Covid-19 Update

 Visiting Arrangements during Covid-19

Due to Coronavirus we have made some changes to our visiting arrangements in Maternity. This is in an attempt to curb / restrict the spread of the virus and protect the health of all our women

Antenatal appointments and Scans with both Midwives and Doctors in Community and Antenatal Clinic:

Women must attend all appointments alone. Partners, children and other people accompanying you will be asked to wait outside if they attend. We are delighted to offer a free picture at scans to all women during this time.

During labour on the Birth Centre and Delivery Suite on Induction of labour on Turpin ward:

Women may bring one birthing partner to accompany them – no other visitors allowed and no swapping.

Postnatal care on Templar ward:

No partners/visitors/family /children allowed onto Templar ward for the foreseeable future.

Appointments

In order to minimise face-to-face contact we have conducted a risk assessment and cancelled some appointments and transferred some others into telephone only. The appointments and scans which remain face-to-face are vitally important for us to be able to ensure the health of you and your baby so please continue to attend them if you are well. If you cannot attend an appointment because you have symptoms or are self-isolating due to a household member then please call the Homerton Maternity Helpline on 0208 510 5955 10am - 8pm each day or email on: huh-tr.maternityhelpline@nhs.net.

 

Information on Coronavirus information in English, Albanian, Dari, French, Farsi, Hindi, Kurdish, Mandarin, Pashto, Portuguese, Spanish, Turkish, Urdu and Vietnamese can be found by following this link. More languages are being added regularly:

https://www.doctorsoftheworld.org.uk/news/coronavirus-information/

 

Coronavirus (COVID-19) infection and pregnancy

What the updated guidance means for you and your pregnancy
On 23rd March the UK Government published new guidance on social distancing measures that we should all be taking to reduce social interaction between people. This is in order to reduce the transmission of coronavirus (COVID-19). Pregnant women were strongly advised to follow this advice as much possible as they may be at increased risk of severe illness and to significantly limit their face-to-face interaction with friends and family if possible. It is reassuring that there is as yet no robust evidence that pregnant women are more likely to become infected than other healthy adults. It is known from other respiratory infections (e.g. influenza, SARS) that pregnant woman who contract significant respiratory infections in the third trimester (after 28 weeks) are more likely to become seriously unwell. It is therefore imperative that pregnant women follow guidance by the UK government.

  1. Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature (above 37.8 degrees Celsius) and/or new and continuous cough
  2. Avoid non-essential use of public transport
  3. Work from home, where possible. Your employer should support you to do this.
  4. Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars, clubs
  5. Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
  6. Use telephone or online services to contact your GP or other essential services
  7. For pregnant healthcare workers, pregnant women of any gestation should be offered the choice of whether to work in direct patient-facing roles during the COVID-19 pandemic. This choice should be respected and supported by their employers.

What effect does coronavirus have on pregnant women?
It has long been known that, whilst pregnant women are not necessarily more susceptible to viral illness, changes to their immune system in pregnancy can be associated with more severe symptoms. This is particularly true towards the end of pregnancy. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or long-term conditions. There are no reported deaths of pregnant women from coronavirus at the moment. If you have an underlying condition, such as asthma or diabetes, you may become more unwell if you have coronavirus.

What effect will coronavirus have on my baby if I am diagnosed with the infection?
As this is a very new virus we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage. There is also no evidence that the virus can pass to your developing baby while you are pregnant (this is called vertical transmission). It is therefore considered unlikely that if you have the virus it will cause abnormalities in your baby.

Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused this or the doctors made the decision for the baby to be born early because the woman was unwell. As we learn about the risk of pre-term birth and coronavirus infection, we will update this information.

What can I do to reduce my risk of catching coronavirus?
There are general principles you can follow to help prevent the spread of respiratory viruses, including:

  • washing your hands more often - with soap and water for at least 20 seconds or use a hand sanitizer when you get home or into work, when you blow your nose, sneeze or cough, eat or handle food
  • avoid touching your eyes, nose, and mouth with unwashed hands
  • avoid close contact with people who have symptoms
  • cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands
  • clean and disinfect frequently touched objects and surfaces in the home

Should I still attend my routine antenatal appointments and scans in the community and at Homerton Hospital?
Over the next week we will be putting into place new measures which will reduce the number of face-to-face appointments during pregnancy and the postnatal period and replace them with telephone contact. Your midwife will be in contact with you to discuss this if any of your future appointments are affected by this change. If you have a scheduled appointment, do expect a telephone conversation with your midwife and/or an obstetrics doctor.

