Learning the lessons of the first wave of COVID-19 is vital if we are to ensure the safe delivery of maternity services. These are the recommendations from the Royal College of Obstetricians & Gynaecologists (RCOG) and the Royal College of Midwives (RCM), who between them represent the majority of maternity staff, as services begin to prepare for a second wave.
In response to widespread maternity staffing shortages* during the peak of the pandemic, the Colleges are calling on NHS Trusts and Boards to ensure that maternity staff are not redeployed to other areas of the hospital.
They also identify key principles for ongoing service planning in the second wave, including:
- Day assessment and triage services, where women can attend for emergency review, should be maintained and maternity staff should actively encourage women to attend if they have concerns about their or their baby’s wellbeing.
- All places of birth, including midwifery-led units and support for birth at home, should be maintained as far as possible in the context of local staffing and service capacity.
- NICE-recommended schedules of antenatal and postnatal care should be offered in full, wherever possible.
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:
“We are acutely aware how difficult restrictions on birth partners attending maternity services have been for women and families throughout the pandemic. With increasing prevalence of the virus in many areas and a growing number of local lockdowns and restrictions, services are likely to reluctantly need to maintain some of these restrictions for some time to come. However, we know that all services are prioritising enabling birth partners to attend labour and birth and as many key appointments, including scans, as possible.
“As we approach a potential second wave of the pandemic, we intend to support clinical leaders in maternity to continue to provide safe and personalised care to women and families, and to continue to plan service provision during these challenging times.
“Maternity services are ‘front door’, essential services. Inpatient maternity services provide care that is largely unscheduled or urgent, with workloads difficult to anticipate in advance. Maternity staff cannot be replaced by other staff groups due to their specialist skill set and protecting this workforce is therefore crucial to ensure that maternity care can be sustained.”
Gill Walton, Chief Executive of the Royal College of Midwives, said:
“From shifting to virtual consultations to taking clinics out into the community, there is no doubt that maternity teams have stepped up to ensure the women in their care continue to receive the best and safest possible care under the circumstances. They have responded quickly to the challenges and, like the rest of the NHS workforce, have shown great resilience, even in the face of their concerns about their own health and wellbeing. It should not be underestimated the pressure that staff have been under – which is why good, early planning for what is likely to be the second wave is absolutely vital if those staff are to feel valued and supported.
“The wellbeing and safety of pregnant women and their babies will always be our members’ paramount concern. Maternity services are open, and have been throughout the pandemic, and midwives are ready to support the women in their care in the most appropriate way. It is so important that if women have any worries at all about themselves or their baby, day or night, whatever day of the week and whatever is going on with COVID, that they contact their maternity services.”
The Colleges’ recommendations are based in part on the findings of a study** published today in BJOG: An International Journal of Obstetrics and Gynaecology. In a survey of 81 obstetric units, 42% of the 194 units in the UK, respondents were asked about service modifications during April 2020, when the UK was at the peak of the pandemic.
The authors found substantial changes to maternity services with an estimated:
- 70% of obstetric units reporting a reduction in antenatal appointments
- 56% reporting a reduction in postnatal appointments.
- 60% of units temporarily removing the offer of births at home or in midwife-led unit
Most units (86%) reported a reduction in emergency antenatal presentations, suggesting women may have delayed seeking care during the pandemic. This may have been due to confusion around whether these appointments are essential, fear of attending a hospital or not wanting to burden the NHS.
The study also found evidence of innovation in maternity services to ensure pregnant women continued to receive appropriate support. Virtual or remote consultations formed a strong element of this, with an estimated 90% of maternity services reported these to deliver some maternity care appointments.
The study authors highlight that more research is needed to understand whether these service modifications have been associated with changes in maternity outcomes and also what modifications staff and women consider to be useful or not.
These service modifications were implemented in line with guidance published by the Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives (RCM) to respond to acute staff shortages and to ensure the safe ongoing delivery of maternity care during the pandemic, while reducing transmission to women, their families and maternity staff.
Lead author Professor Asma Khalil, consultant obstetrician at St George’s University Hospitals NHS Foundation Trust, said:
“We don’t yet know what the full impact of these emergency service modifications has been on women and their families but this data will be invaluable in understanding the potential indirect effects of COVID-19 on pregnancy outcomes, over and above any direct impact from the virus itself, including potential delays in accessing care because of concerns of transmission.
“Our study suggests the RCOG, the RCM, the NHS and maternity services themselves should reflect on the impacts of modifications to both staffing and service provision, and prepare action plans to achieve as high quality care as possible should they be faced with a ‘second wave’ of the pandemic or further health system shocks in the future.”
Notes to Editors
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- *An RCOG survey on the impact of the redeployment of maternity staff during COVID-19 reported widespread maternity staffing shortages for sickness and clinical vulnerability, and this may also have been exacerbated by the redeployment of junior O&G colleagues away from maternity services. Maternity staff includes trainees, junior medical staff, midwives with dual registration as nurses and maternity support workers.
- **Jardine J, Relph S et al. Maternity services in the UK during the COVID-19 pandemic: a national survey of modifications to standard care
- The Royal College of Midwives has made a plea to NHS leaders to protect the safety of pregnant women by ringfencing maternity services in the current crisis.
- Read the RCOG/RCM national guidance on coronavirus infection in pregnancy and Q&As for pregnant women
- A single-centre study demonstrated a significant increase in the rate of stillbirths during the pandemic. Khalil A, von Dadelszen P, Draycott T, et al. Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic. JAMA 2020 [published Online First: 2020/07/11]
- NHS England campaign: Help us help you: NHS urges public to get care when they need it
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.
About the RCM
The RCM is the only trade union and professional association dedicated to serving midwifery and the whole midwifery team. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources. For more information visit the RCM website at https://www.rcm.org.uk/