Maternity services

The initial Ockenden Report was released in December 2020 following a review of care in the maternity units of Shrewsbury and Telford Hospital NHS Trust. The maternity unit at Homerton Healthcare NHS Foundation Trust, with the support of the Board, have worked collaboratively with those who use our maternity services, commissioners, primary care providers and the regional maternity teams to  implement the recommended actions from the report and have made positive progress.

The final Ockenden report was released on 30 March 2022 with further recommended actions for maternity services across England. We are in the process of reviewing these and will continue to work with those who use our services, as well as with our local partner organisations and our user-led Maternity Voices Partnership, to implement the actions. Safe, compassionate and responsive care is at the centre of all we do at Homerton Maternity and we welcome these actions designed to improve maternity care nationally.

 

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

Baby Buddy 2.0, is a free app from the parenting charity, Best Beginnings. It’s designed to help parents give their child the best start in life, with bite sized information and advice from pregnancy, to birth, to their babies first year.

It has birth planning tools, a personal child health record for growth, vaccinations, appointments and other development milestones and daily personalised content for mums, dads and non-birthing co-parents. With information available 24/7, the Baby Buddy app echoes midwife advice and guidance, endorsed by health professionals* and approved by the NHS. With personal care and support plans, parents can make informed choices about care for themselves and their babies, improving experience from pregnancy to babies first birthday. 

Parents in North East London can now access extra, localised information from their local maternity unit. When joining the app, parents due to give birth at The Royal London Hospital, Newham University Hospital, Homerton University Hospital, Whipps Cross Hospital and Queen’s Hospital will have access to additional information regarding their maternity unit. To download or for more information visit the Baby Buddy website: www.babybuddyapp.co.uk

*Baby Buddy is endorsed by Royal College of General Practitioners, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Community Practitioners and Health Visitors Association, Royal College of Psychiatrists, Royal College of Speech & Language Therapists, British Society of Paediatric Dentistry and Faculty of Public Health. 

FAQs - your Baby Buddy questions answered

• What sort of information is on there?
  Loads of bite sized advice and information to take you from pregnancy through to birth and into your babies first year. There is information for dads, a space to create your personal care and support plan. You can look up information about local maternity services and keep a record of your babies’ growth, vaccinations and developmental milestones.
• Is it for me or for my baby?
  Both! And for other parents and care givers too.
• Who can use the Baby Buddy app?
  Whether you’re a mum, dad, co-parent or caregiver, Baby Buddy gives you the knowledge, confidence and practical skills to look after your baby, giving them the best start in life. You can even add multiple children and pregnancies to your personalised account and share child records and create shared spaces with other users of the app.
• I’m a dad, can I use it too?
  Yes. With personalised daily information for Dads from pregnancy until your baby is 1 year old. Information for dads and co-parents will be slightly different to mums but why not use it as a chance to share what you have learnt.
• I’m a LGBTQ+ parent, can I use it too?
  Yes. Baby Buddy have widened their support for LGBTQ+ parents with a new personalised daily information journey for Mums with a female partner and Mums with a non-binary partner. Users can select the pronouns that Baby Buddy uses to refer to your partner. The team at Baby Buddy are working hard to continue improving Baby Buddy to be as inclusive as possible.
• Do I have to sign up with my personal details?
  Parents will need to sign up with a preferred name, email address and postcode for localised information.You can also create a Baby Buddy account using your NHS login. NHS login allows you to access different digital health and care services using the same account. You can read more about it here: www.nhs.uk/nhs-services/online-services/nhs-log-in/ Be assured data is stored safely and securely and not shared or sold to any third parties. You can read Baby Buddy’s full privacy notice here: www.babybuddyapp.co.uk/privacy-notice
• Is it free?
  Yes! Baby Buddy 2.0 is free to download, with no adverts, and no in-app purchases. The app is developed by Best Beginnings; a charity committed to empowering parents, co-parents and caregivers.
• How do I get it?
  The Baby Buddy App is available, free, through Google Play, the App Store and the NHS Apps library.
• Is it in other languages?
  Baby Buddy is currently only available in English, however designed with a literacy age of 9 means it’s easily accessible to those whose first language may not be English.

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

 

Linda Machakaire
Interim Director of Midwifery & Lead for Neonatal Nursing
Tel: 020 8510 5767
Email: linda.machakaire@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: alice.compton2@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. 

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

*This is a mandatory field. If already booked with Homerton Hospital could you provide your hospital number (number on the front of your blue book)

First name

Family name

Date of birth

Address

Postcode

Mobile

Due date by scan

Have you had a baby before?

If yes, how many?

What kind of deliveries did you have?

Have you had any problem in this pregnancy?

If yes, what problems

First day of Last Menstrual Period (LMP)

* Spam Guard: Is a fire hot or cold?

The following changes to visiting restrictions in the maternity unit will go live as of Tuesday 08^th February 2022

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 most recent wave of 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.

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.

 

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 at various venues such as local pharmacies, or via the link below:

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

If you cannot order online, call 119. Lines are open 7am-11pm and calls are free.

Results should be registered at the link below:

Report a COVID-19 rapid lateral flow test result - GOV.UK (www.gov.uk) – you should be ready to show the result as registered on the website to reception staff or your midwife.

HUH Lateral Flow Tests Maternity Updated Feb 2022 [pdf] 510KB

 

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 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 Children’s 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 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.

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.

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.

 

Birth partners/support persons:

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:

A single visitor, the same visitor each day, can be with your 24 hours a day on the postnatal ward if you wish. We cannot accommodate more than one visitor, including any children, on the ward at present, and cannot accommodate swapping.

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 19^th 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

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.

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:

• Follow the guidance on social distancing and appropriate use of face coverings (this guidance covers England only - if you live in Scotland, Wales or Northern Ireland, you should follow the specific advice in those parts of the UK)
• Keep mobile and hydrated to reduce the risk of blood clots in pregnancy
• Stay active with regular exercise, a healthy balanced diet, and folic acid and vitamin D supplementation to help support a healthy pregnancy
• Attend all of your pregnancy scans and antenatal appointments unless you are advised not to
• Contact your maternity team if you have concerns about the wellbeing of yourself or your unborn baby

 

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/

 

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

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.

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.