Welcome to our Maternity Unit

 

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

We appreciate that this is challenging time and that you may be anxious about attending Homerton or about the care you will receive when you are with us. Whether you are attending for antenatal appointments, scans or during labour, birth or the early postnatal period you will be met with dedicated professionals who will have the skills, resources and equipment to provide a safe and caring environment for you and your baby. Maternity care is essential and has been developed over many years to reduce complications in pregnant women and babies. We follow Public Health England infection prevention and control guidance stringently, use appropriate PPE and have made significant changes to both the environment of the hospital and visiting arrangements promote social distancing. It is therefore vital that you continue to see us for all planned care.

It is particularly important that you do not delay seeking help if you notice any emergency signs, such as significant changes in the baby’s movement, pain, swelling, redness, ache or tenderness in one leg, and fluid leakage or bleeding, significant itching, heart palpitations, persistent headache, blurred vision, flashing lights or pain under the ribs. Please call Delivery suite immediately on 02085107351/7352 if these occur

You can contact a midwife for advice or support via the Homerton Maternity Helpline on 0208510 5955 from 10am - 6pm each day or via email on huh-tr.maternityhelpline@nhs.net

The CQC

The Trust has now received its CQC report following an inspection earlier this year. Homerton Hospital has been rated Outstanding.

 Highlights from the maternity part of the report are that:

  • The Maternity Department overall is rated ‘Good’.  
  • The rating for the ‘well led’ category moves from ‘Requires Improvement’ to ‘Good’.
  • The ‘safe’ rating from maternity has moved from ‘Good’ to ‘Requires Improvement’. The primary reason for the change in rating is due to lack of interface between the maternity and Trust IT systems. We were aware of this issue and had been working to address this prior to the inspection and will continue to work on this with our external providers.

I want to assure you that that the quality of care provided to you and your baby remains of the usual high standard. The inspection team acknowledged improvements made since the last inspection and  identified a number of good / outstanding practices.

As we have always been, the maternity team are committed to providing outstanding care to our families.

The overall Homerton Hospital site rating is now rated as outstanding! We are extremely proud of this recognition and acknowledgment of the quality of services we provide to all patients.

If you have any questions relating to this statement; please contact us using the following email address -huh-tr.HUH.Senior.Midwives@nhs.net

Homerton Maternity Unit Statement on increased risks to pregnant women from BAME backgrounds

Here at Homerton maternity unit, we recognise that pregnant women from BAME backgrounds, and their families, are likely feeling anxious about the news that coronavirus is more likely to affect people from BAME backgrounds more severely. 

We are working hard to reduce the increased risk of a number of poor outcomes that are not related to coronavirus but have been shown to affect women and babies from BAME backgrounds.

We understand that hearing about these risks will be very worrying, and want to tell you what we are doing to try to ensure you and your baby are safe and well.

  • Implementing new guidance for care as it is published by our Royal Colleges and NHS England
  • Developing a pregnancy-specific COVID-19 assessment tool that includes ethnicity as a risk factor for more severe disease. This will alert staff that they may need to escalate for a review and possible admission to hospital at an earlier point for those from BAME backgrounds.
  • Regularly auditing our outcomes via ethnicity so that we can identify areas for increased focus and service development
  • Involving all staff in discussion and training regarding unconscious bias, engaging in hospital-wide work to dismantle systemic racism, and reviewing our services to find ways we can adapt services to better suit families from different cultures and backgrounds.

How you can be involved

We would welcome hearing your views on maternity care and how Homerton can provide the best care to women of BAME backgrounds, both during the pandemic and in the future. There are a number of ways we are doing this:

  • Encouraging engagement from women and their partners from all backgrounds with our Maternity Voices Partnership (forum run by local parents for families who are using or have used our services, to gather feedback and help improve maternity care locally). If you would like to get involved, please contact us via:
  • Looking for more effective ways of communicating with women from different backgrounds so that important health messages reach everyone. If you can advise or help us, or would like to share your experience, please get in touch via any of our social media channels
    • Instagram: @homerton.maternity / @homerton_birthcentre / @homerton_homebirth
    • Twitter: @huhmaternity

Important things you can do to care for your and your baby’s health:

  • Book early for maternity care and keep all your appointments – whether in person or virtual
  • Call or visit us for a check-up without delay, anytime day or night, if you have any concerns about yourself or your baby – do not wait. Contact details:
    • Maternity Helpline 7 days per week, 10am – 6pm: 0208 510 5955
    • Out of hours: Delivery Suite on 0208 510 7351 / 7352 / 7353
  • Ensure you are regularly taking a vitamin D supplement (at least 10 micrograms daily)
  • Tell us if you have any concerns about your care.

