Last night the BBC Panorama with Stacey Dooley explored the experience of mothers giving birth during the height of the pandemic. I gave birth to my third child on 6th April 2020, two weeks after the UK was put into ‘lockdown’ in response to the unfolding global covid-19 pandemic. At this time the government had instructed all UK residents to ‘stay at home’ in order to limit the spread of the virus, to ‘protect the NHS’ and ‘save lives’. Although studies have not shown any greater risk to pregnant women from Covid-19, it is known that pregnancy can affect the way some women’s bodies respond to viral infections. Taking a cautious approach, pregnant women had already been categorised as in the ‘vulnerable group’ by the Government’s Chief Medical Officer on March 16th and advised to reduce their social contact with others through social distancing measures.
One of the most visible impacts of the coronavirus pandemic has been the sudden disruptions to established practices and routines in pregnancy and maternity care. Although the Royal College Obstetricians and Gynaecologists have worked hard in their attempts to provide as much continuity as possible, some marked changes were deemed necessary in order to manage the threat to safety of both staff and patients.
For example, some maternity units cancelled home births due to staffing and safety concerns, such as the lack of a guarantee that there would be an ambulance for transfer to hospital should complications arise.
Many medical consultations, antenatal classes and breastfeeding support groups were transferred from face to face to virtual appointments, to save NHS capacity, reduce unnecessary travel and minimise human contact. Those still requiring face-to-face appointments would be met by practitioners wearing enhanced personal protective equipment (PPE) – such as face masks, plastic visors, aprons and gloves – to prevent the spread of infection.
New rules were put in place to restrict the presence of birth partners and other family members at antenatal and postnatal appointments, and during childbirth. While typically most hospitals are currently allowing one birth partner to be present at the birth itself, restrictions have been put in place across the board preventing visitors to hospital wards.
Welcoming a new baby into the family should be an exciting, joyous and happy occasion, but even under more normal circumstances pregnancy, birth and early parenthood are highly emotive times, which can be accompanied by heightened stress and anxiety for some. For me, late pregnancy and preparing for childbirth under lockdown was stressful, the uncertainty giving rise so many new questions adding to my anxieties. With official guidance changing all the time, would my partner be able to be there at the birth of his daughter? Would I still be able to have a planned c-section? If not, would I have to labour alone? What would happen if I went in labour early? Who would look after my other children while we were in hospital without breaking lockdown rules at the time preventing different households from mixing? Would the police stop us on the way to the hospital to check if our journey was essential? How long would I have to stay in hospital for? Would the care I received be any different? And most anxiety inducing of all, would I be exposed to the virus?
In the days – and many sleepless nights – leading up to my planned admission into hospital I spent hours scouring the Internet for answers to my questions, finding many other women on message boards asking the same things.
Reading other women’s stories can be comforting and disconcerting in almost equal measure. While there have been plenty of positive stories circulating of happy mums and healthy babies, equally there have been as many distressing stories. There have been reports of women having to attend antenatal appointments alone, only to be given devastating news of complications or pregnancy loss. Women have shared their heart – breaking accounts of still births and anguish of delayed fertility treatments, while others going through surrogacy tell distressing stories of separation from their newborn children.
The night before my planned C-section all I felt was dread. I was terrified of going into hospital, having close contact with others, getting infected and bringing the virus home to my family. These same fears and reluctance for pregnant women to go into hospital have reportedly led to a rise in missed antenatal appointments and births taking place in the car hospital park.
During the final weeks of my pregnancy, all of remaining antenatal appointments were changed to virtual appointments. At the forefront of each conversation was Covid -19, and most of the time was taken up with staff checking that I didn’t have any symptoms of the virus.
Moves towards so called digital health or ‘e-health’ have been gaining traction for many years in different areas of medicine in order to improve access for hard to reach populations, to make efficiency savings and reduce demand for face to face appointments.
In addition, telephone triage services are already an established part of maternity care in the UK, where midwifes provide support and advice to pregnant women and manage access to maternity services over the phone, although there has been little research into this aspect of health service delivery.
However, the rapid reconfiguration of NHS services from face-to-face to online video consultations and telephone appointments in response to the pandemic has been quite remarkable, especially in primary care. Some GP practices for instance report that 99% of their work was transferred online allowing them to comply with the rules on social distancing.
Although I was grateful that the changes made meant I didn’t have to leave my home, the conversations I had with health care professionals during this period felt more rushed and impersonal than before. I felt as though I wasn’t able to properly talk through the procedure I was about to face or to formulate a birth plan with a professional. Concern seemed to centre on whether I was infectious or not, with other aspects of my maternal health falling aside. Downsides of virtual appointments have been discussed in depth, including possible interference in the relationships between patients and practitioners. That personal connection between practitioner and patient can become disrupted when meetings are no longer in person. Midwifery especially is such a tactile profession with the materiality of the pregnant body and its fleshy reality at the centre of interactions. After the telephone appointments I worried if my blood pressure was too high, whether I had proteins or ketones in my urine, whether my iron levels were normal, what my ‘bump’ was measuring – all of these things had seemed so important just a few weeks earlier.
