One chance at birth. Protect maternity services in the crisis.

Maternity care and women’s health require an excellent response to the Coronavirus outbreak. Virus or no virus, there is only one chance of birth. Two human lives are involved in each birth. There should be no short cuts during this crisis. Services for women and babies were already in trouble before the virus. The Royal College of Midwives has called on NHS leaders to ”protect the safety of pregnant women by ring fencing maternity services in the current crisis

While other areas of the health service can postpone and cancel procedures, there is still an ongoing need for maternity services. Women are still pregnant, still having babies, and they need the care and support of properly resourced maternity services. We have to ensure that midwives and maternity support workers are ringfenced from any redeployment to ensure that women continue to receive safe care.

Over a fifth (22 per cent) of survey respondents also reported that local midwife-led maternity units had been closed, with more than a third (36 per cent) of areas also either stopping (32 per cent) or restricting (four per cent) homebirths. In 11 cases the midwife-led unit has been closed to provide facilities to assess or care for coronavirus patients.

We need careful professional responses, careful supervision of new and inexperienced staff, and good supplies of personal protective equipment and good supplies of ventilators and we need testing of staff and patients for the virus. We need meticulous recordkeeping so long term effects can be traced

The response of NHS front line staff, of volunteers and returnees to the professions has been outstanding. They are saving thousands of lives by their response. It is right that the nation clapped them on Thursday!

NHS staff kept the NHS afloat through years of cuts. Staff worked a million hours per week of unpaid overtime. Their last pay deal was such a disaster that the RCN apologised for advising staff to accept it. More than a million volunteers also helped out in the NHS even before the recent call-out

Even before the virus there was a dire shortage of midwives. The Guardian is reporting that the midwife shortage has doubled as NHS staff are diverted to tend to Corvid patients.

Reports have come in of the first deaths from the virus working surgeons in the NHS. The NHS staff are putting themselves on the line for all of us. We must protect them too, by demanding better equipment and more testing.

Sadly, the main organisation of the NHS, in contrast to the workforce, has been found seriously wanting. “When this is all over, the NHS England board should resign in their entirety.Lancet  The culture of doublespeak and the use of soundbites has not changed. Staff still fear to disagree with management, whistleblowing procedures are poor. Annual surveys show staff unsure of their managements. In some hospitals, we hear of bullying by management happening even as the virus rages

The most up to date advice for pregnant women found whilst writing this article for pregnant women and pregnant NHS professionals are found here for professionals and here for parents. “ Our advice remains that if you feel your symptoms are worsening or if you are not getting better you should contact your maternity care team or use the NHS 111 online service / NHS 24 for further information and advice.”

The Lancet voice has a useful podcast on Corvid Virus and pregnancy. In this podcast doctors dealing with pregnant women and new babies speak from the virus outbreaks in China, Italy, Spain and other counties sharing their experiences.

In Italy, Spain and France numbers of the dead are growing and medics are amongst the dead. We send our solidarity and sympathy but know we are not far behind if the virus continues in the same way here.

Current research shows that Pregnant women are not more severely affected by the virus. There is no evidence of vertical transmission from other to baby, so far. Mothers in labour are still advised to bring a birth partner but only one. Visiting has been restricted to reduce the amount of virus coming into the hospital Advice from Liverpool Women’s hospital is to be found here

Pregnant women over 28 weeks are advised to self-isolate

Save Liverpool Women’s Hospital is a campaigning organisation trying to save Liverpool Women’s Hospital, to campaign for better health care for women and babies and to defend and win back the NHS. We have been campaigning for five years and learned a lot about how the NHS works now, how it used to work before 2012 Act, how the NHS was originally designed to work, and how it has been damaged.

At the last local CCG meeting, one of our campaigners tried to persuade them to take more time to plan the Corona Virus crisis but was unable to do so. They discussed the reorganisation of the CCG instead. When our campaigner raised the issue of migrant access, she was told there was no problem with people being afraid of charging. She then raised the example of the three mums dead from fear of migrant charges. Still, no action was suggested. You can hear a detailed report in the second part of this podcast here

The role of CCGs seems to change quickly. All commissioning for the crisis was taken off the last week but now some claim to be trying to source PPE. And some are gaining praise for their efforts. What is happening?

