Rachael Corser, chief nurse at East and North Hertfordshire NHS Trust and senior responsible officer for the Hertfordshire and West Essex Local Maternity and Neonatal System, has today issued a statement about changes being made to maternity visiting and partner attending restrictions following the release of new guidance this month.
We know that, for many families, pregnancy and childbirth is a wonderful experience. For some pregnant women and their partners, it can also be a stressful and uncertain time, and so we can appreciate why you feel strongly about the current visiting restrictions in place at our maternity department.
East and North Hertfordshire NHS Trust’s approach – ensuring that women are kept safe – has been developed in collaboration with Maternity Voices Partnership (MVP), which is made up of a group of women and their families who provide a voice for the women who use our maternity services.
The impact of COVID-19
Following the ‘Framework to assist NHS trusts to reintroduce access for partners, visitors, and other supporters of pregnant women in English maternity services’ guidance which was released on 8 September 2020, changes were made to the restrictions in place.
This meant that those who can attend with women when accessing maternity services was widened, but restricted to:
- One named birthing partner attending during admissions in single rooms in early labour, throughout active labour and the immediate postnatal period.
- One named person attending during the 20-week anomaly scan.
- One named person attending during antenatal contacts associated with the specialist bereavement or mental health team.
Throughout the pandemic, we have continued to allow essential visitors, such as carers, to attend appointments, scans and accompany women in the antenatal or postnatal period as necessary. This is to ensure these women can access their healthcare fairly.
We have been continually reviewing our visiting restrictions in consultation with the Maternity Voices Partnership and hold monthly virtual meetings to discuss the impact of COVID-19 on the provision of maternity care.
In line with all of our risk assessments, national guidance, and recommendations, our biggest challenge is how we can accommodate partners or family members while keeping the women and babies in our care safe, and ensuring a safe working environment for our staff.
Social distancing must be maintained within the waiting areas, consultation and treatment rooms, while numbers have to be limited on antenatal and postnatal wards to comply with restrictions within clinical areas.
On 14 December 2020 we received further guidance entitled ‘Supporting pregnant women using maternity services during the coronavirus pandemic: Action for NHS providers’.
Our trust and the Maternity Voices Partnership system lead has reviewed this guidance together, and updated our trust risk assessments which are in place to keep the women in our care and our staff safe. These risk assessments were subsequently shared with our Maternity Voices Partnership group.
On 22 December 2020, the whole of Hertfordshire went into Tier 4 restrictions due to the increasing rates of COVID-19 infections within the region and the pressure which this is placing on NHS services. In light of this and our requirement to ensure the continued provision of maternity services, the following approach has been agreed in response to the latest guidance.
Antenatal appointments will continue to be attended unaccompanied within the hospital setting, with exceptions being to specialist bereavement and specialist perinatal mental health appointments. We will continue to support essential companions including carers and interpreters, and the use of speakerphone or video calling to partners during the appointments.
If your antenatal appointment is taking place at your home or at an external venue which has the appropriate space to enable social distancing, effective ventilation and availability of PPE, you may be accompanied by one nominated person who does not have COVID-19 symptoms, is isolating due to contact with a person positive for COVID-19 or has tested positive for COVID-19 in the previous 10 days – even if asymptomatic.
Due to the availability of space to support social distancing within this environment, we currently support you to be accompanied by one nominated person to your anomaly scan, often known as the 20-week scan which is offered between 18 and 21 weeks.
From Monday 4 January 2021 we will also support you to be accompanied by one nominated person to your dating/nuchal scan, known as the 12-week scan, between 11 and 14 weeks.
Again, there is adequate spacing for social distancing, which ensures the safety of both our patients and our staff.
Please can we request that you do not contact the maternity unit to rearrange scans as the timing of scans will directly impact the screening choices available to you, and we do not have availability of appointments to reorganise scans on this basis.
Unfortunately, it will not be possible for children to accompany you to either of these scans and all nominated persons must comply with the protocols in place.
We are currently not in a position to enable you to be accompanied at other scans such as growth scans because of the impact this would have on the timings of the scan list and the requirement to reduce the number of scans available.
This would directly impact on the service available to women during their pregnancy and would result in you waiting longer for a scan to assess the wellbeing of your baby.