Poster with testimonials from families who have had their baby at Homerton Hospital

Infant feeding

 

Infant Feeding
Breastfeeding is the healthiest way to feed a baby and we encourage women to breastfeed their babies and aim to support you to achieve this. Read our parents guide to breastfeeding policy .

Homerton hospital is committed to promoting breastfeeding and is working towards achieving Unicef Baby Friendly status. The Baby Friendly Initiative is a global programme of UNICEF and the World Health Organisation. It works with health services to improve practice so that parents are enabled and supported to make informed choices about how they feed and care for their babies. Find more information from the  Unicef Baby Friendly web pages, and about breastfeeding in general.

Supporting close and loving relationships
Babies need warm reactive relationships with their primary carers. Keep babies close and respond to their cues for food, love and comfort. This is essential for babies’ health, wellbeing and brain development. In addition it can help new parents to also cope with the changes in their lifestyles during the early postnatal period.

How should I position my baby:

C – Close
Baby should face the breast and be as close as possible to gain a deep latch

H – Head free
Supporting the baby around the neck and shoulders rather than by the head will allow them to tilt their head back and open wide to take in your breast tissue

I – In line
Have you tried swallowing with your head twisted over your shoulder? You will soon get tired. Babies also need to have their head in line with their bodies to help them swallow.

N – Nose to nipple
The chin should lead and the mouth should be wide open when the baby latches with the nipple pointing up toward the baby’s nose so that when you latch it reaches far back into the baby’s mouth.

S – Sustainably
Will you be able to sit in this position for a whole feed? Do you have water nearby?

How do I know if my baby is latching on properly?

  • they take a large mouthful of breast tissue and you can see more of the darker area of your breast (areola) at the top of the baby’s mouth.
  • Baby should have rounded cheeks
  • the chin should be the first thing to touch the breast and should indent the breast and massage the tissue during the feed
  • Baby’s lips (top and bottom) should be turned outward
  • you should hear a 2:1 suck and swallow pattern after the initial let down.

While breastfeeding can be uncomfortable, especially for first-time mothers, it shouldn’t be painful. If you experience pinched, sore or bleeding nipples, or your baby still seems hungry after a feed, these could be signs that your baby isn’t attaching well. Seek help from your midwife.

Really Good Drinking video
Unicef Baby Friendly Assessment Tools
Unicef positioning advice with video

Try different positions
image of rugby position Image of cross cradle position image of koala position
Rugby Cross cradle Koala
image of reclining position image of lying down position  
Reclining Lying down  

https://globalhealthmedia.org/videos/breastfeeding-positions/

https://www.babycenter.com/baby/breastfeeding/good-positions-for-breastfeeding_8784

Seek advice if breastfeeding is painful
If you’re finding that breastfeeding is painful, you should get a healthcare professional to look at how your baby latches on and the position you’re sitting in to breastfeed. You may just need to adjust your position. For drop in support visit the Hackney Breastfeeding Network.

Breastfeed responsively
You cannot over feed a baby who is only having breast milk. Often babies will feed for comfort as well as for nutrition and responsive feeding means breastfeeding whenever your baby shows feeding cues that it wants to be fed. It also means you can offer a breastfeed if your breasts feel full or for your own needs. Feeding regularly will ensure that you have a good milk supply and that the baby feels loved and supported. However, it is not usual for babies to have large gaps between feeds so if your baby is going for a long time (more than 3 hours) without showing feeding cues try to wake them and offer the breast - a baby should feed at minimum eight to ten times in 24 hours, with feeds lasting between 10 and 45 minutes. If your baby comes off the breast, this can mean the breast is nearly empty, so you can offer the other side.

How will I know by baby is getting enough milk?
If your baby is getting enough milk, they should relax during breastfeeding and not be agitated. The best way of knowing how much they are drinking is to see what is coming out. After the first week they should have at least six or more wet nappies and at least two dirty nappies a day. If your baby still seems hungry, they may not be latching on properly and you might need some extra support, so drop into one of our breastfeeding drop-in’s or use the support contact below.

Antenatal colostrum harvesting
Colostrum is a concentrated yellowy fluid produced from the breast for the first few days of your baby’s life to provide complete nutrition for them while their stomach is still tiny.
Colostrum is packed full of antibodies and white bloods cells which help build your babies immune system and protects the baby’s digestive system from infections.