If you have an appointment to see a consultant, you will get a phone call about rescheduling as we want to ensure that all face to face appointments are needed at this time.

If you do not hear from us, that may be because we need to have a face to face consultation. We aim to reduce the risk to women by limiting face to face consultations and performing as many checks as possible at one visit. As long as you have no reason to think you may have coronavirus or have been exposed then you should attend appointments as planned. When you attend the hospital or community appointment you will be asked questions about your current health, in relation to coronavirus, at reception prior to check in.

Going forward we will only be preforming 36/40 week scans for women where there is a particular clinical reason for the scan.  If you are symptomatic of the virus we would ask that you remain at home and contact your midwife or the maternity helpline.

Postnatally we are about to implement a telephone call in advance to every face-to-face contact to talk about any symptoms or exposure you may have had and to make sure that you are healthy. It is very important to make sure that your midwife has the correct phone number for you and to answer all calls including those from withheld numbers. All postnatal appointments with consultants are being replaced with telephone conversations.

All antenatal classes have been suspended at the current time and your midwife will be able to share resources with you for you to read and watch at home instead. These are also available on the Homerton website.

Changes to our Homebirth service during Coronavirus
The wider impact on the NHS of Covid 19 (Coronavirus) has been huge. All NHS services are stretched due to isolation requirements and staff being asked to support other areas of the NHS. One area that has been hugely impacted is the London ambulance service (LAS). We have received communication from LAS outlining the impact Covid 19 has had on their services and how this would effect on providing a service across London. One area of concern outlined was that any requirement for them to attend at a homebirth for a maternity emergency is likely to have a delayed response. Any reason that requires a homebirth to transfer to hospital is a maternity emergency and approximately 40% of our homebirths require transfer to hospital. Therefore we have taken the difficult decision to temporarily suspend our homebirth service with immediate effect. We know that this may cause a number of concerns to you but we have made this decision to ensure that you, your baby and our staff are safe. We would like to reassure you that we will continue to support your birth choices where safely possible in the hospital and for many in the birth centre if your birth remains uncomplicated. We plan to review this decision as the situation progresses.

Changes to Visiting arrangements during Coronavirus
In order to restrict the spread of the virus and protect the health of all our women we have made some changes to our visiting arrangements in Maternity:

  • Antenatal appointments and Scans with both Midwives and Doctors in Community and Antenatal Clinic: Women must attend all appointments alone. Partners, children and other people accompanying you will be asked to wait outside if they attend.
  • During labour on the Birth Centre and Delivery Suite on Induction of labour on Turpin ward: Women may bring one birthing partner to accompany them – no other visitors allowed and no swapping.
  • Postnatal care on Templar ward: No partners/visitors/family /children allowed onto Templar ward for the foreseeable future.

Testing for coronavirus
The process for diagnosing coronavirus infection is changing rapidly. At the current time, only people with severe symptoms who require overnight admission to hospital will be tested. The UK government have suggested that this may change in the coming weeks.

If you do require a test, you will be tested in the same way as anyone being tested, regardless of the fact that you are pregnant. Currently, the test involves swabs being taken from your mouth and nose. You may also be asked to cough up sputum, a mixture of saliva and mucous.

If you test positive for coronavirus, you should contact your midwife or antenatal team to make them aware of your diagnosis. If you have no symptoms, or mild symptoms, you will be advised to recover at home. If you have more severe symptoms, you might be treated in a hospital setting.

What should I do if I think I may have coronavirus or been exposed?
If you are pregnant then you will be advised to self-isolate at home and avoid contact with others if you have either:

  • a high temperature
  • a new, continuous cough

or

  • have tested positive for coronavirus and you’ve been advised to recover at home

Whilst self-isolating it is recommended to:

  • Not go to school, work, NHS settings or public areas
  • Not use public transport
  • Stay at home and not allow visitors
  • Ventilate rooms by opening a window
  • Separate yourself from other members of their household as far as possible, using your own towels, crockery and utensils and eating at different times
  • Use friends, family or delivery services to run errands, but advise them to leave items outside.

