Our maternity services during Coronavirus (Covid-19)

Maternity Services during Coronavirus (COVID-19)

We would like to take this opportunity to update you about your maternity care whilst we deal with the Coronavirus (COVID-19) global outbreak. We want to reassure you that our dedicated teams will continue to strive to provide outstanding care and prioritise your safety and that of your baby at this unprecedented time.

It is expected the majority of pregnant women who are exposed to COVID-19 will experience only mild to moderate cold/flu like symptoms. There is no evidence that pregnant women who have contracted COVID-19 are more at risk of serious complications than any other healthy individuals.

We are taking extra care in how we are looking after all women who access our maternity services to ensure we maintain their safety and well-being. We have created separate areas on both the labour and inpatient wards and are following government guidance to care for those who have confirmed, or are suspected to have, COVID-19. This ensures that those women who are unaffected are also kept safe and well.   

For the most up to date pregnancy COVID-19 advice and information we recommend you visit the RCOG website on Covid-19 virus infection and pregnancy.

Help and advice regarding Covid-19

If you think you may have symptoms of COVID-19 you should use the NHS 111 online service for information. Please only call 111 if you are not able to access the advice on-line as there are very long wait times.

  • Stay at home and do not come to the hospital if you have a high temperature or new persistent cough, and follow guidance available at: https://111.nhs.uk/covid-19
  • If you do not start to feel better within 7-14 days this may be a sign that you are developing a more significant illness that requires enhanced care. You should use the NHS 111 online service for advice.
  • If you develop more severe symptoms of COVID-19 such as for example; difficulties in breathing you should phone 999.
  • If you are concerned about your pregnancy or new born baby, you should contact our dedicated 24 hour Maternity Helpline which is available 7 days a week on: 01708 503742

Protecting yourself and others from COVID-19

As a precaution, you should follow government advice about pregnancy and social distancing; stay away from public places and avoid anyone who has symptoms suggestive of COVID19. Please refer to the current guidance on social isolation both for yourself and your household. This can be found at: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection

Please follow the Government advice:

  • Stay at home as much as possible. Only go outside for essential food items or health reasons.
  • Work from home if practical to do so.
  • If you do need to go out stay two metres away from other people.
  • Avoid touching your face, especially your mouth and eyes with your hands.
  • On returning home wash your hands as soon as you get home.
  • If you are more than 28 weeks pregnant you should be particularly attentive to social distancing and minimising any contact with others.
  • Pregnant women with significant heart disease (congenital or acquired) are strongly recommended that you follow shielding measures to keep yourself safe. Shielding means you are advised to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks.

If you work in an essential service as a Key Worker as deemed by Government guidance and you are less than 28 weeks pregnant, please seek advice from your employer and access for up to date advice

https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-30-occupational-health-advice-for-employers-and-pregnant-women-during-the-covid-19-pandemic-20200406.pdf

Maternity Care

It is important for your maternity care and safety that you let us know if you have confirmed or suspected COVID-19. Please let your community midwife know, on the telephone number within your handheld notes, so she/he can make alterative arrangements to ensure that you receive the care that is required.

  • Please do not attend if you have any symptoms suggestive of COVID-19 (fever/high temperature, persistent cough, shortness of breath)
  • Please do not attend an appointment if you or anyone in your household is self-isolating for suspected or confirmed COVID-19.
  • Please do not allow any other member of your household to accompany you to hospital at any time including if you are labour, if they are showing symptoms or are meant to be self-isolating.
  • Please do not bring any children with you to the hospital or to any of your appointments. They will not be allowed to accompany you and you will be asked to reschedule. Children can be carriers of COVID-19 and can easily spread it whilst not displaying any symptoms themselves.
  • Please ensure that your community midwife and the hospital have your correct telephone number.
  • If you are concerned at any time about your pregnancy or new born baby, you should contact our dedicated 24 hour Maternity Helpline which is available 7 days a week on: 01708 503742

Please keep us informed so we can keep you and your baby safe

Outpatient/Hospital Appointments:

