While the treatment of illness is often seen as the raison d’être of the NHS, there is another aspect of care provided by the health service that is every bit as vital, varied and complex.
Pregnancy, childbirth and the postnatal period each present a wide range of needs that cannot be deferred and must be met by a host of support services provided across primary and secondary care sectors and the community.
As with so much else of what the NHS does, however, COVID-19 has inevitably affected the way in which expectant and new mothers access the care that they need.
It’s very difficult for pregnant mums and people in the postnatal period to necessarily get the right support and know what’s availableJamie Gilmour
Indeed, a report published last year by the RCOG (Royal College of Obstetricians and Gynaecologists) found that there had been ‘substantial and heterogeneous’ modifications to the way in which maternity services were provided during the pandemic.
Based on responses to a survey, carried out between May and June 2020, from a total of 81 obstetric units throughout the UK, the report found that 70 per cent of units reported a reduction in antenatal appointments, while 56 per cent confirmed a reduction in postnatal appointments.
Eighty-nine per cent of units said they had used remote consultations in place of face-to-face sessions, while 59 per cent said they had had to remove access temporarily to giving birth at home or in a midwife-led unit.
There has been some recognition of the challenges created by these adaptations, with the National Insitute for Health and Care Excellence and RCOG recommending that as many antenatal appointments as possible take place face-to-face, with a minimum of six out of eight appointments to be provided in-person.
Behind the figures, however, are the very human stories and experiences of mothers and babies, and how the upheaval in the way maternity care has been provided has affected them.
Manchester-based specialty trainee 7 in paediatrics Jamie Gilmour gave birth to her daughter in April and had seen the changes to maternity services in her trust prior to going on maternity leave.
She says that, while she was fortunate to have had a straightforward pregnancy and birth, she is now finding access to postnatal services in her area is not always consistent or straightforward.
‘[As an expectant mother] you’re told you’re at high risk and to try and stay away from everybody for social distancing purposes, so there is almost a fear of going into hospital,’ she says.
‘When you then do need support, you’re not sure whether the service you need is either going to be there at all or available in the right way.
‘It’s very difficult for pregnant mums and people in the postnatal period to necessarily get the right support and know what’s available.’
There were gaps in some of these services already before the pandemicSally Wilson
Having worked on a paediatric ward with a tertiary neonatal unit prior to going on maternity leave herself, Dr Gilmour says accessing such services even within hospital settings has not always been straightforward.
‘We struggled to get breastfeeding support to come to the paediatric ward from the postnatal ward, never mind trying to get people to visit mums at their homes,’ she explains.
As well as redirecting services that were traditionally delivered face-to-face to online and telephone-based, the clinical demands posed by the pandemic have also seen shortfalls in staff.
A survey of staff working in maternity settings conducted by the RCOG last December found that 61 per cent of those responding said members from their departments had been redeployed to other parts of the health service during the pandemic.
While the survey notes the majority of staff were returned to maternity settings between April and September, it remains unclear exactly what effects these shortages may have had on mothers and babies during this period.
Mental health concerns
Another critical area linked with postnatal care is that of perinatal mental health. Like many other forms of maternity support access to, and need for, these services have been affected by the pandemic.
A report commissioned by the Maternal Mental Health Alliance published in March this year said COVID-19 has posed mental health challenges during pregnancy and early motherhood owing to a variety of issues.
Speaking at the Westminster Health Forum, national training and research coordinator for Action on Postpartum Psychosis Sally Wilson said: ‘There were gaps in some of these services already before the pandemic, but we also saw redeployment of services away from midwifery, health visiting and perinatal mental health teams.
‘We need to recognise that perinatal and maternity mental health services are essential and lifesaving. Moving forward, these services must be prioritised and protected as we go into the future.’
Further research into what effect the pandemic has had on maternity care is also backed by Dr Gilmour, adding that she does not feel enough consideration was given to how mothers, their partners and babies would be affected by changes to services resulting from COVID-19.
While acknowledging that infection control remains a critical consideration in delivering healthcare, reliable access to PPE and universal vaccination among healthcare workers, and ever improving rates among the general public, meant that a greater return to in-person maternity care might soon be possible.
She further added that taking a standardised, national approach to policy on the access rights of birthing partners would help to eliminate the current post code lottery of different rules at different trusts.
‘I think impact [on changing maternity services] was considered purely on reducing transmission and reducing face-to-face contact,’ she says.
‘Even now on paediatric wards only one parent can go and stay with the child. If a child is admitted with weight loss or jaundice postnatally with difficulties feeding, the mum would be admitted with the child, but she then can’t get support from her partner.
‘Now we’ve got greater availability of testing and staff are vaccinated, I do think we need to start moving back to being more face-to-face with these services.’