NHS services have begun suspending home births as professional bodies advise pregnant women who have symptoms of Covid-19 to give birth in hospital.
Experts have urged caution over home births, saying that while they may seem a logical option in the current climate of physical distancing, they can require additional resources and are not suitable for women who may have coronavirus.
The Hillingdon Hospitals NHS foundation trust in London and NHS Greater Glasgow and Clyde are among those that have said they are suspending home births. The latter said: “This is to allow us to concentrate our maternity staff in our hospitals to cover those who are absent from work because they are either self-isolating or symptomatic.”
Private Midwives, a UK-based nationwide private midwifery service that is registered with the CQC, has reported growing numbers of women seeking advice about a home birth. “We have seen about a doubling in the number of enquiries in the last few weeks,” said Edward Sparks, the chief executive.
He said women were citing two main reasons. “One is that they are thinking about a home birth when previously they may not have done because they just want to avoid going into hospital, bearing in mind the pressures they know the hospitals are under. They are looking to plan ahead and have a bit more certainty and know who is going to look after them.”
The other reason, he said, was that NHS services were being suspended and people who had already planned a home birth were looking for other ways of sticking to their plan.
How much do children spread coronavirus?
The diverging approaches to school closures may stem from the considerable uncertainty around the extent to which children are playing a role in spreading Covid-19.
Children make up a tiny minority of confirmed cases – fewer than 1% of positive tests in China were children under nine. It is probable that a bigger pool are getting infected but only experiencing mild or no symptoms. Among those who have tested positive, nearly 6% developed very serious illness, according to an assessment of 2,000 patients aged under 18 in Wuhan, with under-fives and babies being most at risk.
A significant unknown is how infectious children are, assuming large numbers are getting infected. Early evidence suggests that around 50% of transmission in the pandemic at large has involved asymptomatic people and children could be among this group.
“It seems most plausible to me that they are being infected but are at low risk of developing disease,” said Prof Peter Smith, an epidemiologist at the London School of Hygiene and Tropical Medicine. “We know that for flu, children are important transmitters of infection, which is the basis for the flu vaccination programme directed at children, but we do not know yet how important they are as transmitters of coronavirus. So closing schools would be based on the assumption that they do make an important contribution to transmission.”
Rates of various illnesses are seen to rise and fall at the start and end of school terms. School holidays were thought to have led to a plateau in the 2009 swine flu pandemic. Also advised hygiene and social distancing measures, such as hand washing and reduced physical contact, just aren’t very effective in a primary school playground setting. So there is the potential for schools to act as a local fountain of infection for the surrounding area.
“Every mother and father knows that when kids go back to school they’re going to get hammered by colds and flus and sore throats,” said Paul Hunter, professor in medicine at the University of East Anglia.
This uncertain science has to be carefully weighed against the certain disruption and cost of school closures, including taking large numbers of doctors and nurses out of the workplace, and unintended consequences such as grandparents, who are among the most vulnerable, taking on childcare and facing greater exposure.
“Quite a few areas around the country are struggling to provide the community services that they were previously,” said Sparks, adding that a team of midwives could look after more women if they were in hospital in one location.
Last week the Royal College of Midwives noted that two midwives were required to be away from a unit for a home birth, and in the pandemic there may be times when this was not possible.
“There are definitely certain parts of the country where there are women who were going to be having a home birth with the NHS, now that is not going to be possible for resource and staffing issues,” Sparks said.
Birte Harlev-Lam, executive director for professional leadership at the Royal College of Midwives, said a home birth may still be an option for women who were showing no symptoms of coronavirus and were otherwise healthy, but it may depend on staffing levels.
“Maternity services are working around the clock to support women’s choices about where they give birth, including at home,” she said. “However, safety is always the paramount consideration for maternity services, so there may be situations where, due to staffing or other concerns, home births may not be possible.”
2/2 We are currently advising against homebirth for anyone with suspected or diagnosed Covid-19, due to the continuous monitoring and medical backup that is needed to keep you and your baby safe. More here: https://t.co/soenw0wZaT #covidmaternity @RCObsGyn
Experts say pregnant woman who are otherwise healthy do not have an increased risk of contracting Covid-19.
Harlev-Lam said home births could increase pressure on ambulance services if women needed to be transferred to hospital.
She said women who thought they may have Covid-19 should not have a home birth. “This is because of the extra monitoring and medical backup that might be needed to keep her and her baby safe,” she said.
A spokesperson for the Royal College of Obstetricians and Gynaecologists said women who are expecting to undergo an elective cesarean should continue as planned rather than opting for a home birth.
“The overwhelming majority of elective caesarean births in the UK are offered for clinical reasons, such as a baby being in a breech position, and these will continue to take place in an obstetric unit in hospital,” the spokesperson said. “Any woman who is concerned, or wishes to change her birth plan, should contact her maternity team who will be able to advise her about the options available to her.”
Not all NHS trusts have suspended home births. A spokesperson for Oxford University Hospitals NHS foundation trust said: “There hasn’t been a noticeable increase in demand for home births, and we are providing a normal service at present. We will continue to review what can be provided regularly over each 24 hour period and will respond accordingly, taking into account the needs across all of the maternity services, staff availability and national guidance.”