It will be interesting to see if any of these changes to health service delivery remain in place in the longer term.
I arrived at the hospital on the morning of my daughter’s birth, feeling very nervous and still unsure of quite what to expect. My partner was allowed to walk me to the door of the ward where we said a quick goodbye and teary eyed, I was shown to a bed while my partner had to go and sit in the car and wait – for five hours – until it was my turn in theatre.
Staff on the wards and in theatre were all in plastic aprons, face masks and gloves, doctors had added plastic visors. There was a visible display of handwashing by every professional before and after visiting each patient. I was issued a face mask of my own to wear if leaving the bed space. Although I had been worried about being in hospital beforehand, I did feel safe there. The visibility of the measures that were being taken to prevent the inadvertent spread of this pathogen made the severity of the threat hit home, but also was reassuring in the sense that it seemed like everything possible was being done to protect staff and patients alike.
I walked down to theatre with a nurse in a facemask and plastic apron, arriving in surgery to be greeted by the medical team all in full PPE. My partner appeared amongst the mass of people, and I almost didn’t recognise him at first, dressed in scrubs and hidden behind a face mask. It all felt a bit surreal.
Concerns have been raised about disruptions to communication because of PPE, particularly for those with hearing loss who rely on lip reading to communicate. Even without hearing loss, I found it difficult to hear exactly what anyone was saying to me through the face masks and plastic visas or to tell who was who. I wasn’t able to see their faces or read their facial expressions, voices were muffled. It is amazing how something as simple as a smile can put a patient’s anxieties at ease. I wasn’t asked what I wanted to happen nor given the opportunity to follow my birth plan for a natural c-section and immediate skin to skin with my baby. It seemed as though everyone wanted the procedure to be over as quickly as possible, and in that moment the safe delivery of my baby was all that seemed to matter to me too.
My partner got to see our daughter’s birth and stay with me in the recovery for around 15 minutes before being asked to leave and my newborn daughter and I were wheeled back to the maternity ward to recover.
The mood on the maternity ward was friendly and calm, I spent a lot of time talking to the three other new mothers on the same bay as me and to the nurses and health care assistants. It felt as though there was an immediate, albeit temporary, bond between the four of us women on the bay that day, living through a shared experience. The sounds of video calls introducing new babies to their siblings and extended families replaced the chitter chatter of visitors. One of the unexpected positives of the visitor ban for me was how peaceful and private the maternity ward felt in the absence of visiting family members and the hustle and bustle of their comings and goings.
Angela Barry, a midwife in a London hospital, writing about her experiences of the postnatal ward during the pandemic in The Guardian, reached a similar conclusion. She writes how she has observed women sharing birth stories with one another and helping each other with breastfeeding, building, as she puts it “a spirt of female empowerment and togetherness” in a way she “thought was a thing of the past”. She comments that, at her hospital at least, they may consider making changes to visiting arrangements post-pandemic.
The rest of my time in hospital passed in a bit of a blur, aided by the diamorphine and sleep deprivation no doubt. Discharge felt very hurried, just 30 hours after giving birth I was in the car on the way home.
One of the most enjoyable parts of early parenthood is bringing the new baby home from hospital and to meet siblings, grandparents, family and friends. For those of us giving birth during the lockdown and those with young babies, this was another major disruption to how we had imagined things. Earlier on in the pregnancy I had envisioned a steady stream of visitors coming for cups of tea and cuddles with the new baby. I had expected to be spending lots of time outdoors with friends who are also parents, sharing cake and stories of sleepless nights, going to baby groups and meeting other new parents, building our social networks. This has been replaced by video calls and socially distanced greetings in gardens and doorways, grandparents getting their first glimpses of their new grandchildren through screens and windows. As the old saying goes, it takes a village to raise a child, a consequence of lockdown rules on social distancing is the physical separation from our ‘villages’, leaving new parents without vital support networks.
Concerns have been raised about the impacts of social isolation due to the lockdown on parents and children, in particular in relation to mental health. The Parent – Infant Foundation for example, surveyed 5000 new parents as a part of Infant Mental Health Awareness week, reporting that they perceived their babies to be more clingy than usual and crying more.
In addition, there are lots of reports of grandparents in particular finding this physical separation difficult. Grandparents have expressed a real sense of ‘missing out’ not being able to cuddle their grandchildren, get to know them, bond with them and be there to witness them growing from tiny babies into independent little people. Indeed, when the daily government coronavirus briefing changed format at the end of April to allow members of the public to question ministers, the first question was from a grandmother asking ‘when can I hug my grandchildren again?’ The intensification of the grandparenting role over recent years has begun to attract sociological attention, with these intergenerational relationships shown to have positive benefits on wellbeing and longevity. As the lockdown eases in England, some families have been reunited. However, many families are still waiting. The social distancing measures imposed on us due to Covid -19 thus, may have far reaching implications for all members of the family.
These are just some of the things that have struck me related to my own experiences of pregnancy, childbirth and early parenting during this extraordinary time. I wonder which, if any, of these changes should become a part of ‘the new normal’ as society continues to respond to the threat of the virus – and will any of these changes be here to stay as the pandemic abates?
Written by Dr Catherine Coveney