Fundamental changes in the CCG network have been underway with mergers and changes to adapt to the new STP/ Integrated Care networks 44 areas of the NHS. A summary of changes can be found here

A huge amount of money is allocated each year to the NHS. That pipeline of money is siphoned off by business and financial consultants who are restructuring the NHS on US models The process of making the NHS reflect the US model is well underway and must be reversed. Infant and maternal mortality in the USA is dreadful

Testing, Testing, Testing .In this crisis, we need testing for mothers and staff. A gaping hole in the UK response is the lack of testing, mapping, tracking and isolation.Maternity is the largest reason for healthy people to use hospital facilities, yet neither staff nor patients are tested for the virus. Personal protective equipment is as short in maternity hospitals as anywhere else. It is impossible to know who carries the virus in the non-testing environment.

The experience of giving birth safely and happily is a human right and one our campaign will always defend.

Different parts of the country are experiencing different levels of infection. The most up to date figures are here Liverpool is still not a leader in the infection but the Northwest is a growing hotspot behind London and the West Midlands. The public good, not private profit must drive this response.

Public good and public service is the best way to provide health care. It is more efficient and efficacious than for-profit companies. PFI was and is a disaster.  It is important to remind people of Carillion’s nonsense, remind people how campaigners fought to prevent the PFI and the contract being given to Carillion. Liverpool faces this crisis with a broken half-built hospital because those who run the local NHS allowed PFI and then let contractors work unchecked. Remember all the outsourcing nonsense? Carillion, Interserve etc.? All the reduced wages and reduced service levels, reduced sick pay rights? Remember companies who took on services they failed to effectively deliver, remember the cut wages and sick pay?  Remember the companies like Carillion who either went bankrupt or restructured their debt

An Interserve Executive is being given the task of organising mass testing for Corvid 19, the Corona Virus. Interserve! Not public health, not even the NHS, Interserve. In this current Corona Crisis, who would you want to administer widespread testing when it finally is ready? Would you give it to a skilled, well educated public health service, or would you give it to an outsourcing company recently in dire financial trouble

We welcome any increase in testing but it has to be conducted well under rigorous conditions. The CV of the woman chosen, comes from Interserve? Really? Not a professor of public health? Not a public health practitioner? Not an epidemiologist?

 Women are at the heart of this crisis in the communities.

Women are at the heart of the social crisis around this virus. Most key workers are women, many of whom have young children and are many single parents. Many have caring responsibilities for older family members too. Contact out in the community is going to increase the key workers viral loading as they meet more people. Only the most obviously ill patients are being treated in hospital, so most of the virus is in the community, including in care homes and mental health facilities.

 Most of the additional informal care at home is falling to women in the community. With one in five workers expected to get sick, the pressure on women will be immense. Domestic violence  is increasing under the lockdown internationally. Pregnancy sadly is a peak time for domestic violence, All services must be aware of this and the government should intervene as the Spanish government has done. Disgustingly a UK boxer even filmed a tutorial telling men how  to hit their girlfriends during the lockdown

The Coronavirus is an equal opportunity killer but men are slightly more likely to die from Corona. Most people who have died are older rather than younger and most have other illnesses. Multiple illnesses amongst older people are itself a result of poverty and inadequate health care. People who live in poor areas have 19 years more ill-health than those in poorer areas and this is reflected in maternity outcomes too

The building sites across the country who are still working, not respecting safe distancing, are not going to help the figures for male illnesses. These men by and large will go home taking their acquired virus load with them.

Our concerns around the virus extend to babies and young children. Babies and young children seem to resist the virus better than older people but many children are already weakened by poverty. Liverpool has far too many underweight babies born reflecting the poverty of the area. Child poverty in Liverpool is a scandal but one that will get worse in this crisis Far too many babies in Liverpool are dying under one year old with at least one in three directly attributable to poverty

Mothers and babies in the UK have not had the best possible service from the NHS and life expectancy and healthy life expectancy for women have been falling

The worsening of Infant mortality over the last number of years is spelt out, in detail, by Danny Dorling

These developments mean that the UK as a whole now has one of the worst IMRs in Western Europe, falling behind the EU average of 3.6 per 1000, and ranking 25th of the 42 countries with available data for 2017.16 This is a marked change since 1990 when the UK had the seventh best neonatal mortality record in Europe and was even better, relatively, before that.17

Women are at the heart of the  family money issues in this crisis.

 “Making the household budget stretch even further when there is less money and more mouths to feed more hours of the day”

Many women are caught in low pay in the economy at large and in the low paid end of self-employment.  Women comprise 34% of self-employed workers, most of them on the low paid end of the pay structures and will be dealing with all the complications of this.

We heard (Shock! Horror!) that in Italy, such is the extent of the epidemic that patients are being treated in corridors. We were in this situation even before Corona fully hit us. A situation caused by policies like closing beds and hospitals, like diverting much-needed funds to for-profit companies, like not training enough doctors, nurses, and midwives and making the burn out rate soar in the NHS.