Whilst we attempt to limit the spread of COVID19 we ask that you please:

  • Please attend your Maternity appointments alone. 
  • For scan appointments, partners are able to attend 20-week anomaly scans and any repeat scans as required. However due to the high volume of women and very limited space in our hospitals, particularly in our waiting areas, we are not yet able to offer this for women coming in for their 12 week scans, as we would not be able to comply with stringent infection prevention and control guidance. This will remain under review and we will continue to look for ways to further support women and their partners.
  • We may contact you via telephone prior to any planned appointments, visits and attendances to ask screening questions to ensure you are well enough (asymptomatic) to attend. If you are contacted you must accurately and honestly answer the questions asked regarding COVID-19 symptoms, self-isolation or family members within the household who are self-isolating. This allows us to make a plan of care for you that will keep you and your baby safe.  It also helps us keep our staff safe so that they can continue to remain well to care for you and others.
  • Some hospital appointments will now be conducted over the telephone rather than face-to-face. We will inform you if this applies to you and your appointments.
  • All parent education classes and tours of labour ward have been cancelled for the foreseeable future. We are looking into ways of delivering these classes virtually – please follow our BHRUT social Media feeds for more information over the coming weeks.

Antenatal Care in Community

Your antenatal care pathway has also been adjusted to include telephone consultations when appropriate. This facilitates social distancing whilst ensuring that you and your unborn baby remain well. Your midwife will contact you to discuss your adjusted antenatal care pathway. Please inform your midwife if you or a family member in your household is displaying symptoms of COVID-19.

If you are concerned at any time about your pregnancy or new born baby you should contact either your Community midwife or our dedicated 24 hour Maternity Helpline which is available seven days a week on: 01708 503 742.

Labour / Triage Assessment

If you think your labour has started, or you need to attend the hospital due to an urgent pregnancy concern, please contact the dedicated 24 hour Maternity Helpline on 01708 503 742. A midwife will take a history and advise you when and where to come in. Please do not attend without calling first. This is particularly important if you have suspected or confirmed COVID-19 or people in your household with symptoms of COVID-19.

Please note that during this COVID-19 outbreak some of the available options to you may unfortunately be limited or suspended such as Water Birth and/or non-emergency Epidural service. We will try our best to support your birth choices when possible.

Personal Protective Equipment (PPE)

The maternity team will be wearing Personal Protective Equipment (PPE) due to COVID-19 when they provide patient care to you and/or your baby, this will include face masks. This is for their own and your protection, however this can make communication more difficult please bear with us.

If you have suspected or confirmed COVID-19 you will be cared for in an isolation room (or bay) with the maternity team wearing PPE which will include a gown, gloves, face mask and eye protection. In an emergency this may cause a delay in staff responding as they must be wearing PPE before assisting for their own protection. Staff has been practising putting on PPE at speed to minimise and reduce the potential impact of these delays on you and your baby.

Visiting Policy

Unfortunately, all visiting is currently being restricted due to COVID-19 and the need to prevent the spread of the virus.

  • Only one named person will be allowed to accompany you whilst you are in labour and for the birth.
  • Please ensure that you have considered having a back-up birthing partner should your partner be self-isolating or symptomatic of COVID19 and therefore unable to accompany you.
  • We are aiming to discharge suitable women straight home from the labour ward.
  • If your partner has any fever/high temperature, persistent cough, shortness of breath they must  not accompany you (that means not entering the hospital building).
  • All other visitors must wait to see you and your baby until you have been discharged home.
  • No children will be allowed within the Maternity Services departments.
  • Please speak to a Midwifery Matron for exceptions in extreme cases only.

From Monday 21 September the following visitor arrangements will apply:

  • One visitor (the birthing partner) will be able to visit our antenatal, postnatal and Coral wards, for a two-hour slot between 1pm and 5.30pm. The ward will arrange your visiting time with you.
  • If you have had an elective caesarean your birthing partner can stay with you while you are in our High Dependency Unit or Recovery area.
  • Visiting hours have been extended on our Neonatal Intensive Care Unit (NICU). One parent at a time can attend between 10am and 10pm.