Being able to hand express colostrum will give you the confidence to provide food in the early days to your baby. Expressing colostrum before you give birth ensures that your baby will have access to your milk early and can be particularly useful for:

  • diabetic mothers
  • twin Pregnancies
  • expected Pre-term pregnancies
  • small babies
  • women who have breast abnormalities
  • anyone on Beta-blocker medications

Ask your midwife for a colostrum harvesting pack.
Download a PDF of our expressing pack https://www.homerton.nhs.uk/download/doc/docm93jijm4n7855.pdf?amp;ver=16371

Expressing - basics of breast massage  and hand expression video

Expressing – milk storage

Storing breast milk safely

You can store breast milk in a sterile container:

  • in the back of the fridge for up to 6 days
  • for 2 weeks in the ice compartment of a fridge
  • for up to 6 months in a freezer, if it's -18C or lower

Storing breast milk in small quantities will help avoid waste. If you're freezing it, make sure you label and date it first.

Defrosting frozen breast milk
It's best to defrost frozen breast milk slowly before giving it to your baby. If you need to use it straight away, you can defrost it by putting it in a jug of warm water. Use it straight away.

Never re-freeze milk that's been defrosted
Once your baby has drunk from a bottle of breast milk it should be used within 1 hour and anything left over should be thrown away.

Formula feeding
Breastfeeding is the healthiest way to feed your baby. If you are unable to, or choose not to breastfeed, we will support you in this decision. Advice and support is available from your midwife and health visitor. It is also important to be responsive to your babies feeding cues and also pick up on when they might be full as it is possible to overfeed a bottle fed baby. Hold the bottle at a horizontal level and pace the feed so the baby can take breaks and let you know when it has had enough. 

Tongue Tie
If you had your baby at Homerton we provide a service to assess if your baby has a tongue tie and if it is affecting feeding. If necessary we can undertake a frenulotomy (tongue tie division). Referrals can be made via your midwife/health visitor or GP, if you have any concerns please speak to one of them and they can refer to us. We can only assess babies born at Homerton even if you are resident within Hackney and the City. We can only see babies younger than 8 weeks.

Additional Resources for mothers

Infant Feeding Team support

Email: huh-tr.homertonbreastfeedingsupport@nhs.net
 
please include the following details: 
•    your name, telephone number, and hospital number (this is a 6 digit number which can be found on the front of your blue notes) 
•    the date and time of your baby’s birth 
Website Breastfeeding helpline
NHS Breastfeeding 0300 100 0212
Breastfeeding Network  0300 100 0210  
Bengali/Sylheti  helpline 0300 4562421
National Childbirth Trust (NCT) 0300 330 0771
La Leche League 0845 120 2918

 

NHS Maternity Survey 2021

The Care Quality Commission will shortly be conducting a survey about women's recent experiences of giving birth , antenatal care, and postnatal care. This survey is part of a national programme to improve experiences of maternity care. Taking part in the survey is voluntary and all answers are confidential. If you are invited to take part you will be send a letter with details explaining how to participate.

NHS Maternity Survey Poster [pdf] 582KB

 

How to Contact Us

Contacts
   Telephone Opening hours
Maternity Helpline

020 8510 5955

and email:

huh-tr.maternityhelpline@nhs.net

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

 

Felitta Burney-nicol
Interim Director of Midwifery
Tel: 020 8510 5767
Email: f.burney-nicol@nhs.net

Mr Yinka Akinfenwa
Associate Medical Director, Consultant Cbstetrician/Gynaecologist and Lead Consultant for Fetal Medicine
 
Mr Ademola Kojeku
Clinical Lead for Obstetrics, Consultant Obstetrician/Gynaecologist, Lead Consultant for Emergency Obstetric Unit

Philippa Cox
Deputy Head of Midwifery
Tel: 020 8510 7046
Email: philippacox1@nhs.net

Gitty Blum
Matron for Delivery Suite, Emergency Obstetric Unit, Triage and Homerton Birth Centre
Tel: 020 8510 7350
Email: gitty.blum@nhs.net

Sarah Read
Matron for Community Midwifery and Antenatal Clinic
Email: sarah.read20@nhs.net

Alexandra Dyer
Matron for Maternity Wards, Antenatal Screening and Newborn Hearing
Tel: 020 8510 7350
Email: alexandra.dyer1@nhs.net

Ella Hill Behari
Lead Clinical Midwife Specialist, Fetal Medicine Unit
Email: ellahill1@nhs.net

Louisa Griffiths
Maternity Risk Managment Midwife
Email: huh-tr.maternity.clinicalgovernance@nhs.net
Tel: 020 8510 5768

Sumayyah Billal
interim Lead Midwife for Midwifery Led Care
Tel: 020 8510 5055
Email: sumayyah.bilal@nhs.net

Emma Yates
Interim Consultant Midwife, Public Health
Tel: 020 8510 7715
Email: emmayates1@nhs.net

Latica Charles
Interim Named Midwife for Safeguarding
Email: latica.charles@nhs.net

Alice Compton
Quality Improvement Lead Midwife
Tel: 020 8510 4031
Email: olivia.houlihan@nhs.net

Paula Griffin
Professional Midwifery Advocate
Tel: 020 8510 5235
Email: paula.griffin1@nhs.net

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

Antenatal self-referral form

Homebirth enquiry form

Warning
The National Institute for Health and Care Excellence (NICE) recommend that if you have a straightforward pregnancy  and you have not had any complications in any  previous births you may want to choose to give birth at home. If this is an option that you would like to consider please complete this homebirth enquiry form and the Homerton Homebirth team will contact you as soon as possible. Please note the homebirth team only cover the City, Hackney and a small part of Waltham Forest.

