Making a birth plan is something we have come to expect. Many women spend hours preparing theirs, researching, visualising, and planning how they would like their labour and birth to be. Most have understood that things may not go quite to plan. Now we have to consider birth and Covid-19. A major game changer.

What I write today may well be “out of date” tomorrow, as the world seeks to work out what this virus means for us all. We are all living in a time of immense change and that can be frightening and disorientating. Your hormones in pregnancy work to make you protective of your baby, this is obviously a good thing but can make calm and rational review of plans more difficult. As midwives we work to create a calm and safe place for you when we work together, whether before, during or after the birth. In the face of Covid-19, that continues to be our aim.

The most recent expert advice about birth and Covid-19 from the RCOG is here

You may well be familiar with “Maslow’s heirachy of needs” which ranks the things we need to live. The principle is that until one level is satisfied, the next cannot be. In the face of a crisis, in this case considering birth and Covid-19, we need to ensure that we have fully addressed the things which as fundamental to survival before looking at the more optional. enhancing issues. This is why you may find that your choices are restricted.

We need to remember that birth plans are a very recent phenomenon. They were just starting to be “a thing” when I was pregnant with my son. My mother and grandmother were aghast at the idea that I would expect to have any influence over how things would be. Their attitude was “we knew it was going to be hard, but we knew that everyone does it and that once our babies were born we would know it had been worth it”. Neither of them had their husband or a supporter with them in labour – but they had a midwife. The term midwife means “with woman” and that is exactly what we do. We are with you, watching, checking, encouraging and empowering you to birth your baby.

So what might be different to your expectations?

Hospital appointments

Most hospitals in the UK are being very strict about visitors. In most cases you will not be allowed to take anyone with you to appointments, including scan and consultant appointments. This is to protect the staff and you, in accordance with the principle of social distancing.  It is obviously disappointing for your partner to miss out on seeing your scan, but preventing the spread of infection is more important. Sure, he shows no sign of the infection- but what about the other 20 partners who are there. One of them may be keeping quiet about their developing symptoms…..You have to be there. Your partner doesn’t. Staying safe is more important that “enjoying” the experience. Sorry- this is tough love.

Hospital birth and Covid-19

In UK hospitals, births rooms are individual and in most cases have en-suite facilities. Hygiene is always important and now are even tighter. Hospitals are working out ways to keep those with possible symptoms of Covid-19 and those without very well separated. This means that once in a birthing room, if you have a midwife who stays with you, the chance of infection is low. Discussions are underway with the NHS to allow private midwives to care for their clients in hospital. That would mean you could be sure that you would have your own midwife who will stay with you, rather than having to simultaneously care for someone else. Call me if you want to know more about this. Remember that the infection is passed by droplet infection and so (mainly) directly person to person. It is not floating freely in the air as droplets fall to the ground almost immediately. It is meeting people which increases your chance of becoming infected, not being in the hospital building. My advice, if you and baby are well, would be to plan to go straight home (directly from that room) within a few hours. Your immediate family can then meet your baby.

Most hospitals are limiting you to one birth partner who can be with you while you are in the birthing room only. It is vital that this person is well – have you got a back up plan in case your planned partner has any symptoms on the day?

If you need to stay in hospital, the restriction on visitors is in place to keep you protected. Use technology to let family and friends see your baby. My grandmother told of being kept on bed rest in a nursing home for 3 weeks after my uncle’s birth. She had no visitors other than my grandfather who was allowed in for half an hour on alternate days. She had no other contact with her family or friends, and the second world war was brewing. She did it, and raised a very happy, healthy and loving family. So can women now. It isn’t what you expected, but the restriction is to keep you and your baby safe.

Home birth and Covid-19

Many women are reconsidering the idea of home birth – both because of the apparent increased risk of infection in hospital but also because of the understanding that hospitals are short staffed. Home birth is a great option for some women. For others, the actual or potential need for medical back up means that hospital is better for them. While hospitals are short of midwives due to many being in self-isolation, many hospitals simply cannot free up midwives to support home birth. As a private midwife I am getting a huge number of calls to discuss this. Homebirth is absolutely something to consider (both my daughters were born at home). However, it is important not to ignore or minimise possible problems. There has been concern that if things become difficult, ambulance response times may be longer than usual. However, so far this has not been the case because of the reduced demand on the ambulance service due to reduced road traffic accidents, sports injuries and so on.

Decision making

In all my work as a midwife I am committed to being honest and open with my clients. Birth and  Covid-19 raise a lot of issues but there is a great deal of half-truth and misinformation out there. If you want to know the facts, and to explore your choices, please feel that you can contact me. An initial consultation by phone is always free.

I work across Surrey, Sussex, Croydon and south London, travelling further afield on occasions for specific complex cases.