At 13 weeks pregnant, Marie Day began bleeding. While a warm, metallic rush between the legs would panic anyone expecting, she was petrified.
Age 40, it was her first pregnancy. Multiple operations devoted to weeding out patches of endometriosis – uterine tissue that grows elsewhere, often in the ovaries or fallopian tubes, and which can cause agony – meant she had been warned that biological children were not likely to be in her future. Plus, a procedure to remove a piece of her cervix, thus capturing a cluster of pre-cancerous cells a few years earlier, meant that a dicey birth could be on the cards. Now, she was convinced that she was losing her baby: one which she believed to be her sole shot at motherhood.
Her partner drove her to hospital for an emergency scan. Clambering out of the car, she left him at the wheel. Due to COVID restrictions designed to allow fewer, potentially contagious people onto waiting rooms and wards, Marie was alone as she had cold gel applied to her belly, a probe traced over her skin and waited to hear a heartbeat.
Thankfully, the scan found Marie's baby thriving in utero; the bleeding a false flag. Her case, though, highlights the very real issues with the pandemic regulations involved in maternity care.
When the reality of the coronavirus crisis – which has spawned 358,000 cases and has claimed over 41,000 lives in the UK, thus far – hit this Spring, things had to change in hospitals. Birthing partners were not allowed into wards until 'established labour' had taken hold (when the cervix is 4-5cm dilated); had to leave after the birth and could not come to antenatal scans.
When these rules loosened, each NHS Trust interpreted guidance in slightly different ways. In some places, pregnant people could now be accompanied to their 12 and 20 week scans and have someone with them in the hours after giving birth. In some places, restrictions remained as they had at the apex of viral spread:
'As a group, we are having women approach us and tell stories about having to go to scans alone, sometimes finding out the devastating news of miscarriage or foetal abnormally,' says Kirstie Broughton, a doula (a non-medical professional who offers support during pregnancy, labour and in the post-natal period) speaking on behalf of BirthBliss Academy.
'I can’t imagine how traumatic this must be at the best of times, but being told when alone is cruel. Women are then going to antenatal appointments alone and having to try and digest lots of confusing information. When it comes to the time for birth a woman may have to go in to hospital for induction, which can take days to start working properly, and she has to stay alone. It may be a slow, painful induction and she still might have to be alone until she’s in established labour.
'The partner (often the dad), is then called to come and see his baby be born. Often the partner will have been sitting in the car park for hours or even days on end. Lots of dads have missed the birth because they’ve not managed to get back to the hospital in time. Once the baby has been born the birth partner is allowed to stay for one hour, or sometimes two, in a few hospitals. The new mum is left to stay in the hospital alone with the baby, potentially for many days.'
BirthBliss Academy have, in response, launched a campaign to have the rules altered, across the board. #ButNotMaternity took flight on the 1st September with an open letter to Chief Medical Officer for England, Professor Chris Whitty; Health Secretary Matt Hancock and NHS England.
They are asking that women and people giving birth are allowed a support figure with them for maternal services (in a COVID secure way, with proper PPE). They believe that as folk are now allowed to convene at the pub, IKEA, or for a pizza in groups of six, that such rules should be relaxed. ('It doesn't make sense to me that I can sit in a cafe with my partner, but I can't take him in for an emergency scan,' says Marie.)
BirthBliss Academy also point out that the pandemic is exacerbating mental health issues among those due to give birth (research which hinged largely on the experiences of pregnant women in North America indicated that self-reported 'moderate to high anxiety' is up from 29 to 72%, in pregnant people.) The group's members are not alone in their calls. Another petition, begun by Holly Avis, asks for partners to be allowed for the whole of labour, in all hospitals. It has close to 400,000 signatures.
'We are disappointed to hear that some women and birthing people are still not allowed to have one birthing partner attend and may be giving birth alone,' say Tinuke Awe and Clotilde Abe of the Five x More campaign, which works to raise awareness of maternal disparities for Black Women in the UK. 'One of our six recommendations from the campaign is to "Find an advocate" for yourself.
This could be your partner, a family member or a trusted friend that can speak on your behalf if need be. As our campaign highlights, Black women in the U.K. are five times more likely to die during pregnancy and childbirth (MBRRACE 2018) and with the added risk of being more likely to be admitted into hospital with COVID-19 if you are from a Black and Asian Minority Ethnic background, this is a very worrying and anxiety filled time for Black women and birthing people everywhere. We believe the rules should be changed to allow for one birthing partner to attend as quickly as possible.'
Changes are being felt. Last week the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) released a statement saying that NHS England should work on reintroducing partners into maternity care. Following this, NHS England sent out a framework to all the English hospital trusts on getting started. Some trusts, says Broughton, have not yet done so. Yesterday (Tuesday 15th September) Hancock said that he would support a campaign from MP Alicia Kearns to have partners present at all scans and through all stages of labour.
Shauna McNamee, a 27-year-old from Tyrone in Northern Ireland, has struggled with restrictions at her local hospital. 'I went for my 12 week scan alone, and it was awful. I had been expecting twins and had already miscarried one, very early, and so I didn't know if this baby was going to be okay. I asked if I could FaceTime my husband in and was told that I couldn't. I had the 20 week scan on my own and felt empty: not excited, not sad. The NHS are fantastic, but it feels like maternity services have been forgotten about.'
As with anything pandemic-adjacent, this issue contains multitudes of grey. 'I really empathise with the women who are pregnant and giving birth during this time. When I had my son, having my partner was so crucial for me. Hospitals can be scary places where we can feel our most vulnerable and not having your partner there can be difficult, understandably,' says GP and mum-of-one, Dr Hena Haq.
She does, though, explain that keeping numbers down in hospitals serves an important purpose. 'The restrictions in place aren't about trying to keep partners away. COVID is unpredictable, and, right now, we're seeing a rise in numbers of cases and of the R number. Most wards, including postnatal wards, are set up with a mix of individual rooms and bays. Each bay usually consists of four patient beds and so if everyone was to have their partner there the whole time, you can easily reach over six people.'
Her suggestion? 'Speak to your midwife or doctor. Everyone understands and should be able to support you and perhaps try to figure out alternative solutions. Each hospital has different guidelines, so keep up-to-date with what is going on at yours.
Lea Jones*, a 26-year-old in Oxfordshire who is 31 weeks pregnant, has dealt with a stream of changing regulations. 'My partner has had to stay in the car for my scans so far, so we paid for a private one, so that he could see the baby and hear the heartbeat,' she says. At Lea's trust, new rules mean partners are now allowed for the entirety of labour, which she's 'relieved' about. He has to leave within an hour of the baby arriving, though: 'which worries me a lot. What if I end up having to stay in hospital? This is my first child and it's terrifying.'
It's this lack of clarity that fuels Marie's deepest fears. 'My care has been great from the NHS, and no one has been dismissive,' she says. 'But, with this, it almost feels like women have been forgotten.'
Women's Health has reached out to NHS England for a response, but has yet to hear back. In a statement given to the New Statesman, a spokesperson said of the matter:
'The NHS continued to deliver safely 1,800 babies every day during the pandemic, and while it is understandable that the pandemic has caused expectant mums increased anxiety, the important changes to maternity services – backed by the Royal College of Midwives – were made to keep women and their families safe.
'Now we have moved past the peak of the pandemic and after extensive engagement with the various professional bodies involved, new guidance has been issued to all maternity units so partners can attend antenatal and postnatal clinics safely, in addition to attending labour which they have been able to do throughout the pandemic.'
*Name has been changed
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