Expert / 26 December, 2020 / Dr Ellie Rayner
As a practising obstetrician working fulltime within the NHS throughout the pandemic, I completely understand how difficult this time has been for expectant parents and how going into a second lockdown may feel. Be reassured that all maternity services and staff are committed to providing safe and effective maternity care throughout the pandemic and are here for you day and night offering pregnancy support. I have included some important considerations for any expectant parent in light of the new lockdown restrictions and as we approach winter to help you stay safe and stay well during your pregnancy and as you approach birth.
If you are staying inside or not as active as you normally would be it is really important to make some small changes to stay well. Pregnant women are at higher risk of developing a blood clot, so keep as mobile as you can and make sure to drink plenty of water to reduce your risk.
All pregnant and breastfeeding women need 10 micrograms of Vitamin D every day to help keep our bones and muscles healthy and you should consider taking a supplement for this. Vitamin D is made when our skin is exposed to sunlight. Normally we only recommend this during the autumn and winter months when we cover up more or spend more time indoors, however, in light of the pandemic, as you may have spent more time indoors than normal this year, we would encourage you start taking this.
Vitamin D supplementation is particularly important if you have with dark skin (such as if you are of African, African-Caribbean or South Asian origin) or women who cover their skin for cultural reasons. Women who wear high factor sunscreen or who have a BMI >30 may also be susceptible to lower levels.
Keeping active and eating well are both important aspects of any pregnancy. Regular exercise during the pregnancy stages is important for both yours and your baby’s wellbeing. It can give you more energy, improve your mood and sleep and can help reduce your risk of developing raised blood pressure or pregnancy diabetes (gestational diabetes). It also helps you cope with labour and can make labour easier.
During lockdown, some of your usual classes or activities may be cancelled or limited, but it is important to try and maintain a similar level of exercise to what you were previous undertaking. Walking, jogging, at home aerobics or yoga are all safe. If you didn’t exercise very much before pregnancy, you can still start now with 15 minutes 3-4 times a week and increase as you feel able.
The flu vaccine is available free of charge for all pregnant women as pregnancy can alter the way our bodies handle viral infections, making a small number of women more susceptible to more severe infection. Both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives strongly recommend the flu vaccine to all pregnant women, particularly in light of the COVID-19 pandemic, as it is possible to get infected with both infections at the same time and this could cause a more serious illness. The flu vaccine is completely safe throughout pregnancy and your GP, midwife or Obstetrician can arrange this for you.
The coronavirus pandemic has inevitably had an effect on everyone’s mental wellbeing and anxiety, and this is likely to be the case for many pregnant women too. It is important to remember that this is a normal response to a difficult situation, however there are some things you can do to help you feel more in control.
Regardless of whether you are symptomatic of coronavirus, self-isolating or shielding, it is really important that if you do have any concerns about your health or pregnancy that you speak to your midwife or doctor as soon as possible. Maternity care is still essential, and the NHS is working hard to ensure that services are running and have safeguards in place to make sure you can access the care that you need when you need it. Please do not hesitate to call if you have symptoms such as pain, bleeding or not feeling your baby move as much as normal, your maternity unit will be happy to advise and see you where needed.
Preparing for labour, birth and the newborn period is a really important part of any pregnancy, particularly if you are first time parent. The COVID-19 pandemic has undoubtedly limited access to antenatal classes and expectant parent groups, however, there are still lots of options for you online and in the safety of your own home. As an obstetrician and antenatal teacher, I know how many questions you have and how many different choices you are going to be asked to make about your labour, birth plan and new baby and how overwhelming this can feel.
As always throughout your pregnancy and relating to any issues of health and wellbeing, it is extremely important to ensure the reliability of any information you access online or via social media. Here are a few general considerations to keep you and your baby safe:
Unfortunately, like all areas of the NHS, some maternity services have had to adapt and change the services they offer and the way they offer them in order to provide safe staffing for emergencies and to manage any additional pressures they may be under. All maternity services are dedicated to providing safe and effective care to all mothers and babies and to ensuring as much as possible women’s pregnancy and birth choices are maintained.
In some areas, maternity services have had to make difficult decisions to limit birthplace options, such as pausing home births. Whilst the majority of areas have reinstated these services this is an ever-evolving issue and it is important to stay up to date with the information being released by your maternity unit and to prepare for different eventualities. There are lots of ways you can personalise your birth environment to make it feel more familiar and safer for you, even if it isn’t your first choice birth place such as bringing your own music, using aromatherapy oils in an electric diffuser, bringing battery operated tea-lights and wearing your own clothes can help you feel comfortable and more at ease.
Most women will go into spontaneous labour at term, between 37 and 42 weeks of pregnancy. However, in the UK, approximately 25%, 1 in 4 women will have their labour induced. Induction of labour is the process when labour is started artificially, and this might be something you are recommended from quite early in pregnancy or something that comes up later due to a change in circumstances.
An induction of labour usually involves an initial period of time preparing the cervix which often involves some time spent on the antenatal ward as an inpatient. During this time, restrictions on birth partner attendance may be in place to help protect the safety of mother, babies, their partners and all of the hospital staff. These restrictions may vary from hospital to hospital, with some not allowing partners at all on the ward, some for a limited time during the day only and some may have no restrictions at all.
As with other aspects of life during COVID-19, these restrictions are changing all the time, so it is important to consider all of the scenarios and make different plans accordingly to ensure you are as prepared as possible for every eventuality. Regardless of local restrictions, you should be able to have at least one birth partner with you during labour and birth. If you are being induced and you go into active labour, or the maternity team move you to the labour ward or delivery suite for the next step in the induction, then you will be advised to call your birth partner for them to be with you to support you as long as they don’t have symptoms or have tested positive for COVID-19.
If you are having a planned Caesarean Section, commonly referred to as an Elective Caesarean, then this is usually performed under a regional anaesthetic called a Spinal. This works by numbing the nerves in your abdomen and legs, allowing a Caesarean Section to be performed while you are awake.
If this is the case, you will be able to bring a birth partner into the operating theatre with you to support you, as long as they don’t have symptoms or have tested positive for COVID-19.
If you are in labour and are recommended an emergency caesarean section or assisted vaginal birth in the operating theatre then, as long as this is also being performed under a regional anaesthetic, you should be allowed your birth partner with you. Occasionally, in some circumstances, you are advised to have a general anaesthetic, where the anaesthetist puts you off to sleep. Even in non-COVID-19 times, if this is the case, your birth partner is not able to be in the operating theatre with you.
The maternity staff are used to dealing with this situation and will make sure your birth partner is able to see you and your baby as soon as safely possible. After your Caesarean Section, you will usually be advised to stay in hospital for at least one night, however, most women who have an uncomplicated Caesarean Section can return home the following day providing they and their baby are well.
During this time on the postnatal ward there may be restrictions on the time your birth partner can be present and your midwife can explain what the current restrictions are and how long they expect you to need to remain in hospital after your birth based on your individual circumstances.
The really good news is, this time around, compared to previously, lockdown restrictions don’t prohibit postnatal mother and baby classes as the importance of finding a supportive postnatal network has been recognised. Classes such as baby massage are able to operate face-to-face in smaller groups so have a look in your local area if any of these are available for you.
If you need any further information about current recommendations and advice regarding pregnancy and COVID-19. Please see the Royal College of Obstetricians and Gynaecologists latest patient information.
Stay safe and stay well.
Dr Ellie Rayner, obstetrician and gynaecologist and founder of The Maternity Collective.