The NHS was woefully underprepared for this crisis. All the years of cuts, understaffing, burnt-out staff, bed closures and post-2012 reorganisations were bad enough.

The lack of preparation for a pandemic was even more unacceptable The Lancet, the doctors’ paper agrees with us “The NHS could have prevented “chaos and panic” had the system not been left “wholly unprepared for this pandemic”, the editor of a British medical journal has said.

The shortage of materials for NHS staff is directly down to political and financial decisions the Guardian reported here.

The NHS used to have a national procurement body but it was outsourced and run in some way by DHL, who has since lost the contract despite the boasts in this posting. Jobs the national health service could do, the private sector failed. A new supply chain body was set up in April 2018, making grand claims of new efficiencies but somehow its got this crisis all wrong.

The NHS was woefully short of beds and staff

The Kings Fund reports that

The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2018/9, while the number of patients treated has increased significantly.

We need old fashioned public health services. Dr. John Ashton, a Liverpool based  public health expert has gained publicity for his challenge to the government over this crisis. He  wrote in 2016 ” The state of public health services in England – why hospital physicians should be worried”

In this Coronavirus Crisis, we urgently need (but are being denied) old fashioned public health measures deliver by skilled experts. Much of public health has been decimated by local government cuts in this era of Austerity.  In 2017 John Middleton wrote” There is a high burden of preventable disease and unacceptable inequalities in England” Across the world, and for two centuries it has been recognised that humans living in close proximity to each other, need well organised public health services.

In Liverpool, we rightly commemorate the work of Kitty Wilkinson who set up the first wash house during the 1832 Cholera epidemic in the city. Similar solidarity action today, across the area, is providing formal and informal support within our communities in the crisis of hunger and poverty and this new  virus crisis. If Kitty could intervene all those years ago should not pandemic precautions have been in place today?

Picture from Liverpool Express

Our campaign calls for testing in the population. We agree with the WHO. The World Health Organisation, (WHO) say “Test, Test, Test”. Using the WHO recommendations, some countries have defeated the virus at least in its early presentation. What happens when the virus crops up again we still do not know, we do not know how long immunity to the virus will last or how the virus will react in different seasons. But for now, China, South Korea and Singapore appear to have defeated the virus .unlike the UK and Europe.

Maternity services need widespread coordinated public testing as much if not more than any other section of the NHS. Public testing could dramatically reduce the number of infected cases and let staff know when they are dealing with someone with the virus, even if they are  symptom-free. Testing and isolating reduces the number of infections

Aggregating across all individuals and under the optimistic assumption that all the contact tracing can be performed rapidly, we expect contact tracing to reduce the basic reproductive ratio from 3.11 to 0.21—enabling the outbreak to be contained,” they write. “Rapid and effective contact tracing can, therefore, be highly effective in the early control of covid-19, but places substantial demands on the local public health authorities.”

Professor Allyson Pollock quotes this in this article where she argues for widespread testing

Universal healthcare for all .As well as calling for testing we call for universal access to healthcare. For the NHS to be safe for all it needs to be available to all.

Think of the three mums who, thinking they could not afford NHS treatment for maternity, died last year from lack of care. Even today across Merseyside hospitals posters warn patients they might not be eligible for free NHS treatment

Will everyone who fears the virus dare to go for treatment? Mum and baby and everyone they meet are at risk, unless healthcare is universal.

The Government have said all Covid treatment has to be available to all

This means, as, for any other infectious disease in Schedule 1, there can be no charge made to an overseas visitor for the diagnosis, or, if positive, treatment, of this coronavirus.

  • No charge applies to a diagnostic test even if the result is negative. No charge can apply to any treatment provided for suspected COVID-19 up to the point that it is negatively diagnosed. t is very important, for public health protection, that overseas visitors are not deterred from seeking treatment for COVID-19. Please ensure that overseas visitors are not charged, or informed that charges may apply, for the diagnosis or treatment of the coronavirus
  • : patients that are known to be undergoing testing and treatment for coronavirus only are not subject to Home Office status checks

Portugal has offered to treat all migrants as residents during the crisis. The UK should do the same

Can we keep maternity hospitals free of the virus?

In Italy, doctors have described key tasks for the hospitals

Over the last fortnight, Italian hospitals rapidly restructured to achieve complete segregation of covid-19 positive and negative patients. Using designated “clean” and “contaminated” areas, this flow is maintained from presentation to discharge.

