Thanks Claire - Ive been wondering how long it will take for the home CTG monitoring issue to raise its head....

 

All the best

Soo

---

From: Claire Feeley <[log in to unmask]>
Sent: Friday, March 20, 2020 11:12 AM
To: [log in to unmask] <[log in to unmask]>; A forum for discussion on midwifery and reproductive health research. <[log in to unmask]>; Soo Downe <School of Community Health & Midwifery> <[log in to unmask]>
Subject: Re: Place of birth related to Covid-19

 

 

From Birthrights  twitter today : Understand @PennineAcuteNHS @BSUH_maternity @sarahnoble02  (South Warks) 

@NHSHomerton  planning to ramp up homebirth services in response to increased demand. Good to see services responding to where women feel safe - good for infection control too? @MidwivesRCM

  #CovidMaternity

 

Although- some bright spark has commented as to offering the at home CTG monitoring!!! it's his business in the Netherlands... we need to quash that.

 

basically my understanding is that IM's have had the go ahead to support NHS, will have emergency indemnity once the emergency legislation is passed end of March, but it is up to the individual trusts to implement, this means honourary/bank contracts etc. So the same process as for the likes of me going back in. RCM has also started to respond along with the NMC senior midwifery advisor regarding the IM situation, think they're being mobilised to facilitate this too.

 

Hope this helps a bit. we can learn from these forward thinkers outline in the tweet and disseminate? 

 

I for one, would prefer to go in and help community to keep women at home as much as poss.

 

Thanks

Claire Feeley

 

On Friday, 20 March 2020, 11:03:08 GMT, Soo Downe <[log in to unmask]> wrote:

 

 

I think it is worth linking up with areas where they are still supporting home births/MLUs, as an exemplar to others? Sarah, did your earlier email imply you are doing this? Jane, Chris, do you know what is happening elsewhere in London?

 

It would be great to work with the RCM on this - has anyone got good contacts with the RCM professional department?

 

Claire, can you advise everyone how the IMEs can contribute?

 

All the best

 

Soo

 

---

From: A forum for discussion on midwifery and reproductive health research. <[log in to unmask]> on behalf of Lucia Rocca <[log in to unmask]>
Sent: Friday, March 20, 2020 10:52 AM
To: [log in to unmask] <[log in to unmask]>
Subject: Re: Place of birth related to Covid-19

 

Yes Chris,

we have a situation in which several NHS Trusts are suspending all homebirths and re-deploying all staff to hospitals.

I thik that the idea of pop up FMUs and homebirth team working together could be a great idea.

How could we move on to propose to support such a plan?

I have been working with north west London LMS and I have offered help with setting up a new model, if they with to do so.

.....

how can this idea be moved forward?

there needs to be a buying in first form NHS Trusts, at least a few early adopters....

 

Tracey, Chris, Soo,

any idea about how to approach Maternity Services?

 

I am available to help

 

best wishes

 

Lucia

 

 

 

 

Dr Lucia Rocca-Ihenacho

PhD, MSc, RM

Lecturer in Midwifery and NIHR Research Fellow

Centre for Maternal and Child Health Research

School of Health Sciences

City University London

1 Myddelton Street

London
EC1R 1UW

 

07989 230313

Skype contact: luciainsky

 

 

 

 

On Fri, 20 Mar 2020 at 11:04, McCourt, Christine <[log in to unmask]> wrote:

Clare – first, leaving aside the more complex questions about risk management is this legal? could a service not be sued by a patient for refusing to send an ambulance in an emergency situation?

 

Second point that has just come into mind. yesterday, a few people were talking about pop-up FMUs on various discussion lists. Having seen reports of hotel owners donating their hotels and staff to the NHS in the last few days (e.g. an entire chain in Norway, Gary Neville in England) could smaller hotel owners do likewise given that many are having to close now? If it can be organise for extra beds. I have also come across reports of hotel use before by overcrowded services, although that may have been for postnatal only.

 

People are thinking differently in response to the urgency of the situation in many areas, including public health services, so why not this? Staff time and energy is very pressed but some professionals and managers are also stuck at home in isolation because of relatives/housemates with symptoms and couold be engaged in some creative thinking and planning.

 

 

Dr Christine McCourt Professor of Maternal Health, Centre Lead, Centre for Maternal & Child Health Research School of Health Sciences City, University of London 1 Myddelton Street, London EC1R 1UB T: +44 (0)20 7040 5863 M: +44 (0)7912 351476 www.city.ac.uk

 

 

From: NORMALBIRTH-RESEARCH <[log in to unmask]> on behalf of Claire Feeley <[log in to unmask]>
Reply to: NORMALBIRTH-RESEARCH <[log in to unmask]>
Date: Friday, 20 March 2020 at 08:21
To: NORMALBIRTH-RESEARCH <[log in to unmask]>
Subject: Re: Place of birth related to Covid-19

 

CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.