If you have any questions about your pregnancy or our visiting policy please speak to your midwife.

Postnatal Care in the Community

Your postnatal care pathway will be adjusted to include telephone consultations and to minimise the face to face appointments during the COVID-19 outbreak. Once you are discharged home from hospital a midwife will contact you the following day by phone to assess you and your baby’s wellbeing.  The midwife will discuss your ongoing postnatal care pathway and provide you with contact numbers should you at any time be concerned regarding yourself or your baby. Please inform your midwife if you or a family member is displaying symptoms of COVID19.

For the most up to date advice; find us on social media

Trust Coronavirus Website- https://www.bhrhospitals.nhs.uk/coronavirus

Trust Facebook page - https://www.facebook.com/bhrhospitals

Trust Twitter page- https://twitter.com/BHR_hospitals

Maternity Twitter - https://twitter.com/TeamMidwife

Our maternity services remain committed to providing you with outstanding care and have dedicated staff working round the clock and hard to ensure you have a safe and positive pregnancy and birth. Maternity staff cannot work from home as we need to care for you and your baby throughout the antenatal, labour and postnatal period; however they themselves will need to respond to personal or family challenges in dealing with COVID19, which may mean we are working with a lot less staff than usual. Our first priority is providing the best service we can for you and we ask that you understand the challenging situation that we are working in and support us in our efforts to care for you as safely and efficiently as we can during this time. Thank you.

Sue Lovell
Director of Midwifery

COVID-19 Universal Testing of Maternity Patients

In line with current UK guidance we are now offering COVID-19 screening (testing) to all women who are admitted to our maternity unit. All women who are being admitted and are expecting to stay overnight on the Antenatal ward, Labour Ward, Queens Birth Centre, Maternity High Dependency Unit (HDU) and Postnatal Wards. This also includes all women attending for any planned elective procedure(s) for example: elective caesarean section or induction of labour.

A screening test will be offered on each and every over-night admission to hospital you have, and every 5 days whilst you are an inpatient.

Why are we doing screening tests?

So that we can ensure that our Maternity Services remain safe for all our women and babies and that they can be cared for in the safest environment. We can also ensure you are given the most appropriate advice regarding self-isolation.

We know that some people who do have COVID-19 do not develop or show any symptoms. Offering screening to everyone who is admitted to hospital will help us keep our patients and staff as safe as we can.

What does the test involve?

The screening test is a simple swab. To test for COVID-19 a sample is needed from two areas; one from inside your nose and one from the back of your throat. The test should not be painful but may be felt as uncomfortable.

The swab is then sent to the laboratory for testing and the results should be available within 48 hours.

When will the test be taken?

The test will be offered and taken on admission to the hospital (unless you are in labour at which point the test will be taken after the birth of your baby or if you have a planned admission to hospital (i.e. elective caesarean section, induction of labour) the swab will then be taken at your pre-operative assessment or your induction of labour appointment.

Will my birth partner be offered the test?

The test is not currently being offered to birth partners. The Public Health England guidance is for the test to be taken for women being admitted to hospital only.

How long will my test results take?

Usually within 48 hours. One of the maternity team will contact you if the swab test is positive for COVID-19 and give you appropriate advice.

Pregnant and new mums should continue to follow strict social distancing.

Am I required to take the test?

The test is recommended but it remains your choice whether to take the test or not.

What if I decline the test, will I still be welcomed into the hospital regardless of whether I am symptomatic or not?

Absolutely, you will always be welcome. We are actively encouraging all women to continue to attend for their antenatal, labour and postnatal care for the wellbeing of themselves and their babies. Your care will not change if you do not have any COVID-19 symptoms.

How do I receive my test results?

If you are an inpatient, one of maternity team looking after you will inform you of your result. If you are at home, a maternity team member will contact you by telephone if your result is positive, or send you a letter if your result is negative. You will also be given advice on any further plans if needed.

What will happen if my swab test result is positive and I am pregnant?

