Maternity Care and Coronavirus (COVID-19)

Information for anyone booked for, or seeking to book, maternity care.

This leaflet sets out the arrangements for maternity care at the Rosie Hospital during the current COVID-19 pandemic. These vary from our usual arrangements. Our priorities are safe care for you, the safety of our staff and reducing the spread of Coronavirus infection (COVID-19).

Antenatal Care

If you are pregnant and need to arrange to see a midwife, please contact the Rosie Booking Line on 01223 348981, you will be asked to leave a message and you will be telephoned back to arrange your booking appointment.

Your antenatal care will be given using a mix of telephone calls and face to face consultations. You may leave your home during lockdown restrictions for any medical need, including face to face antenatal appointments. Your midwife will make contact with you by telephone and arrange your further appointments, which may be a combination of telephone and face to face, or entirely face to face.

Results of antenatal screening will be discussed at your 16 week appointment with your community midwife. We recommend that all pregnant women receive the Whooping Cough [Pertussis] vaccination after 16 weeks gestation of pregnancy, you should contact your GP surgery to arrange this.

We continue to offer face to face appointments for all other antenatal appointments but this may change over time. These measures have been put in place to limit physical contact and spread of the virus.

If you are not self-isolating due to symptoms (high temperature and/or new continuous cough and/or loss of sensation of taste or smell) in your household, please continue to attend your planned appointments as usual. We are aware that some GP surgeries and Children’s Centres may close and will contact you if the location of any of your appointments needs to change. We may also contact you in advance of your appointment to screen for symptoms.

If you would like to bring a birth partner or support person with you to any antenatal appointment, please check our website for full details on current visiting arrangements:

Maternity Care during COVID-19

Please do not bring any other children with you when you attend antenatal appointments.

Hand hygiene, visiting policy, social distancing and PPE

Continue to follow government advice and keep away from others (social distancing). Wear a face covering when required to do so in public places. This includes when visiting hospitals or healthcare settings. For hospital appointments you (and your support person/birth partner) will required to wear a surgical mask, which we will provide you with when you enter the Rosie hospital.

In pregnancy you are clinically vulnerable and should take particular care to minimise contact with others outside your household. When attending the hospital, GP surgery or Children’s Centre clean your hands when going into the building and when you leave. For home visits, please provide facilities for midwives or maternity support workers to wash their hands on arrival and please ask all members of your household to practice social distancing. It is good practice for you to wash your hands regularly for your own protection and that of your baby once born.

The visiting arrangements at the Rosie hospital are regularly reviewed, taking into account current Government advice and the incidence of coronavirus in both the hospital and the local population. Please check our website for full details on current visiting arrangements:

Maternity Care during COVID-19

We ask that, where possible, your birth partner or support person is from your own household. They will need to wear a mask at all times while inside the Rosie hospital. Your birth partner will not be able to go to the Addenbrooke’s concourse as this is shut to visitors, so they must bring any food and drink they need with them.

You must observe social distancing in waiting areas and, as far as possible, during appointments. A face to face appointment will involve some contact between you and the midwife, doctor or sonographer for the purpose of, for example, measuring your abdomen to check the growth of your baby, palpation (feeling your bump to check how the baby is lying in the womb), scanning or taking a blood pressure.

All staff at the Rosie are aware of the symptoms of COVID-19 and are asked not to attend work if they are symptomatic, in accordance with advice from Public Heath England to reduce the chance of spreading the virus. All staff are aware of the hand hygiene policy and this is strictly enforced.

Your midwife, doctor or sonographer will be wearing a mask, apron and gloves. Additional personal protective equipment will be worn if you have symptoms of, or are confirmed to have, Coronavirus (COVID-19), for labour and birth, or for theatre. This is to protect you and our staff.

While we do not expect you to wear a mask during labour, we will ask you to wear a face mask while you are an inpatient in the Rosie hospital if you are able to do so. Your birth partner will be asked to wear a mask at all times while inside the Rosie hospital, and at all times when the midwife is present during any community appointments or at a home birth.

Antenatal Education

Face-to-face antenatal education classes have been suspended. We have developed an area of our website with advice and information, including links to other resources, and some online classes – please ask your midwife for further information or visit:

Antenatal education

COVID-19 Testing

We encourage all pregnant women and birthing people and their chosen birth partner to make use of the twice weekly lateral flow testing that is now available. In particular we recommend that you and your chosen birth partner complete a lateral flow test before any planned appointment, and twice weekly from 37 weeks of pregnancy. These tests are voluntary, however on arrival for your appointment you and your birth partner may be asked to verify a negative result. Lateral flow tests can be ordered here:

GOV UK - Order coronavirus (COVID-19) rapid lateral flow tests

Everyone admitted as an inpatient to Cambridge University Hospitals NHS Foundation Trust is now recommended to have testing for COVID-19 as part of a nationwide programme. This is to help identify those with the condition, including those who do not have symptoms, and to help keep our staff and other patients safe. If you are identified as COVID-19 positive this may have implications for your care which your midwife and/ or obstetrician can discuss further with you prior to testing.

