Many women and their families are concerned about how the strain on the NHS and the advice to socially distance themselves will affect their care during pregnancy. Whereas it is not possible to predict what impact COVID-19 will have on staffing and provision on a national level and what measures individual Trusts will take to work through this crisis, we do know that care for pregnant women will remain a priority.
The antenatal care-pathway (the schedule of appointments and content during pregnancy) is very similar throughout the United Kingdom and the timing of most routine appointments during the first half, or a little more, of your pregnancy can be relatively flexible without compromising your care. The following overview aims to offer you some information and reassurance about possible changes to your antenatal care.
This is typically your first contact with your community midwife and it can take place any time after your 5th week of pregnancy. Having your booking appointment later than 10 week gestation could affect your screening choices, as certain tests are time-specific.
So, if you find that your booking appointment has been cancelled or postponed, or you have to self-isolate, you are likely to have a wide margin of flexibility to rearrange it. If you are already over 11 weeks pregnant, however, an inevitable re-scheduling of your booking appointment may mean that your dating scan will occur later, possibly affecting your choices to have screening for certain chromosomal syndromes. Being seen after your 10th week of pregnancy, may also mean you miss out on the optimal timing to have screening for certain inherited blood disorders and certain infectious diseases. However, although early detection of these is ideal, you can still be screened for them at any time during your pregnancy.
Many Trusts are using telephone or online services instead of face-to-face encounters for those appointments that allow it. It may be that part of your booking appointment can be completed this way, whilst tests and observations are performed at a different time.
16 week appointment
In this follow-up appointment, your midwife usually reviews and relays to you results from any blood tests, scans and screening tests you may have chosen to have, ensures you have a date for your anomaly scan if you want one, refers you to the health visitor (who, if you want, will meet you a few weeks before your due date), discusses options for antenatal classes in your area and generally checks how you are doing. All of the above can either be done over the telephone or delayed, if necessary.
Some Trusts will offer further screening at this appointment if blood tests showed your blood type to be Rhesus negative. However, if your Trust does not offer this, you will be given the option to have preventative treatment to reduce the risk of Rhesus disease. Delaying seeing your midwife for a few weeks shouldn’t adversely affect you or your unborn baby at this time. If there was a need to postpone this appointment, your blood pressure, urine testing and any further blood tests could wait.
Follow-up at 22-25 weeks
Routinely, you would be seen again in the community between 22-25 weeks if you are pregnant with your first baby or, in some cases, if your history deems it necessary. If this is not the case with you, your next appointment won’t be until you’re 28 weeks pregnant.
First time mums or women with a history of pre-eclampsia in a previous pregnancy are recommended to have their blood pressure and urine checked around this time. If postponing of this appointment cannot be helped, a midwife should ideally conduct a telephone assessment and, if there are no concerns, book you in to have you blood pressure and urine checked.
Your 28-week and 31-week appointments
Most women have their first symphysis-fundal height (SFH) measurement (measuring the size of your ‘bump’) at their 28-week appointment, although some NHS Trust commence this earlier. At this appointment, as well as the routine checks on blood pressure and urine, women are also offered repeat blood tests to check for anaemia (low iron in your blood) and to confirm that they have not developed any antibodies in their blood.
If you were not seen between 22-25 weeks or have not had a SFH measurement, it may be particularly important to not delay this appointment by much.
As with the 25-week appointment, only first-time mums or women whose blood pressure needs to be monitored more closely, will be offered to be seen at 31 weeks. If you do not need to be seen then, your next appointment won’t be until you are 34 weeks pregnant.
Appointments from your 34th week of pregnancy until your baby is born
From 34 weeks onwards, all pregnant women are offered fortnightly appointments during which their general well-being, blood pressure, urine and their baby’s growth are monitored a little more closely.
Delaying any of these appointments by a few days is unlikely to adversely affect your wellbeing or that of your unborn baby. However, your care provider should be making plans for you to be seen as soon as possible if one of them are cancelled or postponed.
Ways in which your care may change during the pandemic
Changes to the service may mean that your appointments need to be done, in most part, over the telephone or online, with shorter face-to-face interactions with your midwife and with observations such as blood pressure and urine checks or blood tests being done by health care assistants to free up midwives’ time. This may mean not having all your care provided in one go.
Essential scans should still take place as necessary, but other scans and hospital appointments may need to be re-scheduled.
Every maternity unit will have a triage or assessment centre that is open 24 hours and where you’d still be able to ring for advice if you have any concerns about yourself or your pregnancy. If your concerns are regarding exposure to or symptoms of Covid-19, the official advice is to call NHS 111 or use the NHS 111 tool.
In this time of crisis, pulling together and accepting that things will be different will prove essential in preserving our mental health and supporting our care providers. Yet, your wellbeing during your pregnancy remains a priority and we would urge you to continue to contact your maternity unit or named midwife if you have any concerns about yours or your baby's wellbeing.