You should stay at home for 7 days if you live alone or 14 days if one member of your family or household has a new continuous cough or high temperature. Do not go to a GP surgery, pharmacy or hospital. You do not need to contact NHS 111 to tell them you are staying at home.

You should contact the maternity unit to inform them that you have symptoms suggestive of coronavirus, particularly if you have any routine appointments in the next 14 days. You can do this via the Homerton Maternity Helpline 0208 510 5955 10am - 8pm each day or via email on  huh-tr.maternityhelpline@nhs.net

Please let us know your full name, hospital number (this is a 6 digit number which can be found on the front of your blue notes), estimated date of delivery (due date) and about any appointments you have booked in the next 14 days.  Please do not contact your named midwife as we anticipate a number of staff may be absent from work over the next month or so and we want to ensure the message is received.

You should use the online coronavirus service, or call NHS 111 if:

  • you feel you cannot cope with your symptoms at home
  • your condition gets worse
  • your symptoms do not get better after 7 days
  • If you have concerns about the wellbeing of yourself or your baby during your self-isolation period, contact your midwife, or out-of-hours, your maternity team. They will provide further advice, including whether you need to attend hospital.

Your antenatal care whilst in self-isolation
It is likely that routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect other patients.

If you have confirmed coronavirus infection, as a precautionary approach, an ultrasound scan will be arranged 14 days after your recovery, to check that your baby is well. This 14 day period may be reduced as more information on how infected people are in recovery becomes available.

If you have recovered from coronavirus and tested negative for the virus before you go into labour, where and how you give birth will not be affected by your previous illness.

If you have concerns about the wellbeing of yourself or your unborn baby during your self-isolation period, please contact the Homerton Maternity Helpline 0208 510 5955 10am - 8pm each day or Delivery suite on 020 8510 7351/7352. They will provide further advice, including whether you need to attend hospital. Please contact us prior to attending hospital.

If attendance at the maternity unit or hospital is advised, pregnant women are requested to travel by private transport (a private car or taxi)

Going into labour with suspected or confirmed coronavirus
As a precautionary approach, pregnant women with suspected or confirmed coronavirus when they go into labour, are being advised to attend an obstetric unit for birth (rather than the Birth Centre or a Homebirth), where the baby can be monitored using continuous electronic fetal monitoring, and your oxygen levels can be monitored hourly.

The continuous fetal monitoring is to check how your baby is coping with labour. As continuous fetal monitoring can only take place in an obstetric unit, where doctors and midwives are present, it is not currently recommended that you give birth at home or in a midwife led unit, where only midwives would be present.

Women with suspected or confirmed coronavirus are advised not to use the pool during labour as it is an infection risk.

There is currently no evidence to suggest you cannot give birth vaginally or that you would be safer having a caesarean birth if you have suspected or confirmed coronavirus, so your birth plan should be followed as closely as possible based on your wishes. However, if your respiratory condition (breathing) suggested that urgent delivery would be needed, a caesarean birth may be recommended.

There is no evidence that women with suspected or confirmed coronavirus cannot have an epidural or a spinal block. There is no evidence that the use of Entonox (gas and air) is an aerosol-generating procedure (AGP) and so we are continuing to offer it.The labour ward team will discuss all the options with you in early labour to ensure you are aware of the pain relief options available to you.

If you go into labour, you should call your maternity unit for advice via Delivery suite on 020 8510 7351/7352, and inform them that you have suspected or confirmed coronavirus infection. If you have mild symptoms, you will be encouraged to remain at home (self-isolating) in early labour, as per standard practice. This means we would advise you to stay at home until your labour is well established.

When you and your maternity team decide you need to attend the maternity unit, general recommendations about hospital attendance will apply:

  • You will be advised to attend hospital via private transport where possible, or call 111/999 for advice as appropriate
  • You will be met at the maternity unit entrance and provided with a surgical face mask, which will need to stay on until you are isolated in a suitable room
  • Coronavirus testing may be arranged
  • Your birth partner(s) will be able to stay with you throughout. Only one birth partner would be allowed on the delivery suite and no partners are allowed on the postnatal ward. We are sorry to have to implement this drastic measures but you will be well supported by your midwife and we would aim to get you home as soon as it is safe to do so.

