Visitor restrictions in maternity units have changed significantly over the last few weeks which is fantastic news. However one of the areas where we would like to see more progress is Trusts and Boards inviting second birth partners back into maternity services as a matter of course. This may not come top of the list of priorities for many services, but it is relatively easy to accommodate. Birthing rooms are often much larger than scan rooms or appointment rooms and the risk of passing on COVID is low compared to wards or waiting rooms. In addition only a small percentage of women/birthing people want an additional person (around 4% according to Royal Surrey who have remain open to partners throughout the pandemic). However it is usually really important to those who do make this request.
This week we are publishing a series of blogs to explore the issue of second birth partners from a range of perspectives. For our first blog, we interviewed Tamsin Bicknell, Consultant Midwife for Public Health at Homerton University Hospital….
We understand that Homerton has facilitated two partners being at a birth throughout all or most of the pandemic?
Yes that’s correct. In the initial stage of the pandemic, between late March and early July last year this was reduced to a single birth partner in general (with our ‘exemptions list’ running concurrently), but the usual 2 birth partner policy was reinstated as soon as possible. The ‘exemptions list’ was managed by myself, and was designed to take into account those with circumstances and personalise their care but being flexible with the ‘visiting’ rules we had in place. Midwives could request an exemption, or women could contact the team directly (often using the Birthrights template!). This often meant facilitating two birth partners instead of one, allowing 24 hour visiting on the postnatal ward, or facilitating attendance for partners at early scans (for instance for those who had experienced pregnancy loss previously and felt particularly anxious). Examples of families whose needs we facilitated include a surrogacy team – who had two birth partners so that the intended mother could be present as well as the surrogate’s own birth partner; and subsequently that both intended parents could be present and care for their new baby on the postnatal ward to start their family experience. Another was a client with a history of childhood trauma and subsequent mental health needs meaning she needed her partner to be present with her at all times to manage her anxiety – and a doula too during labour who was able to support the midwife caring for her to best meet her needs in view of her past experiences. This included an individualised postnatal plan too.
Can you explain a bit more about why you took this decision?
We felt as a team very strongly that birthing people having the support they need during labour (and at other times) is essential for many reasons. For labour to progress women need to feel safe and supported, and their own birth partners are best placed to provide this (along with the expert care from a midwife of course!). We also recognised the incredibly high levels of anxiety the restrictions were creating for families, and the impact this could subsequently have on family mental health, early bonding and family relationships. Once we felt that we had a handle (as much as this was possible in the extremely fluid circumstances!) on the infection control procedures and PPE needed to keep everyone safe and had evidence that these were working, we felt that we could and should reopen this. Locally, we also have a population who routinely use non-familial doula support services, and during the restrictions this meant women having to choose between their partner/husband and doula, which we also felt very uncomfortable about.
Essentially, we recognised that the care we offer as professionals is ideal as part of a wider team that includes the family – and that without them present in the way birthing people want, there is something missing at an incredibly important, emotional and memorable time for families.
What things helped? And/or did you have to overcome any obstacles in implementing this policy? eg lay out of the estate, opposition/support from elsewhere in the Trust?
Our Chief Nurse has been supportive of our plans and allowed us to take the lead on deciding what we should do for our families throughout the pandemic. Even when the rest of the Trust has had to completely close to visitors to manage outbreaks and risks, we have had recognition of the importance of managing the perinatal period differently.
I would say one of the biggest challenges has been managing the changing guidance, rules and feelings of everyone involved, and keeping everyone up to date. Staff have felt understandably very worried, especially in the first few months, and balancing their feelings and anxieties with those of the families we care for was tricky. The divisional management structure of some parts of the maternity pathway also posed challenges, where we had to negotiate agreement across different teams who sometimes had different views on our proposals.
Ultimately, we found a balance by putting faith in the infection control measures, PPE, testing and vaccination programmes, monitoring the national picture, and considering the duty of care we have to our families – and the kind of care we wish to deliver.
How many women/birthing people have wanted to have two birth partners during the pandemic?
I wouldn’t be able to say precisely, and certainly not everyone needs or wants a second person with them – but it’s important that everyone has the choice.
What advice would you give to any maternity leaders who are thinking about whether they can go back to accommodating a second birth partner?
I would say that at this point is that it’s less about whether we can, but how we can, if not already facilitated. Whilst we remain in a fluid situation and may need to reassess at some point in the future, the country is opening up, infections are the lowest they have been for some time, and we have appropriate protection in place, there is every reason to work it out and very little reason not to.
It might help staff to think about their own families and experiences: how would they feel about the restrictions if they were a service user? What would they want their caregivers to do? If I can now have six people in my home without PPE, why wouldn’t I be able to have another birth partner wearing PPE?