It is hard to see how this Italian model can work in maternity without testing of staff and patients. The assumption is that the maternity hospital is a “clean” area and the Corvid will be kept out as much as possible, but while Corvid in the population, corvid is in the maternity wards.

The nation clapped the NHS workers who are struggling to prevent both huge numbers of deaths and to stop the NHS being overwhelmed. The NHS is, just about weathering the storm of Corona (as this is written) but at a dire cost Crucial life-improving, pain-relieving, surgery, like that for endometriosis, and in some cases even cancer treatment are being postponed or cancelled to allow the NHS to manage a pandemic, that was well predicted and whose numbers could have been far better managed..

This pandemic was not a bolt from the blue. Serious scientists, who should have been heeded, predicted it. The literature showing that the pandemic was predicted and that proposals to address it were prepared is extensive but this is a useful summary This also gives detail on international discussions

Nor is this pandemic non-political. It was political choices that landed us in this situation. We had six weeks lost in preparation thanks to this inept government. Testing, mapping, tracing and an earlier lockdown of the population could have saved many lives.

The issue of understaffing in maternity and other areas of the NHS had caused political uproar. Many different enquiries in to maternal and infant deaths have been held See our detailed article here. It is good that more NHS staff were beginning to be recruited even before the crisis and great that that thousands of doctors and nurses have come back to the NHS to help.

The NHS met this pandemic under-funded, understaffed and under-equipped Basic commissioning of equipment and services has failed in the current NHS structure

Personal Protective Equipment is lacking so our NHS staff are at risk from, and present a risk to, patients Personal protective equipment should have been both stockpiled and immediately recommissioned once the WHO warning came out 6 weeks ago. There are small clothes making factories even in Merseyside who could have been commissioned to produce materials

Midwives too have reported shortages of PPE. One report was of midwives being told at what stage of Labour they are to use PPE. The nursing and midwifery council have added their voices calling for PPE for nurses and midwives.

The futile palaver over the shortage of ventilators, over losing an email offering EU cooperation, and getting newly designed ones created from Dyson is more public schoolboys playing games. There is an existing model. Reproduce that at scale or make minor improvements if necessary.

The decision not to buy in advance, not to stockpile was political. It was a political decision coming out of a political context of shaping the NHS as a commercial operation designed for the well being of big corporations.

Each huge accountancy and consultancy organisation in the UK “advised” the NHS and was well paid to do so in the run-up to the car crash that is pandemic preparedness. Breaking the NHS into 44 areas, into local CCG areas has all contributed to the mess.

Reports from China showed no enhanced risk to pregnant women or their babies from the virus, though there were slightly more premature births. There are some reports from the US  who are now reporting larger numbers of virus sufferers, of women giving birth in unusual rooms and of inductions to free up space.

Those with existing family responsibilities are more likely to have exposure to the virus. Women present in the hospital to have babies as the largest cohort of healthy people to use the NHS.

Personal distancing between staff and delivering mum is not possible in the Labour Ward or the delivery suite. All the virus that staff carry can be transferred to the mum, all that the mum carries to the staff. In normal times no one wants a midwife dressed as a spaceman with huge PPE but right now PPE is needed.

Staff and patients in maternity should be tested for the virus, and records should be kept.

Student midwives in their final year are being brought into hospitals to help with staffing levels. The shortage of midwives, of course, predates this crisis and will remain after it. Our campaign has long called for, full bursaries, and full pay whilst training, more training place for midwives. We want no reduction in the quality or quantity of midwife training and education, but a steady ramping up of provision. Student midwives and inexperienced midwives need supervision as they practice, as they work with the mums. That is how the skills are honed. We need too to retain the young obstetricians and gynaecologists. Up to 40% of young doctors were “taking a break at the end of foundation training”

It will be tough for everyone coping through this virus.

Let’s build an NHS without the privatisation, without the financial consultants, one fit for all our babies. One where what NHS administrators say is not from a spin-doctor but from reality,  An NHS without bullying. An NHS were young and old midwives are happy to work, one where young doctors feel valued and well cared for.

For all our mothers, daughters friends and lovers and for every baby. Let’s build the NHS afresh from this crisis.

2 thoughts on “One chance at birth. Protect maternity services in the crisis.”

  1. That this is a Heavy Tome, and thanks to all who have brought it together, speaks volumes of how women’s health is an afterthought. Applause to ALL who work in the NHS & Social Care 👏👏👏for stopping the ship from sinking. 😭😩 We requure a fully funded health service, the sign of a civilised society, that protects all human beings & doesn’t discriminate. 😊👍🌈☀️

    Like

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