Your maternity care rights during the Coronavirus outbreak
If you are pregnant during this time, you may well be concerned how the Coronavirus may affect your maternity care, Birthrights charity offer this advice
Latest version published by Birthrights on Saturday 18th April 2020
If you are pregnant, you may be concerned about how coronavirus or COVID-19 (the illness resulting from coronavirus) will affect your rights to maternity care, if cases increase significantly as expected.
Birthrights have answered the most frequently asked questions.
Q: What rights do I have as a pregnant woman in the current crisis?
A: You still have the right to a safe and positive birth experience. This includes being treated with dignity and respect, having a companion of choice, having access to pain relief, being able to be mobile in labour and give birth in the position of your choice, and being communicated to clearly by staff. On the postnatal ward, your essential needs for food, drink and physical support must be met.
Q: Will I still receive maternity care as normal?
A: You will still receive maternity care. However your care might be slightly different to what you expected. For example, more appointments may be conducted over the phone, if you don’t need to be seen in person, and you might have fewer appointments than usual (a minimum of six antenatal appointments is advised). If you have, or may have, COVID-19, then routine appointments, including scans, should be delayed until after your isolation period.
Q: Will I have to accept changes I am not happy with?
A: Maternity services should still treat you with dignity, and you can always decline any intervention/treatment you are not happy with. However in some cases Trusts may have to make changes to the services they offer. The law allows them to do this, even if it means restricting choices, if they can show that it is a proportionate response to the challenge of coronavirus.
Q: I have been planning a home birth, will I still be able to have one?
A: Yes, if the Trust has enough staff to run this service and women are able to be transferred to hospital if necessary. The situation is changing quickly.
Official guidance recommends that women who have (or may have) COVID-19 give birth on an obstetric unit with continuous fetal monitoring (CTG) and increased maternal monitoring (e.g. oxygen monitoring). However, the fetal monitoring advice is based on a very small sample of births in Wuhan, China, where there was a higher than usual rate of babies being distressed during labour. It is not clear at present whether this was linked to COVID-19, as the sample size was very small, so this advice is only a precaution. If the Trust are not able to offer a home birth to well women, they should be able to give a good, evidence-based reason why coronavirus has changed their ability to offer a home birth, and to offer alternatives such as birth in a midwifery-led birth centre, where possible. NHS England have published guidance setting out the process that Trusts need to go through before reorganising services as a result of coronavirus, and RCM/RCOG have also published guidance on the provision of midwifery settings and home birth during the current pandemic.
Q: If there is no home birth service what happens if I stay at home and give birth without assistance?
A: The legal position is that you cannot be compelled to go to hospital and giving birth without assistance is not illegal, but should be thought about carefully.
Some women have reported being threatened with social services when mentioning this option. This is completely inappropriate. A referral to social services should only be made on the basis of a risk of “significant harm” to the baby after the baby is born, and should never be made on the basis of birth choices alone.
Q: I am due to have an elective caesarean, will this still go ahead?
A: Yes. If you have , or may have COVID-19, your care team will discuss with you the option of delaying the caesarean. However, if the caesarean cannot be safely delayed it will go ahead. If you have, or may have COVID 19, special precautions, e.g. protecting staff with special masks, will be in place.
If you do not have COVID-19, there may be a need for some re-scheduling of elective caesareans, as services prioritise. If capacity is really stretched induction may be proposed as an alternative.
Q: I am due to have a maternal request caesarean, will this still go ahead?
A: Yes, unless the Trust can give a good reason why the Trust cannot honour that commitment due to the changed circumstances. Caesareans will be prioritised according to clinical need but Trusts should be doing their best to follow NICE guidance, and to undertake all caesareans on their lists, even if some re-scheduling is required.
Q: Will I still have continuity of care?
A: Each Trust will have to continue to monitor if it has sufficient staff to offer its usual service, and to make short-term alternative arrangements to see a midwife or doctor even if not your usual one.
Q: Will I have one to one care in labour?
A: Each Trust will have to continue to monitor if it has sufficient staff to offer one to one care in labour, but it has a duty to offer a safe service at all times.
Q: Will I still be able to have my birth partners with me?
A: The World Health Organisation and the RCOG/RCM advise that you will still be able to have your birth partner with you throughout (including in theatre unless you need a general anaesthetic) but visitors should be kept to a minimum. However if your birth partner has symptoms of COVID-19, they are asked not to attend the unit so you may want to consider having a “back-up” birth partner on standby.
Banning all birth partners is a profound restriction on a woman’s right to choose who should give her essential support during a life-changing experience, and also on a partner’s right to be present at the birth of their child. Birthrights does not believe that banning all birth partners can be justified as a proportionate response to the current pandemic, and we are pleased to see this reflected in national guidance.
Q: Will my partners be able to be with me at all times?
A: Many Trusts currently have in place restrictions on visiting except when you are in labour. However the Trust must be able to show that these restrictions are necessary and proportionate. Partners are likely to be asked to limit their movements around the ward.
Visitors should only be restricted on the postnatal ward if the staff are able to meet all your basic needs for food, drink and physical support. If you need additional support, for example if you have had a caesarean, or you have had twins, or you have a mental health condition, exceptions should be considered on a case by case basis.
If you feel that there are reasons to make an exception for you, do raise this with your care team.
Q: Will I have access to pain relief?
A: Yes. Trusts should not withhold pain relief including access to water to relief pain in labour, as well as access to an epidural or other drugs without having a rational and evidence based reason to do so.
Midwives not wearing full protective equipment is not a good reason to restrict access to water for pain relief.
Q: What about the rights of staff?
A: We understand that maternity staff are currently working in very challenging circumstances and are understandably worried about the risk of catching COVID and of passing it on to family members.
Midwives, doctors and other NHS staff have rights as employees, including the right to a safe workplace, and to protective equipment. However NHS Trusts as public bodies also have a duty to protect the human rights of the patients they look after. Trusts must balance the need to protect their staff against the need to protect the rights of their patients. Whilst banning all birth partners, for example, could reduce the risk of infection to staff, it would be a profound restriction on the rights of a woman and her partner. Such a ban would only be proportionate in the most extreme circumstances.
We recognise the dedication and sacrifice of maternity healthcare professionals who are facing increased risks on a daily basis to ensure that women have a safe and positive birth experience.
If you feel your rights during birth are at risk, please do email Birthrights at firstname.lastname@example.org