 

I've been informed of this today :

Glasgow NHS Trust pulled all homeborths for the next 6 months today. It was confirmed by email that paramedics would also not be sent if women chose to stay home. 

 

 

BW

Claire Feeley

 

On Friday, 20 March 2020, 08:16:05 GMT, Soo Downe <[log in to unmask]> wrote:

 

 

I think the situation is mixed in the UK - RCOG/RCM advice is for women  to stay at home as long as possible in the latent phase to avoid both infection risk and overwhelmed hospital services (though I dont think services are overwhelmed yet in the UK, at least outside of London - I was in an outpatients dept in the northwest of England  yesterday, and there were about 4 nurses/staff for every one OPD attendee - though it was late afternoon, and maybe that was just the end of the day, and that older people and those with disease symptoms are not attending OPD).

 

In some places, requests for and provision of home birth services are going up, for the same reasons. In other places, the opposite is happening - home birth services and MLUs are being closed down, and the only place left to give birth is hospital, in opposition to the above rationale for the advice to stay home in early labour. Given that, in some places, birth companion and doula attendance is now restricted to one, some fear that there will be an increase in freebirth. 

 

Women planning home or MLU birth with suspected or confirmed C-19 are being advised to switch to hospital birth for fetal monitoring (whether they have a fever or not).  

 

Others in the UK may have a different view of what is going on in their part of the country. 

 

All the best

 

Soo

 

 

---

From: The normal birth research list <[log in to unmask]> on behalf of Hannah Dahlen <[log in to unmask]>
Sent: Friday, March 20, 2020 8:00 AM
To: [log in to unmask] <[log in to unmask]>
Subject: Re: Place of birth related to Covid-19

 

I am posting for a midwife grappling with the best way forward in providing care for women booked in for Homebirth through public services. Please help her out and overseas strategies really welcome🙏🏽💗

 

“Now is the time to collaborate on a world scale on what decisions are being made about public funded planned home birth.  Can we tell each other what are the reasons for continuing to provide care and the decision to discontinue with public funded home birth in Maternity Systems around the world.  We all need to learn from each other to make decisions about the safest care for woman, their families and midwives. 

 

Overwhelming to have to be the influence to make these decisions for women in our service.”

 

Kind Regards

 

Hannah Dahlen | Professor of Midwifery | Higher Degree Research Director

School of Nursing and Midwifery 

Building EB/LG Room 34, Parramatta South Campus

P: 9685 9118 | F: 9685 99599 | E:[log in to unmask]
Western Sydney University

Locked Bag 1797 Penrith NSW 2751 Australia

http://www.uws.edu.au/staff_profiles/uws_profiles/professor_hannah_dahlen

Twitter @hannahdahlen

 

Error! Filename not specified.

On 20 Mar 2020, at 18:59, Soo Downe <[log in to unmask]> wrote:

yes, I strongly agree Chris

 

All the best

 

Soo

---

From: The normal birth research list <[log in to unmask]> on behalf of McCourt, Christine <[log in to unmask]>
Sent: Friday, March 20, 2020 7:07 AM
To: [log in to unmask] <[log in to unmask]>
Subject: Re: Place of birth related to Covid-19

 

I’m very shocked by the language in the text below – first, use of the word allowed is very striking – this is the mother so where does permission to feed her baby come in?? Even if this advice was logical, the word encouraged or supported would have been more appropriate.

 

Second, I am utterly baffled by what the logic is considered to be – handling bottles and formula and feeding one’s baby with a bottle surely carries equal if not more possibilities of infection risk – it requires contact and there is a much higher chance that a range of people would have handled a bottle and the equipment used to make formula. We know that formula feeding lacks the benefits of antibody transmission so any possibility that breastfeeding may (as it usually does) provide this is an advantage, even if unconfirmed. We also know already from rapid learning in China that younger people appear to be far less affected by this virus, so even if the instructions were logical, they would likely be misplaced. Finally, does anyone suggest that mothers don’t cuddle their babies – what kind of harm might that cause?

 

Need I continue, I have seen social media posts from very distressed mothers in London who are unable to buy formula milk and disposable nappies  in the shops because of others’ stockpiling. Women who breastfeed (and incidentally those who use washable nappies) are protected from the negative effects of this distress and also potentially even the infection risks of trailing round shops in a desperate bid to get supplies.

 

There is a discourse analysis dissertation in this for someone.