We will offer testing, using nasal and throat swabs, at the point of admission. If you have a planned caesarean section or induction of labour we offer this testing to take place before you are admitted.

If you chose to decline this testing and have no symptoms of Coronavirus your care will continue as normal, however if you needed to go to the operating theatre for an emergency procedure then your birth partner would not be able to accompany you into the theatre. If you chose to decline this swab test but you do have symptoms of Coronavirus we will treat you the same as if you had tested positive for Coronavirus (see below).

Induction of Labour

If you are coming to hospital to have an induction of labour we realise this may be a difficult time due the restrictions on visiting and want to reassure you that we have midwives and maternity support workers working on the antenatal ward who are used to supporting women having an induction of labour and are there to support you.

Please do ask if you need additional support – we are here to help you have a positive experience. Our consultant midwife is working with the antenatal ward staff to provide hypnobirthing techniques training and labour breathing exercises.

Please do bring comfort measures with you such as pillows, snacks, relaxing music and a TENS machine. We have ordered more TENS machines which will soon be available on the ward to borrow. You are very welcome to phone or video message friends and family or your doula but please be mindful of others’ privacy. We also have birthing aids available such as birthing balls to help you get into comfortable positions, showers and a lounge area to help you feel comfortable and encourage movement and positions that can help your labour progress.

Labour and Birth

For advice if you think you are in labour, or if your waters break, please call the Rosie Birth Centre or Delivery Unit, depending on your planned place of birth. When you are in labour you can currently have one birth partner with you from the point of admission to the Delivery Unit or Rosie Birth Centre. Your birth partner can stay with you up to 6 hours after the birth of your baby, or until you are transferred to a ward if that is sooner.

We are working hard to ensure that our homebirth service remains available. We are constantly reviewing the service to ensure it remains safe to continue and will keep you posted of any developments if you have booked a homebirth. If you have symptoms of coronavirus, it is recommended that you come into hospital for closer monitoring of your and your baby’s health in labour. Just as with hospital birth, we ask that you have just one birth companion for your homebirth. This means that only one adult should be present with you and your midwife for labour and birth. If you have other children, then you can choose for your birth partner to be responsible for them, or ask another adult to come to your house and care for them in another room, or to take them to a different house whilst you birth. You are the right person to make the decision about what is best for your family situation.

Water birth continues to be offered on Rosie Birth Centre, and Delivery Unit where appropriate, but unfortunately this is not available if you are suspected or confirmed to have COVID-19. Entonox (gas and air) remains available to all women as a form of pain relief in established labour.

In some emergency situations or should you need to transfer to theatre, there may be a delay whilst staff put on additional personal protective equipment and employ measures to minimise the risk of infection spread.

For women who have suspected or confirmed COVID-19, birth partners will not be permitted in theatre. For all other women, birth partners may be permitted in theatre wearing a surgical mask, but will be asked to leave promptly should a general anaesthetic be required.

Elective Caesarean Section does not fall under the suspension of elective surgery and will take place as normal, with telephone pre-op appointments followed by attendance at phlebotomy for blood tests and to pick up pre-op medication and swabs for MRSA with instructions for taking these at home.

Postnatal Care

After your baby is born we aim to discharge you home as soon as it is safe to do so. On the Rosie Birth Centre you will be asked to remain in your room until you are discharged. On Lady Mary Ward you will be accommodated in a bay with 3-4 bed spaces. The bed spaces have a minimum of 2 metres distance from one another. Lunch and Dinner are served to you in your bed space. Only two people at one time are permitted in the dining room to collect drinks, snacks or breakfast, to ensure social distancing. Please respect social distancing with other mothers and staff as you move around the ward.

New mothers with suspected or confirmed COVID-19 will be placed in separate rooms or bays, behind closed doors to minimise the chance of crosscontamination. New mothers with particular vulnerability who would normally be shielding at home will also be accommodated in side rooms.

Due to restricted access to contraception services from GPs and family planning clinics, we are offering all women who wish to have them progesterone-only contraceptives before discharge. Please discuss this with your midwife.

Your postnatal care once you have been discharged home will be a mixture of home visits and telephone assessments. This is to ensure that we are providing a safe service for all and ensuring the safety of our staff.

