V1.5 29.9.20

Maternity care during the Coronavirus outbreak

Information for service users

Surrey and Sussex Maternity Care

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This patient information resource has been created using the best, evidence-based guidance that we have available to us at the time of writing. We will update the electronic resource held on our SASH maternity website with any newly emerging national guidance as it arises. 29/9/2020

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This leaflet provides you with information regarding the adjustments to your maternity care during the Coronavirus outbreak.

We are working hard to ensure that you continue to receive safe and supportive maternity care during your pregnancy and birth. You and your family are at the heart of every decision that we make.

We know that you will be worried about what the impact of this virus means for you and your baby. The evidence we have indicates that if exposed to coronavirus, pregnant women are unlikely to experience severe illness and that you will instead have only mild or moderate flu like symptoms.

If you have a high temperature, a new persistent cough, or a change in normal sense of taste or smell then please stay at home and call our maternity triage 01737 231764 for advice. If you are not able to get through to someone on this line then please call 111.

We recommend that you follow government advice to stay at home, which means:

• Only go out for food, health reasons or work (if this can’t be done from home)

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• Stay 2 metres away from other people • Wash your hands as soon as you come home,

before preparing food and eating. • Wear face coverings as per Governmental

Guidance.

If you are a key worker as deemed by the Government and are pregnant please seek advice from your employer about attending the workplace.

For the most up to date, evidence-based responses to the most commonly asked questions of pregnant families or new parents, we recommend that you visit:

https://www.rcog.org.uk/en/guidelines-research-services/ guidelines/coronavirus-pregnancy/covid-19-virus-infection- and-pregnancy

This leaflet will provide information on our adjusted service and how this may impact you. If you have any further questions that are non-urgent please do one of the following:

• Email sash.sasha@nhs.net • Contact us via social media @sash_maternity_

*we will endeavour to respond as soon as possible but please be aware that we are experiencing a high volume of enquiries.

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Community Midwifery Appointments If you are newly pregnant, you no longer have to see your GP and can self-refer to maternity care using our online self-referral form. This can be found on our maternity internet page: https://www.surreyandsussex.nhs.uk/our-services/a-z-of-services/maternity-services/ Your first midwife appointment “booking appointment” may be undertaken over the telephone or face to face. This phone call will likely last around an hour during which we will ask lots of questions as well as sharing some advice with you. Part of this advice will be in relation to the early pregnancy screening tests that we will provide should you choose to have them. A video resource is available on our maternity internet page for reference in advance. Following your telephone booking, an appointment will be arranged for you to have your first scan.

If you have a high temperature, a new persistent cough, or a change in normal sense of taste or smell then please stay at home and call our maternity triage 01737 231764 for advice. If you are not able to get through to someone on this line then please call 111.

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1 x birthing partner can attend the antenatal scans with you. They must be well with no symptoms or a positive test for Covid-19 and be wearing a face covering. No children are permitted. Please attend alone for your antenatal appointments unless you need support from a carer. Your 16 and 38 week appointments may also be provided virtually by telephone or face to face. We are working towards ensuring all of our contacts are face to face and hope to achieve this very soon. Your 28, 32, 36 and 40 week appointments will all be face to face in one of our antenatal clinics. We respectfully ask that if you are feeling unwell or another member of your household is or has recently been unwell with a temperature, persistent cough, or a change in normal sense of taste or smell that you follow government advice to stay at home. This is to protect your pregnant peers, their families and our healthcare workers. Please call your midwife to arrange an alternative appointment and we will continue to support you. You will be offered routine testing for coronavirus if you are being admitted to hospital or if you are very unwell. Please attend your antenatal appointments alone and at your allotted time. Partners, friends, relatives and

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children will not be admitted into the building unless they have a carer role. 1 x birthing partner can attend the antenatal scans with you. They must be well with no symptoms or a positive test for Covid-19 and be wearing a face covering. No children are permitted. We are aware that the new visiting policies might feel uncomfortable, but please know that we have implemented them for your safety and in line with government advice.

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Your Doctor Appointments Your midwife will be able to advise you of your personalised care plan when she meets you at your booking appointment. This will include the pathway of appointments that you will receive including doctor appointments and scans in addition to your routine appointments. If your medical history or current pregnancy means that you are having shared care with a midwife and an Obstetrician, you may have either a phone appointment or still be required to attend a hospital appointment. You will receive a phone call to confirm the date, time and location of your doctor appointment.

If you have a high temperature, a new persistent cough, or a change in normal sense of taste or smell then please DO NOT ATTEND YOUR APPOINTMENT. Please call the department you have your appointment for advice. Please attend alone for your antenatal appointments unless you need support from a carer.

You may be required to start medication after your booking appointment if you have any known risk factors for developing pregnancy related complications. A prescription for this medication will be arranged for you to collect from your local pharmacy.

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Your Scans

If you have a high temperature, a new persistent cough, or a change in normal sense of taste or smell then please DO NOT ATTEND YOUR APPOINTMENT. Please contact the department for advice.

