Template Campaigning Letters about Maternity Services during the pandemic

AIMS has had many enquiries about how to find out about, and seek to influence, local service changes during this period. Here we have included several examples of issues you might want to raise and people that you might want to raise those with.

Letter about plans to lift restrictions on partners/supporters attending maternity services

The following template letter is intended as a guide for anyone who wishes to write to their NHS Trust/Board about restrictions on allowing pregnant women and people to be accompanied by a partner or other supporter. It will need to be adapted to include information about the situation with your local maternity services.

The guidance on birth supporters is now different in each of the four nations of the UK. This letter refers to the guidance for England, so if you are in Scotland, Wales or Northern Ireland you will need to adapt the wording of your letter in line with the appropriate national guidance. For details of this guidance see the AIMS Birth Information page "Coronavirus and your maternity care".

We would suggest that letters are sent to the Maternity Safety Champion, the Head/Director of midwifery and to the Chief Executive at your local NHS Hospital Trust (or Board in Scotland) to ask them about their plans to change their policy in line with the latest guidance. Their email addresses should be available on the Trust's/Board's website. We suggest that you also send copies to the AIMS campaigns team campaigns@aims.org.uk and to the appropriate people from the list at the bottom of the page, making it clear in your email who else you have sent it to as this may help to focus people's attention on their responsibilities.

Dear…

I am writing as {insert your role e.g maternity service user, partner, MVP user rep, doula, parent support group organiser etc} within {name of Trust/Board} concerning the continuing restrictions on partner attendance at local maternity services.

It is my understanding that {detail here the continuing restrictions in your Trust}

I understand the severe pressure on the NHS at the moment, and the challenges faced by staff. I very much appreciate their commitment to care during this time, and the importance of reducing the infection risk to staff, service users and their supporters. However, I am equally concerned about the impact that these restrictions are having on the basic rights, mental health and emotional wellbeing of maternity service users, their partners and families.

I’m sure you are aware of the {if you are in England, otherwise please substitute your country's guidance} NHS England guidance “Supporting pregnant women using maternity services during the coronavirus pandemic: Actions for NHS providers” published in December 2020. This asked all trust boards to “urgently complete any further action needed so that partners can accompany women to all appointments and throughout birth”. I appreciate that the surge in COVID-19 cases over the winter has probably meant these actions were not the greatest priority for the board. I hope that as the number of hospital admissions is now falling, and as the roll-out of vaccinations to front-line healthcare staff and the most vulnerable groups proceeds, that the board will now address this issue as a matter of urgency, if it has not already done so.

The NHS England guidance also recommends that: “Trusts should work with the local Maternity Voices Partnership (MVP) and representatives from all staff groups in undertaking these actions and communicating the outcomes” {you could add, if appropriate: but I am not aware of any involvement of the MVP in either risk assessment or planning for the lifting of restrictions so far.}

I’m sure you will agree that the anxiety suffered by maternity services users and their supporters is reduced when they are given clear, consistent and up-to-date information about the restrictions that are in place and - most importantly - the justification for them. As NHS England has said “Communications plans should be clear about the timescale for these actions, and information should be readily accessible to women, support people and their families, digitally and in accessible formats.”

I would therefore be grateful if you would let me know:

1. Has the board undertaken a risk assessment in each part of their maternity service to identify precisely whether and if so where there is an elevated risk of COVID-19 transmission if support people are present?

2. If the risk assessment has been completed, where is this information available? If this work has not yet been done when do you plan to undertake it?

3. If you have done a risk assessment, what risks were identified and what plans have been made to mitigate these and enable support people to attend as far as possible?

4. What plans do you have to review the risk assessment as the situation eases?

5. Have you or do you intend to draw up a plan and timetable for lifting restrictions, and if so where and how is this information being made available to service users?

I look forward to hearing from you.

Letter to Head of Midwifery about support for Homebirths

Dear Head of Midwifery {Add name if you know it - it should be on the Trust website}.