You will receive a home visit from a midwife the day after your first night at home. You will have further home or clinic visits with the midwife or maternity support worker, to include feeding assessments and weighing on day three, and screening tests on day five. You will have a telephone appointment at ten to fourteen days postnatal to discuss discharge from the community midwife to the health visitor service.

When you are visited at home by the community midwife please ensure that only you, your baby and one support person are in the room. Ideally this room should be large enough to allow social distancing and well-ventilated, preferably with an open window.

What to do if you have symptoms of Coronavirus or a positive test result at home:

If you have a new continuous cough, or a temperature of 37.8°C or higher, or a loss of sensation of taste or smell, then you might have Coronavirus. You and everyone in your household should isolate and you should arrange to have a test via the gov.uk/coronavirus website.

If you have a positive test for Coronavirus while you are pregnant or up to six weeks after having your baby please inform the midwives via the Assessment Line 01223 217217. They will assess your risk factors for developing a blood clot in your legs or you lungs, as Coronavirus can increase this risk. They may recommend that you take blood thinning injections for two weeks, depending on your risk factors. If you do need blood thinning injections the midwives on Clinic 23 will arrange this for you.

Depending on how many weeks pregnant you are, you may also be offered an extra scan to check the growth of your baby, the midwives on the Assessment Line will arrange this if required.

If you have any appointments booked, either with your community midwife or at the Rosie hospital, please telephone the team or department your appointment is booked with (telephone numbers are at the back of this leaflet) and tell them when your symptoms started and the date of your positive test result so they can rearrange any appointments for when your period of isolation is over.

If you have any concerns relating to your pregnancy you should contact the assessment line on 01223 217217 as normal. You can still come into the hospital if you need to be assessed, but it is important that you call us first and tell us about your Coronavirus symptoms and/or test result so we can make a plan for the best place for you to be seen.

If you are feeling unwell with symptoms of Coronavirus and need medical advice you should call NHS 111.

Please read the current guidance on the gov.uk website for how long you and other members of your household will need to self-isolate.

What happens if you have a positive test for Coronavirus while you are an inpatient at the Rosie hospital:

If the test is positive we will inform you straight away. We may need to move you to a different room or ward – we usually care for patients who are positive for Coronavirus in a single room with an en-suite bathroom. Staff caring for you will wear extra PPE (personal protective equipment), such as a visor and cap, in addition to the mask, apron and gloves that we wear when providing care to all patients.

If you are an inpatient in the hospital when you test positive for Coronavirus we will start you on a 2 week course of blood thinning injections to reduce the risk of a blood clot forming in your legs or your lungs. Your midwife will be able to tell you more about these blood thinning injections and show you how to self-administer them.

Antenatal care after a positive test for Coronavirus

If you need to be admitted to the antenatal ward due to concerns about you or your baby’s health requiring closer monitoring, then you will need to stay in your room and you will not be able to have any visitors for at least the first ten days whilst you are an inpatient.

If you no longer need to be an inpatient you will need to self-isolate at home for at least ten days from the date of your positive Coronavirus test result. If we need to arrange any follow up appointments we will plan these for after your period of isolation has finished.

Labour care after a positive test for Coronavirus

If you are in labour your will be cared for on the Delivery Unit to allow closer monitoring of you and your baby’s health. We will monitor your oxygen levels closely and we may offer you oxygen via a small tube that sits under your nose or a face mask if your oxygen levels drop. We will recommend that you have an intra-venous cannula sited in your hand or arm in-case you become unwell and we need to give you medication quickly. You will be able to have Entonox (gas and air) as normal and you can have an epidural if you would like one. Unfortunately we cannot offer you use of a birthing pool if you have tested positive for Coronavirus due to the potential of you or your baby becoming suddenly unwell and the need for staff caring for you to wear adequate PPE.

We recommend that your baby’s heartbeat is monitored throughout labour by continuous electronic fetal monitoring as there may be an increased risk of your baby become distressed during labour, although there is still very little data on this. If your baby does become distressed then you will have access to care from the Obstetric and Neonatal doctors on the Delivery Unit, however in an emergency situation there will be a delay whilst staff put on additional PPE and employ measures to minimise the risk of infection spread.

Birth partners when you have tested positive for Coronavirus

You can have one birth partner with you when you are admitted/transferred to the Delivery Unit in labour, they can stay with you until six hours after the birth of your baby, or until you are transferred to the postnatal ward or discharged home if this occurs before six hours. Your birth partner will need to wear a mask and remain in your room for the whole time while they are in the Rosie hospital. Your birth partner cannot leave the room to get food and drink, but we will be able to provide them with light refreshments while they are with you.