If you are still an inpatient and your swab test result is positive we will move you into an isolation room or bay where we can look after you. You will be asked to wear a mask when necessary and will have a separate toilet and bathroom. Designated staff will be caring for you wearing the appropriate personal protective equipment (PPE).

If you have been discharged from the hospital during your pregnancy and your swab test result is positive you will be contacted by one of the maternity team to discuss any possible changes to your planned antenatal care.

How will my birth plan change if I have a positive swab test result?

We are following national guidance on how to keep you and your baby safe (Royal College of Obstetricians and Gynaecologists). We will ensure you get the best care and respect your birth choices.

If you have symptoms or tested positive for COVID-19 and go into labour, you will be advised to give birth on the Labour Ward, which is an Obstetric Led unit. This is so the team can monitor you and your baby more closely.

Your birth partner(s) - providing they do not have any symptoms of COVID-19 or a temperature themselves - will still be able to be with you during your labour and birth.

Will I be tested if I am planning to have a homebirth?

Not at this current time – we are following national guidance, which recommends offering a screening test to anyone admitted to hospital for an overnight stay only.

What if I test positive after I have had my baby?

If your baby is well, they will be able to stay with you, however if they become unwell with

COVID-19 symptoms they will require to be admitted to the Neonatal Intensive Care Unit (NICU) for special care.

If you test positive and your baby is already being cared for in NICU you will be unable to visit until a you have undertaken a period of 14 days self-isolation; either 14 days after the onset of illness or/and receipt of positive test result - even if you have no symptoms.  We will attempt to avoid separation of you and your baby where absolutely possible.

If I have tested positive for COVID-19 can I still breastfeed?

There is currently no clinical evidence to suggest that the virus can be transmitted through breastmilk. The benefits of breastfeeding outweigh any risks of transmission of the virus through breastmilk or by being in close contact with your baby. If you are COVID-19 positive take precautions to limit the spread of COVID-19 to your baby by:

  • Washing hands thoroughly before and after contact with your baby.
  • Routinely cleaning and disinfecting surfaces.
  • Cleaning any feeding equipment, including breast pumps, bottles and teats thoroughly before and after use.
  • Avoiding coughing or sneezing near your baby and by wearing a face mask or face covering.
  • Taking care to avoid falling asleep with your baby.

What are the chances of my baby testing positive if I test positive?

As this is a new virus, there is limited evidence about caring for women with coronavirus infection when they have just given birth. A small number of babies have been diagnosed with coronavirus shortly after birth, so there is a chance that infection may have occurred in the womb, but it is not certain whether transmission was before or soon after birth.

Your maternity team will maintain strict infection control measures at the time of your birth and will closely monitor your baby.

Will I or my baby need to stay in hospital if we test positive?

The evidence to date suggests that although babies can develop COVID-19, very few babies develop severe symptoms.

All available evidence suggests that generally pregnant women are at no greater risk of becoming infected with COVID-19 and/or becoming seriously unwell than other healthy adults if they develop COVID-19. Although, pregnant women from Black, Asian and Ethnic minority backgrounds are more likely to experience more severe symptoms and/or complications, and therefore should seek professional advice and assistance quickly if they become symptomatic and unwell.

The majority of pregnant women who become infected with COVID-19 may experience only mild or moderate cold/flu- like symptoms, cough, fever, shortness of breath, headache and loss of sense of smell /taste.

If you have no symptoms or your symptoms are mild, and you and your baby are otherwise fit for discharge from the hospital you will be able to return home and will be advised to self-isolate for 14 days.

How is the hospital protecting us from COVID-19?

We are taking steps to keep everyone as safe as possible. You will notice the screening of temperatures for everyone coming into in the hospital, fewer non-clinical hospital staff around the building, patients, visitors and staff all wearing masks. There is also restricted visiting.

Patients who test positive for COVID-19 are cared for away from others who are not COVID-19 and we use appropriate PPE when providing direct care to you.

We are advising all staff, patients and families to follow social distancing advice and undertake regular strict handwashing

Coronavirus COVID-19: helpful maternity guidance videos

Pregnancy and Coronavirus

RCOG Vice President Dr Jo Mountfield talking about coronavirus and pregnancy from RCOG on Vimeo.