I am writing to you concerning the decision made by {add name} Trust to suspend support for homebirths in the area due to the current COVID-19 pandemic.

I am in touch with many people who have been affected personally by this decision {give details of how you heard these concerns, such as via a local home birth support group/ teaching antenatal classes/being a member of the MVP/being a doula/friends or relatives}.

I am sure you are aware of some of the many and varied reasons why pregnant women and people decide to give birth at home, in consideration of supporting the physiology of birth and increasing safety for mothers by avoiding unnecessary interventions. This is acknowledged in the RCM/RCOG’s “Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic”. This comments that "the International Confederation of Midwives (ICM) recommends that in countries where the health systems can support homebirth, healthy women experiencing a low-risk pregnancy may benefit from giving birth at home or in midwife-led units rather than in a hospital where there may be many COVID-19 patients, if there is the ability to provide appropriate midwifery support and appropriate emergency equipment and transfer"

In addition some will have further reasons for needing support for a homebirth such as previous birth trauma, anxiety and other mental health issues, childcare issues and of course current concerns around COVID-19.

I know that legally all women have the right to give birth at home and cannot be compelled to go to hospital to give birth. Sadly, these rights are not currently being supported by the Trust and, worryingly, this is leading to many parents planning to birth at home without medical support – an option most would not even consider under normal circumstances, but they feel they have no alternative at present.

I understand that the reasons given for the suspension of the home birth service are as follows:

{include the reasons you have been given which might include

• Staff absence due to having symptoms of COVID-19
• Staff absence from work due to self-isolating
• Removing a number of ‘at risk’ staff members away from providing direct patient care.
• lack of ambulance cover for transfers}

I would like to know whether {add name} Trust is following an escalation/de-escalation plan as set out in the latest RCM/RCOG guidance, how regularly this is being reviewed, and what the current level of midwifery staffing shortage and ambulance provision is in this area.

RCM and RCOG have recognised in their latest guidance that “Continuation of as near normal care for women should be supported, as it is recognised to prevent poor outcomes.” They also comment that “Emerging evidence from European settings supports continuing to strengthen community services in order to enable social distancing and minimise spread in healthcare settings.”

I appreciate the need to protect midwives at this time, but keeping midwives working in the community and attending home births where they are less likely to be caring for women and coming into contact with people infected with Covid-19 surely has to be safer for all? I know that some Trusts are actively encouraging low risk women to consider home birth because it reduces the risk of exposure to coronavirus for women, babies, their families and their midwives.

I am aware that other NHS Trusts are continuing to offer support for home births, for example by having dedicated groups of midwives who only work outside the hospital or even giving contracts to independent midwives and/or a private ambulance service to cover any transfers into hospital. The latest RCM/RCOG guidance also suggests that "available midwifery resources" should include independent midwives. The Independent Midwives UK association (IMUK) has offered their services but have been informed by NHS England and the Chief Midwifery Officer that “it is to be left to local HOMs and DOMs to decide if they need Independent Midwifery support.” {If you know of local Independent Midwives who would be willing to offer their services to the NHS you may want to mention them. or make a comment such as I am aware from speaking to independent midwives in this area that several have offered their services and they have all reported that they have not yet had a response from the Trust}. As the reasons given for the suspension of the service all centre on a shortage of midwives, I would like some assurance that this has been extensively explored as an option.

RCM/RCOG say that home birth services should not be stopped just because of inability to provide two midwives. Rather, Trusts should consider using “senior student midwives, returning registered non-clinical midwives, returning recently retired midwives or appropriately prepared maternity support workers to attend as the second member of the team for low-risk home births”. Have you also explored this option? I am also aware there is no legal or reseach supported reason for having two midwives at a birth, so have you considered the option of just providing one midwife for a birth when it is really not possible to provide two?

I urge {add name} Trust to explore whether there is a solution which could be implemented to enable families choosing a home birth in this area to have the midwifery support we need at a time when many of us feel more vulnerable than ever.

I look forward to your reply.