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COVID-19: Pregnancy care and support in Australia

Pregnancy care and midwife support during coronavirus crisis

Here at the Bub Hub we’ve always made it our aim to provide sensible, practical and up-to-date advice to parents and parents-to-be so they can make informed decisions when it comes to fertility, pregnancy, and raising children.

Now, more than ever before, parents need a clear voice amid the confusion. And with that in mind, we’ve consulted a range of experts to discuss the only thing many of us are thinking about at the moment — the coronavirus or COVID-19.

Here’s the latest advice from the Australian College of Midwives about the impact of COVID-19 on pregnancy care and support in Australia.

It’s really normal to have a heightened level of anxiety if you’re pregnant during this pandemic — it is not something any of us have planned for.

The best thing you can do, as a start, is to talk about your fears and concerns with your midwife. It’s possible that having that initial conversation can help you understand your options and work through each of the elements.

Here are some answers to common concerns about pregnancy care and support during COVID-19.

Pregnancy care and support during the coronavirus crisis

Should I keep attending antenatal care appointments?

Women should still continue to have their antenatal care – as per the schedule set out at when they met their chosen health care provider/their booking-in visit.

It might be that now some of your appointments may be undertaken via telehealth (phone or video conferencing) where there is no requirement for a physical check /clinical assessment such as fundal height, blood pressure, fetal heart rate.

For example, to reduce potential contact time of appointment midwives might do a portion via telehealth to gather the administrative data or to provide education and information sharing, and then have a shorter appointment directly with the woman to undertake the clinical assessment requirements.

I’ve just found out I’m pregnant? What next?

The normal process should be undertaken to make a booking-in appointment.

It is possible that the checking in/ booking appointment for women who have just discovered they are pregnant may become a digital process using telehealth to meet a midwife and share information

The first appointment is typically one of data gathering, history taking etc which lends itself to being able to be undertaken using the telehealth options. Whilst it does mean not getting to physically meet a midwife, it does reduce women’s potential exposure by reducing their time in hospitals and waiting rooms.

Subsequent visits may be a mix of telehealth or face-to-face appointment.

What if I test positive or are suspected of being COVID positive?

If a woman is suspected or diagnosed as COVID-19 positive then it is most likely that the planned appointment may be delayed until after the woman tests negative.

For example, if a woman becomes unwell before her 24-week appointment, advises her midwife and is subsequently tested as positive for COVID-19. The midwife may (a) undertake a portion of her appointment by telehealth (to check in with how she is – emotionally and physically – and share any specific information pertinent to that appointment/period of the pregnancy) and delay the clinical assessments until such time as the woman is well, or (b) delay the entire appointment until such time as the woman is well. Being well means testing negative to COVID-19.

If the woman’s condition worsens and she has to go to hospital then her antenatal checks will be undertaken there.

Where the check-up is urgent and cannot be delayed – if the midwife has personal protective equipment there may be scope for the woman to be seen in her home/the community – or more likely she will be asked to attend a hospital for her appointment where they are set up with the PPE and dedicated space.

What changes might happen with midwives/health providers?

Midwives and other health professionals will likely be undertaking a higher level of vigilance as far as reducing contact, social distancing, hand washing and hand hygiene.

If the women is unwell and suspected of being COVID-19 positive they will also be wearing personal protective equipment such as gowns, gloves and masks.

While these extra precautions may add an increased clinical feel to otherwise healthy pregnancy check they will be implemented to safeguard the woman, her baby and the midwives and other health workers.

What about the bringing support people to appointments?

Women are being asked to reduce the number of people they bring with them to antenatal appointments. In some cases they are being asked to not bring anyone at all.

The rationale behind this is to reduce the number of people entering the hospital facility, and thus reducing the overall risk to people who are attending or working there.

If women have telehealth appointments then they can have the people they wish attend, but must be mindful of social distancing requirements.

Where will appointments be undertaken?

Telehealth appointments make it possible for the women to stay in her home environment – thus reducing the risk of exposure as she does not enter the hospital.

Women already receiving care in the community would typically continue to do so unless they become unwell.

For face-to-face appointments with a clinical assessment requirement — we are working with health leaders to look at ways that we can increase the number of women who are seen in the community – either in their home or perhaps in a repurposed community hall, school, hotel, church etc.

This will take a rethink of the way that current services are delivered and a redeployment of staff to different models of care – but there are a number of very successful versions of this happening all around Australia that can be used as a basis so we are hopeful to see change in the near future.

Until change happens, all face-to-face appointments currently in a hospital or health service will likely continue to take place in hospitals.

However, these services are making lots of changes to reduce risk and increase safety for women that will differ at each site but may include:

  • spacing out appointments so that there is a gap between when women are seen to reduce them being in contact with other women
  • triaging women before they attend to ascertain their health.
  • taking temperatures at the door/before entry.
  • having a dedicated space for well women and another for ill women.
  • asking women to wait in their car till they are called in.
  • reducing the amount of time the woman is in the hospital.

What about ultrasounds and blood tests?