If you do not fulfil the criteria above we will arrange for you to speak to our Consultant Midwife to discuss your options. If you haven't heard from us within two weeks, please repeat the enquiry form or contact Homerton Maternity helpline at 020 851 05955.
Thank you

Details

Note: Questions marked by * are mandatory


*

Visiting Homerton during Covid-19

The following changes to visiting restrictions in the maternity unit will go live on Monday 12th April 2021:

 We are very pleased to be able to start easing the visiting restrictions that were put in place for the protection of both our patients, their families and our staff during the pandemic. The restrictions have been very challenging for us all, and we recognise that this has been a particularly difficult aspect of the temporary changes to care provision for our families.

As always, we have been taking an individualised approach where there are families with exceptional circumstances; if you feel this applies to you, please discuss with your midwife and they put you in touch with our senior team who can advise.

We are taking a stepped approach to easing the restrictions, and will monitor the changes closely to ensure we are able to maintain safety for all. Please bear in mind that we may be required to reduce the visiting capacity again if we experience a another wave of infection and work with us to keep everyone safe and well. We appreciate your cooperation and patience during this time.

Antenatal Appointments

One adult of your choice can come with you to all of your antenatal appointments. Unfortunately we cannot accommodate children at scans so we will not admit your accompanying adult to the appointment if children are also with you.

Pregnant people and accompanying adults should collect and complete lateral flow tests prior to attending antenatal appointments. Please see the lateral flow testing section below for more details.  

Everyone attending antenatal appointments on the Homerton Hospital site will be screened (temperature check and risk assessment questions) at the hospital entrance prior to admittance. The adult accompanying you should wait downstairs in the glass corridor (or in Picton suite on the first floor yellow corridor if seating capacity is reached in the glass corridor) whilst you go to the antenatal clinic unit to check in. When you are called for your appointment you can call or text them giving them the room number that you will be in. This will help to promote social distancing and the safety of all in the department.

For appointments in community sites such as GP surgeries or Childrens’ Centres please follow the guidance issued by the individual site.

Scans:

One adult of your choice can come with you to all of your scan appointments. Unfortunately we cannot accommodate children at scans so we will not admit your accompanying adult to the scan if children are also with you.

Pregnant people and accompanying adults should collect and complete lateral flow tests prior to attending scan appointments. Please see the lateral flow testing section below for more details.  

Everyone attending scan appointments will be screened (temperature check and risk assessment questions) at the hospital entrance prior to admittance. The adult accompanying you should wait downstairs in the glass corridor (or in Picton suite on the first floor yellow corridor if seating capacity is reached in the glass corridor) whilst you go to the scan unit to check in at reception. When you are called for your appointment you can call or text them giving them the room number that you will be in. This will help to promote social distancing and the safety of all in the scan department.

Lateral flow tests for pregnant people and accompanying adults

We ask anyone attending routine scans or antenatal appointments to collect and complete lateral flow tests prior to attending.

If you and your accompanying adult receive negative test results and have no symptoms for Covid-19 then please attend the appointment as planned.

If the pregnant person is symptomatic, has been exposed to a positive person or received a positive test result on LFT then please contact your Midwife or the Maternity helpline on 0208 510 5955 10am - 6pm each day to discuss the next steps for your upcoming appointment. Please never put off attending hospital for urgent care due to Covid-19 status or concerns – it is very important you attend immediately if you are concerned for the welfare of yourself or the baby.

If the accompanying adult has been exposed to a positive person or received a positive test result on LFT then they should not attend the appointment with you.

Tests can be accessed via the link below:

Order coronavirus (COVID-19) rapid lateral flow tests - GOV.UK (www.gov.uk)

Tests can be accessed via the link below: If you cannot order online, call 119. Lines are open 7am-11pm and calls are free.

Antenatal (Turpin) ward:

Those undergoing induction of labour on the antenatal ward will, as has been the case throughout the pandemic, be able to have a single birth partner with them from the beginning of the process. Once you are in established labour and move to the delivery suite for one to one care, your second birth partner will be able to join you.