Your baby and Coronavirus
As this is a new virus, there is limited evidence about managing coronavirus infection in women who have just given birth; however, there are no reports of women diagnosed with coronavirus during the third trimester of pregnancy having passed the virus to their babies while in the womb.

If you have suspected or confirmed coronavirus at the time your baby is born, your baby will be tested for coronavirus.

Provided your baby is well and doesn’t require care in the neonatal unit, you will be kept together after you have given birth and will be able to have skin-to-skin contact. There are some reports from China which suggest women with confirmed coronavirus have been advised to separate from their baby for 14 days. However, this may have potential negative effects on feeding and bonding.

A discussion about the risks and benefits should take place between you and your family and the doctors caring for your baby (neonatologists) to individualise care for your baby.

Breastfeeding and Coronavirus
At the moment there is no evidence that the virus can be carried in breastmilk, so it’s felt that the well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk. The main risk of breastfeeding is close contact between you and your baby, as you may share infective airborne droplets, leading to infection of the baby after birth.
A discussion about the risks and benefits of breastfeeding should take place between you and your family and your maternity team.
If you choose to breastfeed your baby, the following precautions are recommended:

  • Wash your hands before touching your baby, breast pump or bottles
  • Try and avoid coughing or sneezing on your baby while feeding at the breast;
  • Consider wearing a face mask while breastfeeding, if available
  • Follow recommendations for pump cleaning after each use
  • Consider asking someone who is well to feed expressed breast milk to your baby.

If you choose to feed your baby with formula or expressed milk, it is recommended that you follow strict adherence to sterilisation guidelines. If you are expressing breast milk in hospital, a dedicated breast pump should be used.

 

Homebirth service suspended for safety reasons.

Our homebirth service has been suspended for the foreseeable future. All imminent mums-to-be using the service have been contacted and informed of the suspension.

With the health service across London, including our colleagues in the ambulance service, under unprecedented pressure due to the Covid-19 outbreak, there has been a growing risk of delay if a homebirth mother requires an urgent transfer to hospital. 

In a message to the mums-to-be, our Head of Midwifery, Shirley Peterson said: “Any reason that requires a homebirth to transfer to hospital is a maternity emergency and approximately 40% of our homebirths require transfer to hospital. In addition, we are aware that there have been some cases where we cannot maintain a safe environment for our midwives as some women have not been honest about their or their family’s status of isolation in regards to Covid 19.

“We know that this will cause a number of concerns to you but we have made this decision to ensure that you, your baby and our staff are safe. We would like to reassure you that we will continue to support your birth choices where safely possible in the hospital and for many in the birth centre if your birth remains uncomplicated. We know that many of you will be concerned because of the increasing cases of Covid 19 and this may have led to your decision to have a homebirth. To maintain your safety, the hospital is only allowing staff and authorised persons into the hospital. On arrival at the maternity unit you will be asked questions to identify whether you are suspected or have Covid 19. This is to ensure that we provide optimum care to you.  It is also to ensure that we protect other pregnant women.  If you do not have Covid 19 you will be cared for away from any women that have Covid 19. 

“The homebirth team are still available to answer your queries and we hope that they can continue to provide your antenatal and postnatal care. We plan to review this decision as the situation progresses and will contact you accordingly if we can reinstate the homebirth service. Please do not hesitate to contact Francine Chang, Homebirth Team lead should you wish to discuss any aspect of this matter.”

Antenatal classes suspended - resources to be used at home

Due to Covid-19 we are currently unable to offer our usual Antenatal Classes. On these files you can find all the information our Midwives would usually provide at these sessions. Antenatal Class videos featuring Homerton Midwives are on their way very soon, watch this space.

Session 1 Slides Normal Birth

Session 2 Slides Delivery Suite and Higher risk care

Session 3a Slides Feeding and care of the Newborn

Session 3b Slides Taking care of yourself after birth

 

We provide maternity care for nearly 6000 women and their babies each year, during pregnancy, labour, birth and up until one month after birth.

During and after pregnancy, we offer both midwifery-led and consultant-led care and our teams are multidisciplinary which means all the care you need is provided within the maternity wards.