Pregnancy health care has been deemed as an essential health service. This means all aspects of routine care will continue – including routine scans and blood tests

The health care providers undertaking these assessments will be following clear guidance on ensuring safety and reducing risk of transmission

Optional ultrasounds such as 3D or 4D would not be classed as essential and are likely to be unavailable, and should be seriously considered by the woman before proceeding

If the woman is unwell when a test or scan is supposed to be undertaken, unless there is an emergency requirement for it, there is likely going to be a postponement until the women is well. Or it may be undertaken in a hospital environment where they have the systems and equipment in place for management of the virus.

This also applies to any referrals that the women may get to allied health professionals for support of her pregnancy – such as physios and dentists. If the work is deemed as essential for the health of the woman or her unborn baby e.g. maintaining good oral health in pregnancy is essential and women with poor oral health should see a dentist where possible.

Can pregnant women attend antenatal classes?

Due to the social distancing requirements and restrictions, gatherings greater than two people, including all face-to-face educational sessions will have been postponed or cancelled until further notice.

A number of providers are creating innovative ways to connect with prospective parents to provide education and support in an online format.

It may be possible to get antenatal education in a one-to-one setting. If you have questions, remember you can always reach out to your midwife or health care provider for more details.

Midwives are a fabulous source of information and this is a perfect time to arrange some good talks with your midwife – go prepared with all the questions you have. Maybe set up a telehealth session just for this purpose.

You can also take antenatal courses online.

Bernadette Lack, an ACM midwife in Victoria is offering free online antenatal classes here: www.facebook.com/events/589925751734702/

For more information on virtual antenatal courses, ask your midwife or health care provider or visit  Childbirth and Parenting Educators Australia (CAPEA).

American-based Evidence Based Birth has also developed a series of online resources to talk you through pregnancy and labour expectations. There will be elements not relevant to the Australian setting but the stages of labour are the same for women around the world.

How might COVID-19 impact your birth?

If you’re booking into services that offer home birth

Typically these women will continue to receive their care as planned.

However If the woman becomes unwell with COVID or COVID like symptoms then she will need to discuss options with her midwife.

Midwives might wear additional protective clothing during birth – such as masks and gowns (they already wear gloves). But these added precautions are typically only required for COVID positive or suspected positive women, and if they are birthing in hospital there may be no change to the home-based practices.

Women would be asked to be considerate when making choices about who would be with them, and whist there may be more than one support person they will need to consider their space they will be in and social distancing requirements, and whether the people they have in are well and healthy.

It will be best to discuss all of these things with your midwife.

If you’re planning to birth in a hospital

At this time births in hospital are occurring as usual

We are working with health leaders to look at alternatives for women including:

  • repurposing hotels as pop-up birth centres.
  • increasing access to birth-at-home services/options for women.

Both of these require a change in the way that health services run and deploy their staff. The existing private midwifery community is at capacity in most areas and so we need to find additional options for women. There are some existing well-structured and successful models around Australia we can use as the basis for this.

We would suggest that all women have a frank conversation with their midwife about what the hospital practices are and the alternatives.

At this stage it should be that if you are not COVID-19 positive or suspected positive that there are NO CHANGES to your options in labour.

What if you have COVID-19 during birth?

Women who are positive are likely to see a lot more health providers wearing personal protective equipment – gloves, gowns, masks, eye protection. They may also be asked to have a continuous CTG in labour and regular temperature and oxygen saturation checks. Their options for use of water – as a bath may be reduced/removed.

They should be able to use the gas and air and move around the room (although typically they will be required to stay to the room they are allocated to reduce the risk of transmission to other areas of the hospital).

However women will be asked to bring in just ONE support person, whereas before they may have been able to have more than one.

All women, regardless of their COVID status, should be able to have a healthy and well support person in labour with them.

What if you’re scared of going to the hospital?

The best thing women can do as a start is to talk about their fears and concerns with their midwife. It is possible that having that initial conversation can help the woman to understand her options and work through each of the elements.

If the woman does not like what is available to her at her current place of care then, like every element of health care, she has the option to look for alternatives.

Alternatives would be:

  • looking for a private midwife for comprehensive continuity care (antenatal, labour and birth and postnatal).
  • a private midwife who provides antenatal/postnatal care (where birth happens in the hospital or in a birth centre if available).
  • a public maternity service that has community-based maternity care options public or homebirth.

We really do not want women to feel that their only solution is to birth alone. So women should be letting health services know what type of services they want. The more women who put in requests, the greater the chance of change happening (it is amazing how powerful pregnant women are!).

What happens if the local birth centre is repurposed for COVID-19 births?

Do you have options to birth at home? I wold be asking about home birth options or whether the health service would be creating a pop-up birth centre at a local hotel.

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The Australian College of Midwives has more information on their website for pregnant women answering some FAQs. Visit www.midwives.org.au/covid-19-advice-pregnant-women

They are also running a survey about maternity care during the COVID-19 pandemic. They are looking to hear from women who are currently pregnant and living in Australia. They will use the information gained to inform discussions with government and key stakeholders about the needs of women and maternity services. Please share the link with anyone you know who is currently pregnant!

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