RCOG Vice President Dr Jo Mountfield talking about attending routine antenatal appointments during coronavirus from RCOG on Vimeo.

Mental health resources during Coronavirus (COVID-19)

Support services for women

Postpartum psychosis

Action on Postpartum Psychosis (APP) will continue their national peer support services throughout the outbreak. The APP forum is available for people affected by PP to talk to other women and partners.

They offer one to one peer support for anyone in the UK, where people are paired with an APP coordinator with lived experience, or a volunteer peer supporter. They offer one to one peer support via email, private messaging on the forum, or via video call. Their regional postpartum psychosis cafe groups will also continue via video call. People personally affected by PP (woman, partner, family members) who would like to access this support should email app@app-network.org.

Bipolar disorder

Bipolar UK provides coronavirus advice for pregnant women with bipolar disorder and also offers peer support on its e-community.

Perinatal OCD

Maternal OCD provides guidance and resources for coping with COVID-19 for people with perinatal OCD

Eating disorders

Beat Eating Disorders provides resources for people with eating disorders during the COVID-19 pandemic.

Depression and other perinatal mental illnesses

The PANDAS Foundation provides support and advice for any parent and their networks who need support with perinatal mental illness.

Perinatal anxiety

Anxiety UK offers support, advice and information on a range of anxiety, stress and anxiety-based depression condition via email, text and live chat services.

Useful links

Mind

https://www.mind.org.uk/information-support/types-of-mental-health-problems/postnatal-depression-and-perinatal-mental-health/perinatal-anxiety/

Anxiety self help guide

https://www.nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/anxiety-self-help-guide

Head space

https://www.headspace.com/

Maternal Mental Health Alliance

https://maternalmentalhealthalliance.org/news/mmha-members-offer-reassurance-amid-coronavirus-outbreak/

Community Infant Feeding support during Coronavirus COVID-19

All drop in clinics and cafes have been cancelled.

London Borough of Redbridge

For infant feeding support please contact telephone Redbridge 0-19 Children's Service on 0300 300 1579. The service operates Monday to Friday, 9am - 5pm. Voicemail covers out of hours and weekends. We aim to get back to everyone within 24 hours at most (excluding weekends).

You will be presented with the following options.

  • Option 1: Loxford, Cranbrook, Valentines, Clementswood, Mayfield
  • Option 2: Seven Kings, Newbury, Goodmayes, and Chadwell Health
  • Option 3: Fairlop, Hainault, Fulwell, Clayhall, Barkingside
  • Option 4: Wanstead, Woodford Green, Monkhams, Woodford Bridge, Churchfields, South Woodford, Snaresbrook and Aldersbrook
  • Option 5 - for any other enquiries (Admin Hub)

If forwarded to voicemail, please leave the following:

  • Your name
  • Contact telephone number
  • baby’s date of birth

Barking and Dagenham

Please call the duty numbers below for Infant Feeding Support.

West Locality

East Locality

North Locality

For more specialist infant feeding support please contact Health Improvement Practitioner Sahera Bharucha (Sahera.bharucha@nelft.nhs.uk).

London Borough of Havering

Havering Children’s Centres Infant Feeding Advisors

  • Telephone: Monday to Friday 9am to 4pm: 01708 432 309 (Becky) or 01708 434 747 (Michelle).
  • Email childrenscentres@havering.gov.uk with questions or to request a call back.

LatchOn Havering

Provides breastfeeding support:

La Leche League

Provides support via:

  • Online meetings: telephone 0345 120 2918
  • Email: local Leaders via helpform
  • Website: www.laleche.org.uk

For further support, contact the National Breastfeeding Helpline on 0300 100 0212, who provides help and support every day of the year from 9.30am to 9.30pm.

For a Specialist Infant Feeding phone consultation from our team, email bhrut.infantfeeding@nhs.net. Include your name and phone number and we will call you back. Call back service available from Monday to Friday, 9am -3pm.