1 x birthing partner can attend the antenatal scans with you. They must be well with no symptoms or a positive test for Covid-19 and be wearing a face covering. No children are permitted. If you require additional scans to the routine screening tests which are around 12 and 20 weeks, your midwife will inform you of the adjusted scan schedule at your booking appointment. These will be specific to your individual needs.

Urgent Care If you are concerned about you or your baby’s wellbeing, then please call a member of our team on 01737 231764. We are her for you and your baby 24 hours a day 7 days a week and want to hear from you. You will be given advice to attend for review only if we feel that is the safest choice for you and your baby.

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Alternatively, a midwife or doctor may be able to advise you over the phone. If you need to attend the Antenatal Day Unit at East Surrey Hospital please attend alone, unless you require the support of a carer, at the time given to you. You will have your temperature checked and be asked regarding any coronavirus symptoms on arrival.

Antenatal Classes Following government advice, we have suspended all group sessions and will not be providing any tours of the hospital facilities. We are working to prepare video resources for you to use. Please check our maternity internet page for these, including a video unit tour. A list of useful, evidence based online resources can be found at the end of this document.

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Care in Labour When you are experiencing signs of labour at home, please call our maternity triage on 01737 231764 for advice. We will continue to do everything that we can to respect your birth choices. Very few of our birthing options have been impacted by coronavirus. We have to limit you to one well birth partner during your active labour and birth.

Homebirths Our Homebirth Team continue to offer place of birth choice at home. If you are interested or wish to know more about Homebirths, please either email the team Homebirth.homebirth@nhs.net, see our website or see our Homebirths Instagram Page – sashhomebirth.

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Birthing Unit We have a very wonderful birthing unit that we aim to make a home from home environment, with pull down double beds, birth pools and minimal medical equipment inside the rooms. All of our rooms in both the delivery suite and birthing unit have blinds and lights on a dimmer setting, together with balls and mats and are your spaces to use to create a positive birth environment. Please see our positions in labour video on our internet and our unit tour video for more information. We maintain the highest levels of sanitation in the hospital and will keep you protected from the coronavirus during your inpatient stay by isolating anyone with symptoms and restricting visiting on the wards.

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Your midwife will wear additional protective clothing including a face mask and apron during your birth. We want you to know that we are smiling under the mask. You will be cared for in a room isolated from other members of the public, but with the continuous support of our midwives and doctors. We have introduced new emergency protocols to follow When caring for a person with symptoms of and those that have confirmed coronavirus. These involve putting on new protective equipment. This can cause a delay as

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people get used to quickly putting on protective clothing during an emergency.

Pain relief in labour We still have all forms of pain relief available to women who do not have any coronavirus symptoms. We have 4 birthing pools available for hydrotherapy and water birth. You can still use Entonox (gas & air) and have an epidural or spinal if required. Mobility and massage is also encouraged, as with all of our births. Please be aware that if you choose to have an epidural during labour then you may experience a delay in this being available to you while our anaesthetic services are under additional pressure in the hospital. If you are symptomatic of coronavirus, then you will not be able to have a waterbirth. For further information on pain relief options, please visit: https://www.labourpains.com/home

Induction of labour If you are booked to come into hospital for an induction of labour you will be asked to call at a designated date/time in advance. The midwife will inform you of

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the current bed status and the time that we would like you to attend. We offer both inpatient and outpatient induction pathways. Information about the induction process will be provided by the midwife or doctor when they book your induction and will be personalised to you. Please attend your induction appointment alone unless you require the support of a carer. 1 x birthing partner can schedule a visit for 1 hour per day on the Antenatal ward (Rusper). They must be well with no symptoms or a positive test for Covid-19 and be wearing a face covering. No children are permitted. To book the 1 hour scheduled visit, please contact the ward directly. Your birthing partner must be the same person throughout the duration of your inpatient stay. If you remain inpatient, your birth partner will be invited to join you when your active labour has commenced.

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Planned caesareans births If you are booked to come into hospital for a planned caesarean birth you will have a pre-operative appointment within 3 days of your birth. At this appointment you will be advised of a date and time to attend the hospital for your birth. We ask for your patience and understanding that this date and time may be subject to change in the interest of maintaining your safety and facilitating our service at this challenging time. You will be limited to one well birth partner during your birth. Your birthing partner can remain up to 1-2 hours following the birth in the recovery area.

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Your postnatal stay If you have an uncomplicated birth and are deemed fit for discharge, you and your baby will be able to go home at around 6 hours after birth. If you require any additional support, including learning to feed your baby, then you will be admitted to the postnatal (Burstow) ward. You will be cared for in a shared bay with other well women. Any women symptomatic of coronavirus will be isolated in another area. If you are symptomatic of coronavirus, you and your baby can remain together. We recommend that you take precautions and will receive advice on this. There is no evidence that the virus crosses into breastmilk. What we do know is that breastmilk can provide protection against many other infections. The well recognised benefits of breastfeeding far outweigh any potential risk of coronavirus transmission. You will be supported with your feeding choice during your hospital stay. Your birth partner will be asked to return home when you transfer from the delivery suite. We are sorry for any distress that this may cause, it is in the interest of your family’s safety.