We are gradually extending visiting on the antenatal ward (those staying in the hospital due to antenatal complications rather than for induction of labour). From Monday 29th March 2021 a single visitor, the same visitor each day, can visit you between 10am and 6pm daily. We cannot accommodate more than one visitor, including any children, on the ward at present.

All birth partners/visitors will be subject to the same screening checks and requirements not to be experiencing any COVID-19 symptoms as previously described.

Second birth partners:

There has been no change to our birth supporters policy. Two birth partners can accompany you to support you throughout your labour and birth, and from the beginning of the induction process if you choose to have an induction of labour. If you are having a caesarean birth, one birth partner will be able to accompany you into theatre.

Birth partners will be subject to the same screening checks and requirements not to be experiencing any COVID-19 symptoms as previously described.

Postnatal (Templar) ward:

We are gradually extending visiting on the postnatal ward (Templar ward). From Monday 29th March 2021 a single visitor, the same visitor each day, can visit you between 10am and 6pm daily. We cannot accommodate more than one visitor, including any children, on the ward at present.

From Monday 19th April 2021 this visitor can stay with you up to 24 hours a day if you wish.

All birth partners/visitors will be subject to the same screening checks and requirements not to be experiencing any COVID-19 symptoms as previously described.

Further information:

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/

Royal College of Obstetricians and Gynecologists (RCOG): https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/  

RCOG Information for pregnant women and their families: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

Public Health England (PHE)https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance

Summary:

Pregnant persons can bring one adult of their choice to all routine antenatal appointments and scans

Children are not permitted at any appointments unless completely unavoidable (i.e. you have no childcare options whatsoever and they would otherwise be left unsupervised at an age where this is inappropriate) and not at all in the inpatient area

Antenatal inpatients can have one visitor daily between 10am-6pm (same person each day)

Up to two birth partners are permitted in Birth Centre or Delivery suite and one for a Cesarean section

From Monday 19th April 2021 Postnatal inpatients can have one visitor (same person each day) for up to 24 hours a day if they would like

We ask Pregnant people and any accompanying adults to order and complete LFT tests before routine antenatal appointments and scans

Please never delay seeking urgent care in hospital because of Covid-19 fears, exposure, symptoms or a positive LFT test

Contact the Maternity helpline Maternity helpline on 0208 510 5955 10am - 6pm each day if you have any concerns

eRedbook (your electronic child health record)

To find out more about about and register for the eRedbook (your electronic child health record) visit this website: https://www.eredbook.org.uk/


The eRedbook app allows you to access your child's growth charts and health records such as immunisation history from the NHS wherever you are.

Starting during your pregnancy, and right up until your child is five, eRedbook will post age-appropriate guidance that is clinically validated by the NHS to help you keep you and your baby healthy. 
 

Use eRedbook’s interactive charts to keep track of your child’s weight and height. Measurements taken by your health visitor will also appear in the eRedbook if it is available from the NHS in your area. You can create a secure photographic record of your child as they reach developmental milestones as a keepsake for yourself.

You can choose to share your child’s record with your partner and other carers, enabling you to work together to keep your child healthy. Records can be shared as read only or read/write, meaning other carers can contribute to the record with your permission.

Coronavirus (Covid-19) infection and pregnancy – Information and Frequently Asked Questions

To download a PDF version of Frequently asked Questions please click here

COVID-19 and pregnancy

Q. What is the main advice for pregnant women?
Studies from the UK show that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all, and most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 may be at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester. Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution.

Pregnant women should follow the latest government guidance on staying alert and safe (social distancing) and avoid anyone who has symptoms suggestive of COVID-19. If you are in your third trimester (more than 28 weeks’ pregnant) you should be particularly attentive to social distancing.

Key advice for pregnant women during the pandemic:

 

Q. What should I do if I develop symptoms of COVID-19?

  • The main symptoms of COVID-19 are a high temperature, a new, continuous cough or a loss or change to your normal sense of smell or taste (anosmia).
  • If you think you may have symptoms, use the NHS 111 online service/NHS 24 in Scotland online for information and advice, and follow the guidance for households with possible or confirmed COVID-19 infection.
  • You should tell your midwife or maternity team that you have symptoms of COVID-19.
  • If you feel your symptoms are worsening or if you are not getting better, this may be a sign that you are developing a more severe infection that requires specialised care. You should contact your maternity team, GP, or use the NHS 111 online service/NHS 24 in Scotland for further information and advice. In an emergency, call 999.
  • Seek medical advice as early as possible if you have any questions or concerns about you or your baby.