If you need to go to the operating theatre for a Caesarean section or instrumental delivery of your baby, your birth partner will not be able to go into the theatre with you, but they may remain in the room and see you and your baby once you leave the theatre and return to your room. You will not be able to have any other visitors during your admission to the Rosie hospital.

Once you have tested positive for Coronavirus all members of your household will need to go into self-isolation at home for at least 10 days. This means that if you have a positive test result for coronavirus before you go into labour, no-one from your household will be able to come into the Rosie hospital when you are in labour as they will be in self-isolation. In this case you can ask someone from outside of your household to be your birth partner – they will need to follow the guidance listed above. They can come into the hospital once you are admitted to the Delivery Unit in labour and remain with you until six hours after your baby is born. They will then need to go straight home and self-isolate for 10 days.

If you have a birth partner from your household already present when you find out you have tested positive for Coronavirus, and you are already in labour, then that person can remain as your birth partner. If they do remain as your birth partner they must remain in your room and wear a mask at all times. If you need to go to theatre they will not be able to accompany you. They can stay with you until six hours after the birth of your baby, they will then need to go straight home and selfisolate for 10 days.

Going home with your baby after testing positive for Coronavirus

Once you and your baby are ready to be discharged from the Rosie hospital you can return home, where you will need to be in household isolation for at least 10 days from the date of your positive Coronavirus test result – please see the gov.uk/coronavirus website for further advice on household isolation. A member of your household can drive to the Rosie hospital to take you home, they should park in the drop off bay at the front of the Rosie hospital and telephone the ward from their car to say they have arrived. They must not get out of the car or come inside the hospital. Hospital staff will then assist you and your baby to the front of the Rosie.

If you require any postnatal care from the community midwives while you are in isolation we will arrange to visit you at home. Staff visiting you at home will wear extra PPE such as a visor and cap, in addition to the mask, apron and gloves that we wear when providing care to all patients. Please ensure that we have the correct contact details for you before leaving the Rosie hospital, as we may need to contact you by telephone while you are isolating.

Birth partners who are symptomatic/ have tested positive for Coronavirus or are in self-isolation

If your chosen birth partner has symptoms of Coronavirus, has tested positive for coronavirus, or is currently needing to self-isolate for any reason, then they cannot accompany you into the Rosie Hospital for any appointment or admission. In this situation you may chose a birth partner from a different household. If you are symptomatic or test positive for Coronavirus during your admission then this birth partner will need to self-isolate when they return home.

Visiting babies on the Neonatal Unit

Visiting on the Neonatal Unit is subject to change depending on the incidence of coronavirus in both the hospital and the local population – please ask your midwife what the current arrangements are. If you or anyone in your household has had symptoms of Coronavirus or a positive test for Coronavirus in the last ten days, then you will not be able to visit your baby on the Neonatal Unit, as we need to ensure we are protecting all our babies, some of whom are very vulnerable.

Your mental health matters to us

During the current pandemic you may be experiencing some challenges with your mental health for many different reasons. Helpful information about looking after your mental health is available from public health England at NHS Every Mind Matters

Many of the organisations that are able to provide additional telephone support are listed through this link, as well as ideas for you to consider to help yourself.

There is also useful information on the CPFT perinatal mental health team website Perinatal service CPFT NHS Trust and links on the Rosie Maternity Voices website Covid Resources Health - Rosie Maternity Voices.

If you feel you need additional psychological support please let a health professional know.

If you are experiencing a mental health crisis, and need access to immediate help, please call the First Response Service on 111 and select option 2.

Contacts

Rosie Booking Line 01223 348981 (voicemail service)

Early Pregnancy Assessment Unit 01223 217636 (up to 13 weeks of pregnancy)

Maternity Assessment Line 01223 217217 (urgent questions, after first scan):

Rosie Birth Centre 01223 217003

Delivery Unit 01223 217217

Scan appointments 01223 217621

Clinic 21 (Outpatient Appointments) 01223 217657

Rosie Hospital Infant Feeding Support 01223 596292 (Monday to Friday, 9am – 5pm)

Rosie Community Midwifery Teams

Ivy: 01223 596212

Lily: 01223 586787

Scarlett: 01223 349376

Primrose: 01223 586790

Rose: 01223 349316

Sienna: 01223 349314

Lilac: 01223 348794

Sky: 01223 348943

Emerald: contact your midwife

Luna: contact your midwife

Rosie E-Midwife: via www.facebook.com/RosieEMidwife1/ or email rosie.emidwife@addenbrookes.nhs.uk

Rosie Website: The Rosie Hospital CUH