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.

Template letter for birth activists re partner restrictions

The following template letter is intended as a guide for Birth Activists who wish to write to their NHS Trust/Board about restrictions on allowing pregnant women and people to be accompanied by a partner or other supporter at antenatal appointments and scans. 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 your 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 (insert name of Head/Director of midwifery)

I understand that policy at {Name of NHS Trust} currently places the following restrictions on women and pregnant people attending antenatal appointments or scan at {Name of hospital(s)}.

{Insert details of current restrictions as shown on the Trust’s website or Facebook page}

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. I do understand that you are concerned about your staff risking being infected by coronavirus. However, I am equally concerned about the impact that these restrictions are having on the mental health and wellbeing of maternity service users.

{You may like to explain your interest e.g. if you are a birth worker or peer supporter who has seen the impact on local women.}

There seems to be a perception in some quarters that for partners to be present at an antenatal scan is “merely” an enjoyable opportunity to see their baby – ignoring the very real support needs that women may have at this time. Anyone attending for a scan is at risk of receiving the devastating news that their baby has died or has a serious health problem. To force someone to undergo this without the support of a trusted person can have a severe impact on their mental health. The anxiety of attending a scan or other appointment without a trusted supporter can be even worse for someone who has had a previous stillbirth or miscarriage, learned of a fetal abnormality during a scan, or who is suffering from antenatal depression or clinical anxiety.

Furthermore, being unsupported can make it harder for women to process the information that they are given or to think of the questions that they need to ask in order to make an informed decision about any tests or treatment that they are offered. This will be particularly difficult for those whose first language is not English, those who are Deaf, or those who have a learning or other communication disability.

As I’m sure you are aware, the revised guidance from NHS England1 on visiting in-patient settings, published on 5th June, relaxed the restrictions which had previously prevented almost all hospital visiting. It now says that "Patients may be accompanied where appropriate and necessary to assist with the patient’s communication and/or to meet the patient’s health or social care needs." Furthermore, the first step recommended in NHS England's 'Framework to assist NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services'2 is for Trusts to allow "supportive individuals for women with specific communication or care needs AND single adults attending where a woman requires familiar support for consultations which may cause her distress" to accompany women to outpatient maternity services.

I hope that you will revise your policy in line with this to allow women to have someone to accompany them to scans or other outpatient antenatal appointments when they have a specific need including:

  • Having had a previous stillbirth

  • Having had a previous miscarriage or serious abnormality identified at a scan (or ideally, anyone who has had a previous miscarriage)

  • English is not their first language (including Deaf people who use BSL)

  • Having a physical or learning disability

  • Being diagnosed with antenatal depression, PTSD or clinical anxiety

I hope that you will also make this policy clear in the information on your website and/or Facebook page, and ensure that both staff and maternity service users are made aware of it.

NHS England has encouraged Trusts to "be innovative in the way you reintroduce visiting" whilst taking steps to reduce the risk of transmission of coronavirus, so I hope that you are moving quickly to address this important issue for women in this area. Please let me know what your plans are for reducing the risk in the ways suggested by NHS England, and when you expect to move to the second step of the framework, which would allow "One adult invited to accompany the woman to specific appointments where social distancing can be achieved, such as antenatal, screening ultrasound scans, early pregnancy, antenatal or postnatal complications, birth planning, unscheduled attendances to maternity triage" in addition to any essential visitor and when you hope to move to the third step, which allows for "One adult invited to accompany the woman for any appointments where social distancing can be achieved."

In the majority of cases the person that a woman wants to accompany her will have been living in the same household as her and is therefore extremely likely to have the same Covid status. This means that as long as they remain asymptomatic, denying them access is not a proportionate response to the risk.

I therefore request that you reconsider the Trust’s position on restricting access for partners and other supporters at antenatal scans and appointments.

I look forward to your reply.

Yours Sincerely

{Name}

References

1. NHS "Visiting healthcare inpatient settings during the COVID-19 pandemic" 5 June 2020, Version 1
www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0524-visiting-healthcare-inpatient-settings-5-June-2020.pdf

2. "Framework to assist NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services"
www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/09/par001599-framework-for-the-reintroduction-of-visitors-throughout-maternity-services-sep-2020.pdf

3. Equality Act 2010
www.gov.uk/guidance/equality-act-2010-guidance

4. RCM/RCOG "Guidance for antenatal and postnatal services in the evolving coronavirus (COVID-19) pandemic" Version 2.2 10 July 2020
www.rcog.org.uk/globalassets/documents/guidelines/2020-07-10-guidance-for-antenatal-and-postnatal.pdf

Letter to Head of Midwifery about support for Homebirths

The good news is that the current guidance from NHS-England “Clinical guide for the temporary reorganisation of intrapartum maternity care during the coronavirus pandemic” 9 April Version 1" as well as the professional bodies representing midwives and obstetricians www.rcog.org.uk/globalassets/documents/guidelines/2020-04-09-guidance-for-provision-of-midwife-led-settings-and-home-birth-in-the-evolving-coronavirus-covid-19-pandemic.pdf supports you in your endeavour to improve local access to support for homebirths. Here is a template letter that you may wish to draw on to ensure that this guidance is being properly followed locally.

