provided by the Trust where I work and also recieve regular updates from the Royal colleges of Midwives(RCM), Nursing (RCN)and Obstetrics and Gynaecology(RCOG).

Despite all possible precautions I appreciate that there will always be some degree of risk. I am of the personal opinion that once routine testing and target isolation becomes more established we will have a better understanding about immunity to and transmission of the virus and how to contain it. New innovations in treatments continue to emerge including trials for a vaccine. In the meantime we will all have to wait and do our best to keep safe. 

To ensure the health and wellbeing of both you and your baby, it is recommended that you are able to access maternity care during this pandemic. To minimise  exposure to the virus, aspects of  maternity care accross  the UK have been adjusted. I have also redesigned the services I offer in line with the RCOG and RCM guidelines. Neccessary arrangements between myself and the hospital where you are booked for maternity care will be made to avoid duplicate appointments. In addition, where it is safe to do so some home visits will be replaced with telephone /video link consultations as discussed previously.

If you were planning to have a home birth or birth in a Midwife led Unit, the current advice if you were to be infected with the Corona Virus is to attend an obstetric unit for birth where both you and the baby can be continuously monitored. This is based on evidence from China where out of 18 mothers infected with COVID-19 and 19 babies, (there were one set of twins), 8 out of the 19 babies were compromised as a result of the virus.

Useful Resources

First and foremost, follow the advice you have been given from your own Maternity Unit if you are booked in one.

Midwives, Obstetricians, Paediatricians, Child Health specialists, Obstetricians, Anaesthetists, Public Health, Infection Prevention and Control teams are all highly experienced, well established institutions are working together collectively to give us the best possible evidence based advice on how to manage Coronavirus in pregnancy, birth and in the post birth period.

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

Please revisit this regularly because as the situation changes and evolves the advice and recommendations are adjusted accordingly.

Other Resources

How to check if you have coronavirus symptoms  https://111.nhs.uk/covid-19

General government advice about Coronavirus(COVID-19) https://www.nhs.uk/conditions/coronavirus-covid-19/

www.laleche.org.uk and follow the link for corona virus

www.lullabytrust.org.uk/safer-sleep-advice/coronavirus-and-caring-for-your-baby/

Some Positives for the moment...

For healthy mothers with no other underlying medical problems, being Pregnant does not appear to increase the chances of  the consequences of infection with COVID-19 than the general population.   

Previous expert opinion stated that unborn babies were unlikely to catch COVID-19 during pregnancy. Samples from amniotic fluid, cord blood and breast milk including placental swabs from infected mothers all tested negative for the virus. However, recent evidence where a small number of babies have tested positive for the virus soon after birth suggests that transmission of the virus is possible during pregnancy. It is important to note that all reported cases of corona virus positive babies  have remained well and currently there have been no reports of developmental problems to date.  The UK Obstetric Surveillance System(UKOSS) is a well established surveilance system already used by maternity units to monitor the health and wellbeing of mothers and babies so that healthcare professionals can deliver care that is evidence based and of the highest standards. All mothers infected with the corona virus during pregnancy and their newborn babies have been included.

From the small number of babies testing positive with the corona virus after birth it is unclear if this occurred in the womb or in the immediate postnatal period. For this reason healthcare professionals will be adhering to strict infection control measures to minimise the chances of transmission as much as possible:- For mothers with suspect or confirmed symptoms of  COVID-19  who are well enough to continue to labour, invasive monitoring or proceedures that increase the risk of infection will be avoided as far as possible. Similarly labouring in water would not be recommended due to the increased risk of transmission from mother to baby.

There is still currently no evidence to suggest that the corona virus is transmitted through breast milk.There is a small risk of the baby breathing in infected air from breath droplets and more so if you sneeze or cough directly onto your baby whilst feeding. It is therefore recommended you wear a mask to prevent this. Ensure you wash your hands before and after contact with your baby which includes breastfeeding. Regularly clean and disinfect surfaces you have come into contact with and try to avoid touching your face and mouth.

Skin to skin contact with baby immediately after birth including optimal cord clamping can still be facilitated so long as you and your baby have remained well during the labour and birth and you have chosen to have this for your baby :)

 Thank you for taking the time to read this document. Please feel free to contact me for further information or a general chat about this or anything that is worrying you about your pregnancy and birth. I will be happy to do so free of charge over the phone for the duration of the pandemic as I appreciate that these are concerning times for everyone. Here are some words I have personally found helpful.

Blue footprint and pink footprint inside a heart shape

Independent Midwife Practitioner
Sarah Joy Jones

Impartial advice to accompany your NHS service

07453 081777
sarahj@withmotherandchild.co.uk