In response to this, we have undertaken a review of the clinic area with estates colleagues and plans have been formulated to create further waiting areas to enable your nominated companion to be in closer proximity to the scan room, reducing any delay to the scanning list.
These waiting rooms will take approximately 8 weeks to be put in place to be used for this purpose.
In the meantime we are reviewing other opportunities including the use of video calling to support partners to be involved in all scans – assessing the impact that this may have on the completion and timing of these scans.
If you attend for a scan in maternity or the early pregnancy unit and there is a finding which is concerning, we will continue to enable you to have someone accompany you in the scan room at that time in order to support you. You will also continue to be supported to have a nominated companion during fetal medicine scans.
Labour and birth
During this pandemic, we have consistently supported women in active labour to have their birthing partner present.
We will continue to support you to have your chosen birth partner accompany you from the start of the birthing process within a birthing area and during all other assessments which are undertaken in an individual room on the consultant-led unit or the midwife-led unit.
Antenatal and postnatal inpatient services
We have reviewed and updated the risk assessments for our inpatient areas in light of the current circumstances and the region being subject to Tier 4 restrictions. Unfortunately due to these circumstances we are not currently in a position to make changes to our restrictions in these areas.
Following review from our infection control and estates teams, screens have been ordered for the antenatal ward which will be placed between the bed spaces to offer further protection and help enable us to ensure women are able to be accompanied once the regional restrictions are reduced.
On the postnatal ward, an increased number of women admitted and staff needed to support them has further reduced the opportunity to social distance.
The distance between the bed spaces is 2 metres from the middle of the bed to the middle of the next bed, with curtains and the wearing of face masks used to reduce risk.
Increasing the number of people on the postnatal ward will directly impact the ability to support social distancing and impact on the safety of women and staff. Screens are not as suitable for the postnatal ward as there is less space between the beds to enable positioning of the screens while still enabling access to the emergency equipment.
Interval slots for visiting are being reviewed in order to enable an opportunity for one nominated companion to spend some time with you and your baby during your stay on the ward.
Video calls will continue so that you can remain in contact with family and friends during your admission.
Our neonatal team understand the importance of you being able to be with your baby on the neonatal unit – with unrestricted access already in place so one partner at a time can be with your baby.
Due to the space in between cots, it is not possible to enable more than one person at a time to be with each baby. Consideration has been made to allocating visiting slots so that both parents can be with their baby at the same time, but this will reduce the access for parents overall as it would reduce unrestricted access due to the number of people who can be in the neonatal unit at any one time.
There are processes in place to accommodate both parents to be present in specific circumstances where this is required.
Our maternity team is acutely aware of the effect that these restrictions may have on women and families, and are here to provide support every step of the way.
We have updated the East and North Hertfordshire NHS Trust website with the latest visiting restrictions, and would advise that if you are attending the trust to check this to see the latest guidance, which can be found at: enherts-tr.nhs.uk/news/latest-nhs-information-on-coronavirus-covid-19/
Further to this, we have updated our maternity services page with the changes to visiting restrictions. This can be viewed via enherts-tr.nhs.uk/services/maternity/maternity-unit/
We have also updated some frequently asked questions about the maternity visiting restrictions, which can be found at: enherts-tr.nhs.uk/news/faqs-for-changes-to-maternity-restrictions-at-east-and-north-hertfordshire-nhs-trust/
We also have a maternity advice line running from 7am to 9pm every day to answer any other questions that you may have. You can call the advice line on 07789 935620.
We will continue to support women and families during this difficult time while we work together with the MVP to maintain a safe environment within our maternity services.
When the tier level restrictions within the region changes we will immediately take steps to review our risk assessments in collaboration with the MVP to make prompt and proportionate adjustments to the maternity restrictions currently in place.
In addition to this, we are reviewing options moving forward to provide partner testing to confirm whether they have COVID-19 prior to admission. Once we have identified suitable options for this the risk assessments will be reviewed to enable further adjustments to the restrictions.
I would like to offer thanks to the Maternity Voices Partnership who have provided support and engagement throughout the pandemic and continue to work in unison with us to review the impact of the restrictions in place.