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1 x birthing partner can schedule a visit for 1 hour per day. They must be well with no symptoms or a positive test for Covid-19 and be wearing a face covering. No children are permitted. To book the 1 hour scheduled visit, please contact the ward directly. Your birthing partner must be the same person throughout the duration of your inpatient stay. Please attend alone for your antenatal appointments unless you need support from a carer. We understand that this will be very difficult for you at such a special time for you and your family. We are working to introduce new electronic resources to allow you to stay connected during this time and will advise you of these when you arrive on the postnatal ward.

Your hospital stay During your stay, you are respectfully asked to avoid close contact with anyone other than the staff caring for you. In public places, please wear a face covering as per governmental guidance. In line with government advice, the hospital canteen has been closed to the public. Therefore, please ensure that you bring snacks and anything that you require for your

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inpatient stay with you. You will be provided with hospital meals during your stay. We are happy to be able to continue to support the presence of birthing partners on our delivery suite and birthing unit.

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Your postnatal community care Your first midwife appointment and any non-routine appointments will be provided in your home. Please ensure that you have adequate ventilation with windows open before the midwife attends, and that visitors are restricted to immediate family only. Your midwife will be wearing PPE – including a face mask, apron and gloves to your home contact. Your day 5 and discharge appointments will be face to face in a maternity clinic in most cases. Your midwife or midwife support worker will call you to arrange a date and time for these appointments.

If you have a high temperature, a new persistent cough, or a change in normal sense of taste or smell then please DO NOT ATTEND YOUR APPOINTMENT. Please call the department you have your appointment for advice.

Please attend alone for your postnatal appointments unless you need support from a carer. If you are unwell, we will arrange care for you and your baby at home where possible, but please be aware that appointments will usually take place in a clinic setting. We appreciate your support with this and attendance in

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clinics on time where you are well and able to do so. This will allow us to maintain social distancing and ensure that the more vulnerable can also receive the care that they need. Please call the maternity triage 01737 241764 if you have a new persistent cough, a temperature or a change in normal sense of taste or smell for advice about your wellbeing and ongoing postnatal care.

Birth Registration You may not currently be able to register your birth due to Covid-19 closures. If this is the case you will be able to do this at a later date. Please check with your local registry office, information regarding this can be found at: https://www.gov.uk/register-offices. You are now able to register for child benefit or universal credit before you have registered your baby’s birth.

Exercise and wellbeing It is important that you remain active during pregnancy and after your baby has been born. This is for both your physical wellbeing (where inactivity puts you at higher risk of pregnancy related complications such as blood clots) and your mental wellbeing.

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Please follow government advice and go outside for light exercise, a walk will be enough. There are also many online video resources to support you with exercise at home for example pregnancy yoga. We recognise that you may be experiencing additional anxiety about your and your baby’s health. If you are feeling anxious, down, depressed or hopeless during this difficult time we would like to support you. Please share this with your midwife or any health professional. Please also take the time to read our emotional wellbeing resource, held on our SASH maternity internet page, and make a plan for yourself: https://www.surreyandsussex.nhs.uk/wp-content/uploads/2019/03/SASH-perinatal-wellbeing-plan-and-mental-health-leaflet-LATEST.pdf The useful resources section at the end of this leaflet includes resources that you might use to help manage your anxiety.

Help us to look after you by taking care of yourself well. Your health and wellbeing are important to us. - The SASH maternity team.

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Useful Resources Up to date coronavirus advice for pregnant women: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/ Surrey and Sussex NHS Trust resources: https://www.surreyandsussex.nhs.uk/our-services/a-z-of-services/maternity-services/ Birth pain relief options www.labourpains.com/home Health and wellbeing in pregnancy www.nhs.uk/conditions/pregnancy-and-baby/ www.gov.uk/ https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-covid-19

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https://www.psychologytools.com/assets/covid-19/guide_to_living_with_worry_and_anxiety_amidst_global_uncertainty_en-us.pdf Bonding and Feeding www.unicef.org.uk/babyfriendly/baby-friendly-resources/ https://globalhealthmedia.org/videoa/breastfeeding/

This patient information resource has been created using the best, evidence-based guidance that we have available to us at the time of writing. We will update the electronic resource held on our SASH maternity website with any newly emerging national guidance as it arises. 29/9/2020.

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We want to hear about your experience Please feedback on your maternity care using any of the following options:

• PALS sash.pals@nhs.net 01737 231 958 • sash.complaintsteam@nhs.net 01737 768 511

x6825 during office hours • https://www.surreyandsussex.nhs.uk/thank-

you/ • sash.positivebirthstories@nhs.net