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 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.
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:

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:

If you live in Northern Ireland

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 from local birth campaigner (England) seeking assurance about the process in place locally for making changes to maternity services

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,

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