As the NHS continues to offer a very reduced service for pregnancy and birth, due to the Covid 19 situation, I am getting lots of calls and emails basically asking the same thing. What midwifery care do you need? Checks in pregnancy are being cancelled- does it matter? You need to know about pregnancy care and choices open to you.

The NHS schedule of antenatal care was effectively abandoned in many areas at the height of the pandemic. Many people were being offered telephone contact only, others being asked to attend “drive through” centres. Is this enough? Is it appropriate? Is it safe?

Whilst we must all accept that the Covid-19 situation has challenged the NHS, the widespread cancellation of care that was previously deemed “essential” causes many midwives and obstetricians to feel very worried. The appointment schedule always had big gaps of time when you didn’t have any appointments, now some women are not even meeting a midwife face to face until they are 28 weeks pregnant.

The initial meeting between a client and a midwife is a really important time during which lots of information is shared in both directions. In a first pregnancy, the client usually wants some guidance about what to expect in the coming months, in subsequent pregnancies there may be issues to address about previous experiences. If this is a pregnancy after a loss (or multiple losses) feelings are often very complicated indeed. Some may be feeling quite ambivalent about being pregnant – it is not happy and exciting news for everyone. The opportunity to share this and to explore feelings, hopes and fears, can make a very significant difference to the client’s emotional health. For the midwife, gathering information about the client’s health history and any significant family health issues can identify reasons to suggest additional tests or extra care.

What midwifery care do you need? Checks in pregnancy are important because as pregnancy progresses the pregnant body has to work harder and harder to support the bodily functions of both parent and child. Physical checks such as blood pressure and urine tests are used to identify changes, warning of potentially very serious conditions such as pre-eclampsia. Other signs can include swelling, especially of the hands, feet and face, epigasrtic pain and visual disturbances. Obstetric cholestasis is a liver problem which is associated with an increased risk of stillbirth. The presenting symptom is most commonly intense itching, especially of the soles of the feet and palms of the hands. Sadly, many women have been turning to social media for advice, asking on Facebook groups or Mumsnet “Is this normal” and “What should I do”? A colleague recently visited a woman for the first time, realising immediately when the woman opened the front door that there were serious problems. She had developed pre-eclampsia, but had been “reassured” on social media that it was “normal” to have extreme swelling & weird visual symptoms.  Her NHS care had consisted of phone calls with the advice to “let us know if you are worried about anything”.  Her baby was delivered by emergency c/section later that day, and she and her baby are now safe and well. That face to face visit quite possibly saved her and her baby from serious harm, even death.  Do you honestly know all the things that could/should worry you in pregnancy? I suspect not. It is my job as a midwife to know, and to ask you the right questions at the right time.

Assessing your baby’s growth and assessing your baby’s heartbeat are standard parts of antenatal care which clearly cannot be done by video link. Please don’t be tempted to buy a home doppler machine. This website explains why this is not a good idea.

As a private midwife I have continued to offer full care to women in Brighton and Hove, Surrey, East Sussex and West Sussex despite the Covid-19 pandemic. You do not have to book full care with me and you do not have to want a homebirth! You can, but you can also choose to have supplementary care, including single consultations, supporting what your NHS provider is currently able to offer you. I also offer pregnancy and postnatal care for those having planned c/section. Home visits for health care have continued throughout the pandemic provided that you and everyone in your household is well. I provide very personalised midwifery care. I have time for you, will answer your questions, help you to understand what the changes are that occur in pregnancy and what your choices for care are. I can help you plan for labour, birth and the early days with your baby. I will perform the usual midwifery checks which have I believe are very important.

Updating this in June 2021, I am sad to note that many NHS Trusts are still not allowing you to be accompanied at appointments. I see pregnancy as being an exciting, often challenging and sometimes frightening time which you are likely to want to share with those closest to you. By meeting with you at home, at a time that suits you, I aim to make it easy for you to determine who is involved in your appointments. I am delighted to meet partners, intended parents in surrogacy arrangements, other children and so on.

If you want to know more, to discuss what midwifery care do you need and what pregnancy care and choices would be best for you, please get in touch.

Leave a comment