 

Q. What effect does COVID-19 have on pregnant women?
Current evidence from the UK suggests that pregnant women are no more likely to get COVID-19 than other healthy adults. Roughly two-thirds of pregnant women with COVID-19 have no symptoms at all (also known as being asymptomatic). Most pregnant women who do have symptoms only have mild cold or flu-like symptoms. However, a small number of pregnant women can become unwell with COVID-19. Pregnant women who catch COVID-19 may be at increased risk of becoming severely unwell compared to non-pregnant women, particularly in the third trimester.

Studies have shown that there are higher rates of admission to intensive care units for pregnant women with COVID-19 compared to non-pregnant women with COVID-19. It is important to note that this may be because clinicians are more likely to take a more cautious approach when deciding whether to admit someone to the intensive care unit when a woman is pregnant.

At present, it is unclear whether pregnancy will impact on the proportion of women who experience ‘long COVID’ or a post COVID-19 condition.

In the UK, information about all pregnant women requiring admission to hospital with COVID-19 is recorded in a registry called the UK Obstetric Surveillance System (UKOSS).

The first report from this study included information about the outcomes of 427 pregnant women admitted to hospital with COVID-19 and their babies during the pandemic, and was published in May 2020. While most women in the study required only ward treatment and were discharged home well, around one in ten women required intensive care, and sadly five women with COVID-19 died, although it is currently unclear if COVID-19 was the cause of their death. The study found that the majority of women who did become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing and good hand hygiene from 28 weeks of pregnancy. An update of the UKOSS report is being prepared (a draft form of the update was published in January 2021). The updated report includes information on 1,148 pregnant women admitted to hospital with COVID-19. It has similar findings to the first UKOSS study: the vast majority of women were discharged home after simple ward care, about 1 woman in 20 required intensive care, and sadly 8 women died. Six of those deaths were because of COVID-19, and two deaths were from unrelated causes.

The UKOSS study and more recent publications have found that pregnant women from Black, Asian and minority ethnic backgrounds were more likely than other women to be admitted to hospital for COVID-19. Pregnant women over the age of 35, those who had a BMI of 25 or more, and those who had pre-existing medical problems, such as high blood pressure and diabetes, were also at higher risk of developing severe illness and requiring admission to hospital. Living in areas or households of increased socioeconomic deprivation is also known to increase risk of developing severe illness.

 

Q. What research is being done to monitor the effect of COVID-19 on pregnant women and their babies?
The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for COVID-19 during pregnancy, through well-established systems already used by all maternity units – this is the UK Obstetric Surveillance System (UKOSS). Any new evidence published from this and other studies will be used to update our guidance.

Imperial College London are also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with COVID-19. Other maternity surveillance programmes are being funded by the National Institute of Health Research (NIHR). You can also ask your maternity team about any local research that is taking place in your area.

The COVID-19 Symptom Study app has been developed by King’s College London and health science company ZOE. Members of the public, including pregnant women, can use this app to report on their health during the COVID-19 pandemic.

 

Q. Why are pregnant women in a vulnerable group?
Pregnant women have been included in the list of people at moderate risk (clinically vulnerable) as a precaution. This is because in a small proportion of women pregnancy can alter how your body handles severe viral infections, and some viral infections such as flu, are worse in pregnant women. Amongst pregnant women, the highest risk of becoming severely unwell (should you contract the virus) appears to be for those who are 28 weeks pregnant or beyond. This is something that midwives and obstetricians have known for many years in relation to other similar infections (such as flu) and they are used to caring for pregnant women in this situation.

Current evidence suggests that hospital admission may be more common in pregnant women with COVID-19 than in non-pregnant women of the same age, however this is partly because pregnant women are also admitted to hospital for reasons unrelated to COVID-19. In the UKOSS study, which examined women with COVID-19 in pregnancy during the spring and summer in the UK, the majority of pregnant women with COVID-19 admitted to hospital were in the third trimester of pregnancy. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and that this is particularly important at 28 weeks’ pregnancy and beyond.

 

Q. Should I take Vitamin D supplementation?
Vitamin D supplementation is recommended to all women during pregnancy.

There have been some reports that people with low levels of vitamin D are at an increased risk of serious respiratory complications if they develop COVID-19. However, there is not enough evidence to show that taking vitamin D prevents COVID-19 infection or is an effective treatment.

Most people living in northern hemispheres will have low levels of vitamin D. Women from Black, Asian and minority ethnic backgrounds, with melanin pigmented (dark) skin, may be particularly at risk of low levels of vitamin D. We therefore advise all pregnant women to consider taking 10 micrograms of vitamin D a day to keep their bones and muscles healthy.

Vitamin D supplements are available from most pharmacies and supermarkets and for eligible families, through the NHS Healthy Start scheme

Speak to your midwife or maternity team if you have any questions about vitamin D supplementation.