 

 

<image001.png>

Dr Christine McCourt Professor of Maternal Health, Centre Lead, Centre for Maternal & Child Health Research School of Health Sciences City, University of London 1 Myddelton Street, London EC1R 1UB T: +44 (0)20 7040 5863 M: +44 (0)7912 351476 www.city.ac.uk

 

 

From: NORMALBIRTH-RESEARCH <[log in to unmask]> on behalf of Kathy Carter-Lee <[log in to unmask]>
Reply to: "[log in to unmask]" <[log in to unmask]>
Date: Friday, 20 March 2020 at 03:49
To: NORMALBIRTH-RESEARCH <[log in to unmask]>
Subject: Re: Place of birth related to Covid-19

 

CAUTION: This email originated from outside of the organisation. Do not click links or open attachments unless you recognise the sender and believe the content to be safe.

 

Yes the Canadian Guidelines read well but the tendency to downgrade the "normal" and esteem medical intervention with "added value" remains, as seen below. A mother can breastfeed but "there is limited evidence (of anitbody transmission)". Surely the whole discussion and list of guidelines shows there is limited evidence on the outcomes and interventions highlighted?

 

Women who choose to breastfeed should be allowed to do so after appropriate handwashing and while wearing a mask. It is possible that the mother can transmit antibodies to the infant through breastmilk; however, there is limited evidence of this transmission and the potential benefits are unclear.

 

 

Keep thinking and questionning!

Go well

Kathy Carter-Lee

LMC Midwife & DHSc Student NZ

 

On 19 Mar 2020 at 23:05, Hannah Dahlen wrote:

 

>

>     Here are the British Columbia guidelines that seem very easy to

>     follow  

>

>     http://www.bccdc.ca/health-professionals/clinical-resources/covid-

>     19-care/clinical-care/pr egnancy       Kind Regards   Hannah

>     Dahlen AM | Professor of Midwifery | Associate Dean Research and

>     HDR| Midwifery Discipline Lead School of Nursing and Midwifery 

>     Building EB/LG Room 34, Parramatta South Campus P: 9685

>     9118 | F: 9685 99599 |  E: [log in to unmask]

>

>     Western Sydney University

>     Locked Bag 1797 Penrith NSW 2751 Australia

>     http://www.uws.edu.au/staff_profiles/uws_profiles/professor_hannah

>     _dahlen Twitter @hannahdahlen     Presentation@300x-100 2020

>     SNMF4513_FM_Email Sig 600x95px 5A   From: normal list

>     <[log in to unmask]> on behalf of

>     "[log in to unmask]" <[log in to unmask]> Reply to: normal list

>     <[log in to unmask]> Date: Thursday, 19 March

>     2020 at 11:40 pm To: normal list

>     <[log in to unmask]> Subject: Place of birth

>     related to Covid-19   Dear all   I generally think the current

>     UK response to Covid-19 is very sensible, and it is especially

>     gratifying to see that the RCOG/RCM advice for pregnant women is

>     to stay at home in the latent phase of labour, and to keep mothers

>     and babies together and breastfeeding (if that is their choice)

>     even if the mother is infected.   However, I have to say I simply

>     dont understand the apparently growing tendency to close MLUs. Im

>     wondering if anyone on this email list can let me know what Im

>     missing here?. It does seem counter-intuitive to move women

>     (against their preferences) to the very place the infection is

>     likely to be most prevalent, especially if they then end up having

>     epidurals, administered by anaesthetists who are desperately

>     needed for sick patients in ITU, and who, because they are the

>     front line for patients in ITU with respiratory distress,  are

>     most likely to be carriers of the infection? I really think Im

>     missing something here.    If the issue relating to closure of

>     MLUs is one of staffing, why not offer the opportunity to healthy

>     women booked for obstetric unit care to change their booking to

>     midwife led unit care, to take the pressure away from the OU, to

>     limit their exposure to the infection (and that of their baby) and

>     to use free capacity in MLUS to full advantage?   Im also

>     wondering about the advice for women with suspected/confirmed

>     covid-19 who are booked at home/in an MLU to move to an obstetric

>     unit for fetal monitoring.    Obviously, if a woman has a fever

>     (for any reason, including covid-19) and is pregnant or in labour,

>     it is clearly important to inform her about the benefits of

>     going to hospital for continuous fetal monitoring, wherever she

>     is booked,  as maternal pyrexia puts the baby at increased

>     risk.    But if she has other symptoms (such as a cough) but no

>     fever, wouldnt it be best for her to stay out of hospital (unless

>     she develops a fever)? Or maybe fever is such a cardinal sign that

>     the vast majority of those with suspected/actual infection will

>     have it?    Any insight on what Im missing would be very

>     gratefully received: especially if anyone had modelling data to

>     explain these decisions and their consequences.    All the best

>       Soo    Image removed by sender. University of Central

>     Lancashire

>

>     Please consider the environment before printing

>

> To unsubscribe from the NORMALBIRTH-RESEARCH list, click the following

> link:

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>                                  =1

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--------

Kathy Carter-Lee

Midwife

[log in to unmask]

021-425-115

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