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.

Letter to MVP chair requesting information on local decision process for changes to maternity services

AIMS is really pleased that guidance from NHS England recommends the involvement of local MVP Chairs where temporary changes to the organisation of maternity services are being considered. The document states "Trusts or LMS must work with their MVP service user chair to develop their plans" and "Where decisions have already been made, the MVP must be involved in regular reviews". However, we are aware that many people are not clear to what degree MVPs and MVP Chairs are participating in local decisions. Below is a template letter that you may wish to draw on to find out how decisions about local service changes are being made, what involvement the MVP (or MSLC) has and how well these decisions and processes are being communicated to service users. There is also a handy checklist produced by Greater Manchester and Eastern Cheshire MVP Chairs which you may find useful when inquiring about the local services currently on offer.

If you decide to send this please copy your letter to campaigns@aims.org.uk

Dear {name of MVP Chair}

I’ve been interested to read the NHS-E/I guidance www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0241-specialty-guide-intrapartum-maternity-care-9-april-2020.pdf and its statements on the importance of MVP involvement, and about NHS Trust communications with service users around service changes during this period.

This guidance is clear that MVP Chairs should be involved in discussions on all such changes. Please could you let us know how you and other members of the MVP are currently being involved in these processes and whether there is any other methods for other to input to the process.

The guidance also says that information on any changes should be made available publicly on NHS Trust websites. {If full information about current services is not available on the Trust’s website, is incomplete or only being shared on social media you may like to add: I have not been able to find any/full information about the current state of maternity services on the Trust’s website. Do you know whether it is being published in a form that is easily accessible to the public? I’d be grateful if you could let me know if so. You may also want to describe any issues you’ve had with finding the information, or any details which are missing from it.}

To help me understand how {name} Trust is following the guidance I would be grateful if you could answer the following questions

  • Has {name} Trust drawn up maternity specific escalation and de-escalation plans?
  • If so, where have these plans been made available?
  • What is the process for reviewing and updating these plans and have these been reviewed at board level?
  • What has been the MVP involvement in the production of these plans?
  • How can I access regular updates regarding service changes?"

You may be interested in the following checklist which has been developed and shared by Greater Manchester and Eastern Cheshire MVP Chairs. This details information about the status of services and current restrictions. You may find it useful as a resource for the MVP, but you might also like to suggest it to {name} Trust as a convenient way to communicate the current status of maternity services to the public.

Thank you for everything you're doing to support women. I look forward to hearing back from you with the answers to my questions.

Kind regards,

Other people who you may want to send a copy of your letter

We would recommend that you also copy your letter to your local MVP chair and the Chief Executive of your NHS Hospital Trust (or in Scotland the NHS Health Board), whose contact details should be available on the Trust/Hospital website. Please include campaigns@aims.org.uk and you might also like to copy in the following stakeholders:

If you live in England:

  • Nadine Dorries MP, Parliamentary Under-Secretary at the Department of Health and Social Care dorriesn@parliament.uk
  • Jonathan Ashworth MP, Shadow Secretary of State for Health and Social Care jon.ashworth.mp@parliament.uk
  • NHS England Maternity Transformation team england.maternitytransformation@nhs.net
  • Professor Jacqueline Dunkley-Bent , Chief Midwifery Officer , NHS England jacqueline.dunkley-bent@nhs.net
  • Your local MP

We believe that the following are correct for Scotland, Wales and Northern Ireland, but please let us know if you know otherwise by emailing campaigns@aims.org.uk.

If you live in Scotland:

  • Jeane Freeman MSP, Cabinet Secretary for Health and Sport CabSecHS@gov.scot
  • The Maternity and Children Quality Improvement Collaborative hcis.mcqic@nhs.net
  • Professor Ann Holmes, Chief Midwifery Advisor & Associate Chief Nursing Officer, Scottish Government ann.holmes@gov.scot
  • Your local MSP

If you live in Wales:

  • Vaughan Gething AM, Minister for Health and Social Services Vaughan.Gething@assembly.wales
  • Wales Maternity and Neonatal Network Contacts elizabeth.gallagher@wales.nhs.uk / jacqueline.davies1@wales.nhs.uk
  • Karen Jewell, Nursing Officer for Maternity and Early Years, Welsh Government Karen.Jewell@gov.wales
  • Your local AM

If you live in Northern Ireland

  • Dr Dale Spence , Midwifery Officer, Department of Health, NI Dale.Spence@health-ni.gov.uk
  • Robin Swann MLA Minister of Health in the Northern Ireland Assembly robin.swann@mla.niassembly.gov.uk
  • Dr Patricia Gillen & Dr Maria Healy (Chairs of the Home Birth Group) p.gillen@ulster.ac.uk maria.healy@qub.ac.uk

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