Information correct at publication May 2020
The homebirth service was temporarily suspended in spring 2020 due to the position statement received from SECAMB. It stated they were not able to support women choosing to birth at home for transfer into hospital in an emergency due to the increased operational pressures caused by the Covid-19 pandemic. Additional concerns for us as a Maternity Unit was also safeguarding the health and wellbeing of the midwives providing the homebirth service.
SECAMB have now declared that their operational pressures have settled to a level that they feel able to confidently support our homebirth service.
Guidance issued from PHE, RCM, RCOG and NHS England has re-affirmed the provision of midwifery led care in all settings and specifically homebirth.
Although births at home have been reinstated we will continue follow the covid-19 outpatient pathway for low risk women offering phone appointments and face to face appointments in clinics.
We will not be providing home appointments/visits with the exception of the homebirth advisory appointment. The attending midwife will explain how you help to reduce exposure prior to them attending this appointment.
We are not able to offer continuity within the maternity department, for example in the event of induction of labour or elective caesarean birth.
The development of a risk assessment tool for use with women choosing to birth at home has been undertaken by the senior management team. We request that our client support our safety and the safety of our caseload. If the midwives do not feel that the environment is safe to work in they can and will leave.
Women and their partners are requested to:
- Wherever possible women and their birth partners will shield from 39 weeks – to reduce risk of contracting Covid-19
- Declare any Covid-19 symptoms prior to a midwife attending the home
- Limit birth partner to 1, to reduce potential exposure to Covid-19
- No visitors to the home while the midwives are in attendance
- Exclude other people from entering the birthing room until after the midwives have left the home ( this includes other children/ household members, childcare)
- Bar pets from entering the birthing room
- Contact the on-call midwife directly via team mobile numbers. In the event of being unable to contact the team the client/partner will contact the Pregnancy Advice Line (0300 123 5473) or Delivery suite (01483 571122 Ext 4699) for advice.
- Partner to ensure reduced exposure access to the home and donning area by opening doors ready for arrival.
Clients /Partners will facilitate a safe Environment by:
- Providing adequate space to enable physical distancing(2m) when not providing direct clinical care. Choose a birth room that is spacious enough or has an adjacent room for midwives to use
- Adequate space to doff and don PPE at entrance to the home (ie, in hallway/porch of house)
- Providing access to a Toilet that is clean with surfaces wiped down after each persons use
- Clean towel for midwife (for washing hands)
For the safety of everyone the homebirth team midwives will:
- Take yours and your allocated birth partner’s temperature on arrival – if anyone in the household has a temperature >37.7c ( or declines having their temperature checked) or any other symptoms of Covid 19 the team will not be able to remain in the home and will recommend transfer to the Royal Surrey. In the event of declining transfer to the unit (suspected covid), the midwives will advise you of the risks of covid 19 and of free birthing and leave your home. Observations will be requested to be repeated as clinically indicated (usually 4 hour temperature in labouror 1 hourly if using pool).
- Arrange for two midwives will attend for labour and birth. When contacted for labour support the 1st midwife will perform verbal covid screening, triage and attend when appropriate. They will arrange for the 2ndmidwife to attend simultaneously.
- Wear PPE at all time while in the client’s home and will maintain good hand hygiene
- Create a clear area for equipment
- Provide their own refreshments and take their hydration and rest breaks outside of your home for example in their car or your garden if permitted
Following birth the midwives will:
- Remain in house for maximum of 2 hours
- Clean and remove their equipment
- Help to double bag rubbish (please provide a roll of good quality bags for this purpose). The team can provide verbal support for emptying and taking down of the pool but are not able to provide hands on help
- Provide advice re on-going PN care, and safety-netting advice
- Arrange attendance at a maternity hub/Shere for PN care and NIPE