Visit the NHS UK website for more information on vitamins in pregnancy and where and how you can access these.

 

Q. What should I do if I develop a temperature, a new cough, or both, when I am pregnant?
If you develop a temperature or a cough, or both, in pregnancy, you should arrange to have a coronavirus (COVID-19) test. While waiting for a test result you should self-isolate. If you are feeling unwell you should contact your maternity unit or NHS 111 or NHS 24 in Scotland for advice.

Please also be alert to the other possible causes of fever/temperature in pregnancy. In particular, these include urine infections (cystitis) and waters breaking. If you have any burning or discomfort when passing urine, or any unusual vaginal discharge, or have any concerns about your baby’s movements, contact your maternity team, who will be able to provide further advice.

 

Q. What is the international travel advice if I am pregnant?
If you are in the UK, you should follow the advice given by the Foreign and Commonwealth Office, which is being regularly updated in line with the evolving situation.

All individuals, including pregnant women, should ensure they have adequate insurance arrangements prior to travel. You should also check that your travel insurance will provide cover for birth and care of your newborn baby if you give birth while abroad.

 

Q. What is the advice for pregnant women with older children attending school/nursery/external childcare?
Pregnant women were placed in the vulnerable category as a precaution during the COVID-19 pandemic. The government‘s guidance on schools and early years settings advises that: children and young people who live with someone who is pregnant (vulnerable) can attend school and early years settings. See the next question for information about pregnant women who are classed as extremely vulnerable.

All pregnant women are advised to follow government guidance on staying alert and safe (social distancing). Pregnant women are at no greater risk of contracting COVID-19 than other healthy adults. However, there are additional concerns for pregnant women in the third trimester. This is based on evidence from the UKOSS study on pregnant women admitted with COVID-19 to UK hospitals from March – August 2020; evidence suggesting an increased risk of admission to intensive care during the pandemic for women who are pregnant; and a recognition of the challenges in caring for women who are heavily pregnant, and the risk of the baby needing to be born early for the woman’s wellbeing. This evidence supports the remaining UK government recommendation that all pregnant women should pay particular attention to social distancing measures and good hygiene and that this is particularly important at 28 weeks’ pregnancy and beyond.

When you take your children to school/nursery/external childcare, you should ensure you practice social distancing – stay two metres away from teachers/carers and other parents and do not go inside the building. If this is difficult, then consider staggering your child’s drop off and pick up times. Remember to wash your hands when you return home and ensure that your children wash their hands when they leave the childcare setting. Alcohol gel can be used if they cannot wash their hands with soap and water.

If you are concerned about the choice of returning to school or other childcare settings based on the risk to children attending, helpful information is available from the RCPCH.

 

Q. What is the advice for pregnant women who are classed as extremely vulnerable (previously classed as shielding) on older children attending school/nursery/external childcare?
Some pregnant women with pre-existing severe medical illnesses have been classed as extremely vulnerable. If you are considered to be extremely vulnerable, you will have been advised of this by your medical team, in a letter informing you of the actions you need to take.

The government has published guidance on shielding and protecting people who are clinically extremely vulnerable. This guidance provides advice on measures to protect extremely clinically vulnerable people depending on the COVID alert level in your area. Even in this situation, if schools and childcare settings remain open, the UK government advice is that children and young people who live in a household where another member is shielding should attend school/nursery/external childcare if stringent social distancing, and hand hygiene, can be adhered to.

 

Q. Should I still attend my routine antenatal appointments and scans in the community and at Homerton Hospital?
Maternity care is essential and has been developed over many years to reduce complications in pregnant women and babies. Not attending antenatal care risks potential harm to you and your baby. It is important that you continue to attend all of your planned care as long as you remain well. Staff at Homerton follow Public Health England infection prevention and control guidance stringently and use appropriate PPE in order to promote a safe environment. Lateral flow testing prior to all scans and appointments is currently in place. Please see the drop-down section on “Visting Homerton during Covid-19” for more details.

Antenatal classes have been suspended at the current time but resources for you to read and watch at home are available on the Homerton website. These include slide-shows and videos containing all the information which would usually be taught in our antenatal classes

COVID-19 and labour/ birth

Q. What is I have tested positive for Covid-19 when I go into labour?
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.

 

COVID-19 and your baby

Q. What effect will COVID-19 have on my baby if I am diagnosed with the infection during pregnancy?
Current evidence suggests that if you have the virus it is unlikely to cause problems with your baby’s development, and there have been no reports of this so far.

There is also no evidence to suggest that COVID-19 infection in early pregnancy increases the chance of a miscarriage.