Our midwives look after women at the hospital antenatal clinic, at local GP surgeries and children’s centres.

We provide a home birth service and hospital-based care during labour and birth. In addition, Homerton is a leading regional neonatal centre and we will be able to provide the highest quality specialist care for your baby after birth if needed.

Please note we are a teaching hospital and as such students work alongside qualified practioners in providing your care. You will be asked for your consent for the student to be present or participate in your care.   

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NHS maternity care entitlement and charges

Some women may be asked to pay for their care. However, maternity care will not be refused or delayed for any woman, whether or not you are able to pay for your care.

Where women are eligible for charges, we can arrange affordable payment plans according to your circumstances. It is very important for yours and your baby’s health that you receive care during your pregnancy, birth and afterwards.

If you are worried about NHS maternity care charges, you can view information about whether this would apply to you via the Maternity Action website or by calling their maternity rights advice helpline for independent legal advice on: 0808 802 0057 (Freephone) Mon/Tues/Thurs/Fri 10 am – 1 pm.

You can also contact our maternity helpline on 0208 510 5955 10am - 6pm daily to speak confidentially to a midwife, or email our consultant midwife to discuss this via tamsinbicknell@nhs.net

Please do not let worries about charges put you off seeking maternity care. Maternity care will never be refused or delayed for any woman, whether or not you are able to pay for your care.

Staff and hours

Contacts

   Telephone Opening hours
Maternity Helpline 020 8510 5955 Every day,10am - 6pm
Antenatal clinic 020 8510 7175 Monday - Friday, 8am - 4pm
Delivery suite 020 8510 7351/7352 Every day, 24 hours
Templar Ward 020 8510 7541 /7561 Every day, 24 hours
Community midwifery 020 8510 5761 Monday - Sunday, 9am - 4pm
Fetal Medicine 020 8510 7291 / 7597 Monday - Friday, 9am - 5pm

Shirley Peterson
Deputy chief nurse and head of midwifery
tel: 020 8510 5767
email: shirley.peterson@nhs.net

Sarah Latham
Deputy head of midwifery
tel: 020 8510 7404
email: sarah.latham11@nhs.net

Mr Yinka Akinfewa
Associate medical director, consultant obstetrician/gynaecologist and lead consultant for fetal medicine
 
Mr Ademola Kejoku
Clinical lead for obstetrics, consultant obstetrician/gynaecologist, lead consultant for emergency obstetric unit, audit and guidelines 

Gitty Blum
Matron for delivery suite, emergency obstetric unit and triage
tel: 020 8510 7350
email: gitty.blum@nhs.net

Tracy Beason
Matron for community midwifery and Homerton birth centre
tel: 07747 457 354
email: tracy.beason@nhs.net

Ruth Stocks
Matron for maternity wards, antenatal clinic, antenatal and newborn screening
tel: 020 8510 7350
email: ruth.stocks1@nhs.net

Sumayyah Bilal
Named midwife for Safegaurding
sumayyah.bilal@nhs.net

Ella Hill Behari
Lead clinical midwife specialist, fetal medicine unit
email: ellahill1@nhs.net

Philippa Cox
Consultant midwife
tel: 020 8510 7046
email: philippacox1@nhs.net

Tamsin Bicknell
Consultant midwife, Public Health
tel: 020 8510 7715
email: tamsinbicknell@nhs.net

Esther Boye
Professional Midwifery Advocate & Practice Educator
tel: 020 8510 5147
email: e.boye@nhs.net

Senior midwives
A senior midwife is available 24 hours a day and is contactable via the hospital switchboard 020 8510 5555. 

Philosophy of care

Our philosophy of care is based on respect for pregnancy as a state of health and childbirth as a normal, healthy, physiological process. 

Pregnancy and birth are very significant events in a woman’s life and that of her family. The care we provide will aim to respect the diversity of women’s needs and the variety of personal and cultural values that women, families and communities bring to these events. Care will be continuous, personal and responsive to a woman’s health, social and emotional needs.

We aim to keep women informed at all times of the progress of their pregnancy and likewise any issues that arise during their care. We will encourage decision-making as a shared responsibility between the woman, her family and her care givers. To facilitate this, care provision must include evidence based information, education and counselling support to enable the woman to make informed choices.