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A pregnant woman wears a protective face mask and looks at her phone
REUTERS/Soe Zeya Tun
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TIMING IS EVERYTHING

How the NHS is changing pregnancy care because of coronavirus

Annabelle Timsit
By Annabelle Timsit

Geopolitics reporter

From our Obsession

Being Human

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Rhiannon Wilkie is 37 weeks pregnant, and due to give birth in the next few weeks. Under normal circumstances, pregnancy comes with its fair share of anxiety and stress—about how to handle things like childbirth, maternity leave, and childcare. But being pregnant during a pandemic, she says, is a whole other story.

Wilkie lives in the London borough of Hackney with her husband and 2-year-old son. Just a few weeks ago, before a highly-contagious strain of coronavirus started spreading in the UK, causing a disease known as Covid-19, she had a plan. When she went into labor, her neighbor would take her son while Wilkie’s husband and a doula accompanied her to the maternity ward at University College London Hospitals (UCLH). Wilkie’s mother, who lives about two hours outside of London, would arrive to watch over her grandson, and eventually bring him to the hospital to see his new sibling.

Now this plan has been thrown into disarray. Wilkie’s neighbor is in a high-risk category for Covid-19, and has left London. Her mother is sheltering in place in her home. And UCLH banned visits to maternity wards and restricted the number of people who can accompany a pregnant person during childbirth from two to one—meaning she had to forget about bringing a doula, and Wilkie’s son won’t be able to visit her and her new baby.

“I was just starting to get my head around feeling okay and feeling prepared for a normal, non-coronavirus birth,” she says, “and this has just completely thrown me. I am trying to imagine what it’s going to be like and I feel quite overwhelmed.”

Wilkie is one of tens of thousands of parents-to-be across the UK whose experience of pregnancy care has been upended by this pandemic. The UK’s public health agencies changed their guidance for pregnant patients last week, and while the changes are necessary to protect their health, many of them say the new rules are causing anxiety and confusion.

Coronavirus and pregnancy

There is a very limited amount of information on how the novel coronavirus affects those who are pregnant. The uncertainty is feeding many patients’ anxiety. Small studies conducted in China seem to indicate that pregnant women are no more likely to catch the virus than others, and that if they get it, fetuses are unlikely to be exposed during pregnancy. But pregnancy can reduce the body’s ability to handle severe viral infections.

In light of this, the UK’s public health agencies released guidelines (pdf) last week (March 21) for pregnancy care. It encouraged those who are pregnant to reduce social contact, but otherwise recommended that “the majority of antenatal and postnatal care should … be regarded as essential care and women should be encouraged to attend.” The guidelines also say that “where practical, appointments should be conducted on the telephone or using videoconferencing.”

For pregnant patients exhibiting symptoms of Covid-19, the guidelines suggest extra hygiene measures for them and their medical staff. Staff in the delivery room should wear personal protective equipment (pdf), including masks, eye protection, and gloves. “I’m a bit anxious about the idea of that,” says Wilkie. Although she says she understands these measures are for everyone’s protection, “it doesn’t feel like a very nice environment to give birth in.”

“The NHS is making arrangements to ensure that women are supported and cared for safely through pregnancy, birth and the period afterwards during this pandemic,” a spokesperson for the Royal College of Obstetricians and Gynecologists said.

NHS guidelines on pregnancy care

The UK is not alone in issuing new rules for pregnancy care. In France, some hospitals have banned all birth partners, including spouses (link in French). Some New York hospitals have done the same. And in some US states, pregnant patients with low risk of complications who are in their last trimester are being told to skip many of their prenatal appointments to avoid spending time in hospitals.

These appointments, which happen up to 10 times in a normal first pregnancy, aren’t just meant for blood tests and scans; they’re an occasion for patients to establish a relationship with and voice their questions or concerns to their physicians, says Katie Hayes, a first-time mom who gave birth to a daughter on March 3 at Royal Free Hospital in London.

“Our baby had hiccups all the time, and you can Google all this stuff, but frankly, when you start Googling things, it can take you down this rabbit hole of concern,” says Hayes. “And then the second you talk to your midwife, they make you feel so much better about everything.”

Since giving birth, Hayes’ midwife checkups have taken place at home instead of in her general practice clinic, which has closed. She says she has been encouraged to do as many appointments over the phone as possible, because midwives are too overwhelmed to visit every new mom at home. “It’s hard to explain not in person. It feels a little bit more foreign.”

As the pandemic evolves, guidance for those who are pregnant seems to be shifting day by day. Wilkie received a text from UCLH on Friday asking her to attend her midwife and ultrasound scanning appointments and come into hospital for tests.

“They don’t seem to think anything is going to be too different, but I’m unsure how much I trust that, because the hospital is already quite different,” she says. She hasn’t been allowed to bring her husband to her midwife appointments, and says she was checked at the entrance for symptoms of Covid-19 and given hand sanitizer.

“I’m feeling quite anxious and stressed about the whole thing,” she explains. “I was feeling okay about it, but then every day changes, and it’s not a great time, emotionally, to be put under stress.”

Read more from our series on Rewiring Childhood. This reporting is part of a series supported by a grant from the Bernard van Leer Foundation. The author’s views are not necessarily those of the Bernard van Leer Foundation.

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