Transmission of the COVID-19 from a woman to her baby during pregnancy or childbirth (which is known as vertical transmission) seems to be uncommon. Whether or not a newborn baby gets COVID-19 is not affected by mode of birth, feeding choice or whether the woman and baby stay together. It is important to emphasise that in most of the reported cases of newborn babies developing COVID-19 very soon after birth, the babies remained well.

Studies have shown that there is a two to three times increased risk of giving birth prematurely for pregnant women who become very unwell with COVID-19. In most cases this was because it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover. Babies born before full term (before 37 weeks) are vulnerable to problems associated with being born premature – the earlier in the pregnancy a baby is born, the more vulnerable they are.

The updated UK Obstetric Surveillance Study (UKOSS) report from January 2021 describes 1,148 pregnant women with COVID-19 who were admitted to hospital between March and September 2020. Nearly one in five women with symptomatic COVID-19 gave birth prematurely. However, women who tested positive for COVID-19 but had no symptoms were not more likely to give birth prematurely. The babies of women with COVID-19 were more likely to be admitted to the neonatal intensive care unit (NICU), but almost all these babies did well. There was no increase in stillbirth rate, and no increase in infant death for babies born to women who had COVID-19. Not all the babies were tested, but overall, only 1 baby in 50 tested positive for COVID-19, suggesting that transmission of the infection to the baby is low.

 

Q. What effect will COVID-19 have on my baby’s care if I am diagnosed with the infection at the time of birth?
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.

Babies and children under two should not wear masks or other face coverings, as they may risk suffocation.

The well-recognised benefits of breastfeeding outweigh any potential risks of transmission of coronavirus through breastmilk and therefore we would recommend you continue to breastfeed if this is your choice. 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.

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.

COVID-19 vaccination and pregnancy

Q. Should I have the Covid-19 vaccination in pregnancy?
The latest advice from the Joint Committee on Vaccination and Immunisation (JCVI) is that COVID-19 vaccines should be offered to pregnant women at the same time as the rest of the population, based on their age and clinical risk group. Women should discuss the benefits and risks of having the vaccine with their healthcare professional and reach a joint decision based on individual circumstances.

The latest advice and a decision-making tool can be found here on the RCOG Website:

https://www.rcog.org.uk/en/guidelines-research-services/coronavirus-covid-19-pregnancy-and-womens-health/covid-19-vaccines-and-pregnancy/covid-19-vaccines-pregnancy-and-breastfeeding/

 

Antenatal classes

During pregnancy, you will have time to think about your future as a parent and to consider some options for yourself and your baby, including decisions about the birth and about feeding your baby. We provide parent education classes to help you prepare for the birth and for parenthood. Please click the following link for details

https://www.homerton.nhs.uk/parentcraft-sessions

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.

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.

Share your views

Please see below for the link to a national survey: London women's experience survey: Pregnancy and giving birth during the pandemic.

The purpose of the survey is to gather feedback of women’s experience of accessing maternity services throughout the pandemic to enable the restoration of maternity services with women’s voices heard from the start.

Please see the link below to share with colleagues, local women and your social media platforms:

 https://forms.office.com/Pages/ResponsePage.aspx?id=kp4VA8ZyI0umSq9Q55Ctv8-cdBeVcUdGq0fmWAvPz8FUOEtIQUtENklNQzZJSEZEN0g5TDhLQUxIRiQlQCN0PWcu

City & Hackney MVP

City & Hackney Maternity Voices Partnership (MVP) is a committee chaired by local mums and consists of local parent reps and health professionals, which advises NHS in City & Hackney on the care they provide to women, their partners and their babies, during pregnancy, birth and in the weeks after the baby’s arrival. The role of the Partnership is to make sure that local maternity units listen to and take account of the views and experiences of people who use their services.  

The MVP wants to hear your views and experiences and provides direct feedback to the Homerton and East London Local Maternity Systems. Please email us.

Join the community and keep up to date on maternity services through Facebook and Twitter: 

City & Hackney MVP Facebook Page - a place to get up to date, reliable information on maternity services in City & Hackney 

City & Hackney MVP Facebook Group - a community of local women and families and maternity service providers to share views and provide feedback.

There is also a weekly Zoom call taking place at 11am on Wednesdays during Covid-19, which is chaired by the Head of Maternity for East London along with the local commissioners and MVPs. We're inviting women to join us and share their views, experiences and to ask questions.  We are really keen to hear from women and families from all backgrounds. If you need a language translator for the call - ELLMS will provide translators. Please email elhcp.enquiries@nhs.net

For anyone that would prefer to send in written feedback please use elhcp.enquiries@nhs.net

Topic: Coronavirus - What are your thoughts and feelings with regards to maternity care?

Time: 11am

Every week on Wed, until May 20, 2020