Issues from the maternity services front line. Protect maternity in the virus crisis

Since we posted our last blog we have been hearing from people directly involved with maternity care locally. Merseyside camapigners for good maternity care are not alone in sharing concerns about how maternity should be treated during the crisis. The Royal College of Midwives has published its concerns, saying “Help us deliver safe care for Pregnant Women.

This is the link to Liverpool Women’s Hospital public information as on 31st March 2020

Even without the crisis, too many babies nationally die at birth or shortly afterwards or sustain brain injury. It is right that we raise concerns at a time when staff are under great pressure.

Here are some of the issues raised locally during this crisis which is still in its early stages. We have raised these issues directly through questions to the board of the Liverpool Women’s Hospital. The Board is not meeting in public but we have submitted questions.

  1. Discharging babies

Delivery suite are needing to discharge women as soon as ossible after birth, for obvious reasons. However, each baby is required to have an Examination of the New-born prior to discharge. Pre the COVID-19 outbreak this was always performed in the community but that is now not possible, therefore it is now the responsibility of delivery suite midwives. However, most midwives are not trained in this. Delivery suite midwives are also needing to complete all the discharge paperwork. It would help the situation if staff who were trained in the Examination of the New-born were allocated to the delivery suite to do all the discharge work. Questions are being asked as to how can delivery suite (d/s) midwives be supported with this extra workload? For mums discharged home before having their baby examination completed they are bringing their babies back to LWH clinic to do this examination, but more staff are needed to do this.

2. Infants who would usually go to SCBU/NICU; because they need 3 hourly feeds / true blood glucose checks are now staying on the delivery suite and therefore the responsibility of the staff there. However, there is not the workforce on the delivery suite to do.

3. COVID-19 / COVID-19 suspected women are cared for on the delivery suite and looked after by the 1 clinician, this ensures social distancing as much as possible. Staff are to care for the women in 4hrly intervals but in reality, staff are working their full 12.5hr shifts with no break/relief. This ensures as few clinicians as possible are coming into contact with the women, however, this way of working is not sustainable long-term.

4 Personal Protective Equipment (PPE) is needed for staff looking after COVID-19 / COVID-19 suspected women. At present only flimsy plastic aprons, paper face marks and the usual plastic gloves are being provided. Staff are to remove all ‘PPE’ when they come out of a clinical room and return with a fresh lot of on. However there is not enough stock, particularly the paper masks, so the same face masks are being re-used when re-entering rooms and used for hours on end. Staff are not getting measured up for the proper COVID-19 protected masks, at present only for theatre staff where a woman/patient is COVID-19 positive are wearing them.

5. On Delivery at present, there is only 1 COVID-19 designated/converted room, a second one is getting sorted. It is important to know how many is the hospital planning on converting? Staff need to know how many pregnant COVID-19 women are they expecting over the next coming months based on Public Health England data.

6. The Clinical staff need to know how many babies are contracting COVID-19 from their mothers in the immediate post-natal period? What are the UK / local stats?

7. For women undergoing a general anaesthetic for a caesarean section when COVID-19 positive – what additional care is provided? Will it always be a consultant who anaesthetises the woman? Are consultant anaesthetists required to be on-site out of hours throughout the pandemic?

8. Staff until recently went home in their ‘dirty’ uniforms. Now this being stopped (thankfully) but not adequate changing room space/showers are available at LWH. There is 1 small locker room (far away from the delivery suite entrance) that staff are required to use, which means they have to walk the full length of the delivery suite in their ‘clean’ outdoor clothes to access the room. Only 1 shower is available, so staff cannot shower before leaving work. Also, the room is far too small for 13 or so members of staff to change all at once. More locker/changing room space needs to be provided for clinical staff.

9. Are Trust cleaning staff available to deep clean the clinical area/consultations rooms after a suspected/confirmed COVID-19 pregnant woman has attended? This is particularly problematic in clinic situations as the cleaning staff only usually attend after hours. Midwives at one Trust have been instructed to leave these rooms free for 20 minutes ‘let the dust die down’ (!), then perform 20 minutes of cleaning, then allow 20 minutes for the room to dry, other Trusts are instructing staff to leave rooms vacant for 4 hours.

Has there been any increase in cleaning staff and what training regarding the cleaning of clinical areas have Sodexo staff had re COVID-19? Particularly, given the long period that the virus is thought to remain active on plastics/wood/cloth. What are the procedures in place to reassure the public this is happening?

10. We hear that LWH is planning on suspending the home birth team, This would mean more women will be coming into the hospital, which is not a good move in this climate. Additionally, ambulances are under pressure but we are also hearing of other maternity units in the northwest being closed and the premises given over to Corvid treatment. Where possible home births should continue.  

11. Staff  are not clear who is eligible for COVID-19 testing – is it all staff or only those in contact with a confirmed COVID-19 patient? When will staff testing begin? And in what order of staff? Will it include ancillary staff?

12. At present, 60 staff (midwives/doctors)  are off – mostly related to COVID. Last week it was 42.

13. Regarding staff; what are LWH numbers of COVID-19 confirmed cases, suspected cases, staff returned to work cases, self-isolating because of a high-risk group, and come into contact with COVID-19 person?  

14. For patients what are numbers of confirmed/suspected cases?

15. How is patient crockery/cutlery being dealt with for COVID-19 patients?  There need to be disposable versions used. Midwives are taking responsibility for the cleaning of this.

16. Student midwives are remaining in clinical practice: Why?

a. There is mounting evidence that the clinical area is not a safe place i.e. not the required standard PPE for all staff or the optimum (even by pre-COVID-19 standards) staff: patient ratio, already the workforce is down / out of practice (self-isolating).

b. Medical students have been pulled from practice, why not student midwives (& nurses)

c. How is the Trust dealing with mentoring/ supporting students? We are hearing from the students that they are not getting adequately supported/mentored in practice, even already.  It has always been the case that students are taken out of clinical areas where this is happening. Why is this now not happening? The situation will worsen regarding supervision/mentorship. We are not yet at the peak of the crisis

d. Most midwives find mentoring students an extra responsibility. Is this necessary now? Is it not possible to pause all clinical learning and focus on theory only, this would be a far better option than putting students in an at-risk environment. Universities could front-load their learning with theory. Have the Trust considered this? In particular to ‘save’ the future workforce

17. Birth partners are essential for patients emotional and mental health support for every mum in labour. We know from the MBRRACE Report and our BAME community that given the raised risk for BME women the presence of support is essential. Yes, partners too might carry COVID-19. This is another reason to make maternity a key area for staff, patient (and partner) testing. It’s not a reason to leave a woman on her own giving birth in this high-stress time. The RCM supports birth partners being present. However severely restricting other visitors seems semsible and appropriate to keep everyone safe.

18.  Children seem  to be less susceptible to the coronavirus than older people There  is a detailed article on this here,  It is interesting that this work is being led in Liverpool.

There is only one chance at birth. Each birth involves two human lives. Defend maternity services, defend maternity staff, defend all our mothers, sisters, daughters, friends, and lovers during this crisis.

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