With various different restrictions in place throughout the country, which are changing on a weekly basis, confusion as to what is and what is not safe during the COVID-19 pandemic is having an impact on expectant parents nationwide. Parents are more reluctant than ever to visit their midwife, GP centre or hospital to be assessed in fear of contracting coronavirus (Best Beginnings et al, 2020). With fewer appointments and less contact with a healthcare professional, opportunities to detect certain complications in a timely manner are sadly being missed (Best Beginnings et al, 2020).
To empower parents with safer pregnancy information, such as what signs and symptoms they need to look out for and report to their maternity team without delay, the Mums And Midwives Awareness (MAMA) Academy, produce ‘Wellbeing Wallets’, which are currently being distributed in two thirds of NHS Trusts across the country, as part of the government's strategy to reduce stillbirth by 50% by 2025 (NHS England, 2019). NHS England have been encouraging every trust to implement the wallets for the past 3 years, for consistency of care (Kings Health Partners, 2017). The wallets give parents permission to contact their maternity team straight away if they notice certain symptoms, such as a reduction in baby movement or signs of pre-eclampsia. An audit conducted within the Maternity Day Assessment Units of St.George's and Lewisham and Greenwich hospitals found that over 70% of women regularly read the wallets (Kings Health Partners, 2017). A total of 14% reported that their attendance at the day assessment unit was prompted by the Wellbeing Wallet; with reasons mainly being reduced fetal movements, but also included warning signs of other significant health conditions, including pre-eclampsia. Women did not report any anxiety caused, and over 80% of women felt the information on the wallet was clear, even though 40% of them spoke English as a second language. All the staff felt there were no unnecessary attendances.
Sandwell and West Birmingham NHS Trust reported a stillbirth reduction of two thirds in 2018 becuase of implementing MAMA Academy wallets and raising awareness of reduced movements.
The average cost of care related to a stillbirth and additional care in the first subsequent pregnancy (52% of women fall pregnant again within a year) is £4191 (Campbell et al, 2018). The wallets contribute to preventing stillbirths, so even if a Trust only prevents one stillbirth as a result of providing every pregnant woman with MAMA wallets, then the initial outlay brings the Trust profit (and one less dead baby). A typical example of 4000 wallets purchased at a cost of £3000:
- First stillbirth prevented: £3000 cost, £4191 saved, £1191 profit
- Second stillbirth prevented: £0 cost, £1191 + £4191 = £5382 profit
- Third stillbirth prevented: £0 cost, £5382 + £4191 = £9573 profit
The future is digital
For Trusts that are now digital/paper light, MAMA Academy have just launched the ‘Pregnancy Passport’. The passports are wipe clean for hygienic purposes and fully recyclable. They are A5 in size and designed to fit inside a woman's handbag.
The mother's essential information, such as next of kin, blood group and risk factors, can be written within it, in case her digital notes cannot be accessed for any reason. This information has been extremely beneficial when a woman has transferred from another Trust using different digital record software, as the two systems cannot yet talk to each other, which is likely to be the case for the foreseeable future.
Every encounter counts
Even before COVID-19 arrived, MAMA Academy was working towards reminding parents about symptoms to report, in order to reduce stillbirth rates. This is currently more vital than ever, as parents have shorter and fewer appointments, the majority of which are being carried out online, whilst life resumes in the background (the washing machine may be on or little Johnny is drawing on the walls).
Therefore, MAMA Academy suggests that midwives ask parents to relay back the information they have been given, to ensure they have understood the information, as well as its importance. Also, make sure parents have the right numbers to hand, should they need to call a midwife.
Effective communication
- ‘You were right to come in.’ This supports their decision and validates their concerns
- ‘Babies can be quiet for a number of reasons, but it can be because they are not well and need urgent help.’ This summarises a range of possibilities but that it may also be serious and urgent
- ‘We have various ways that we can check what is happening, you can't work it out for yourself at home.’ This informs parents what can be offered and why coming in for an assessment is right, not to self assess (perhaps via a doppler or Google)
- ‘If your baby needs help, you are then in the place where we can take action quickly.’ This explains why the hospital would be appropriate.
- ‘Most of the time, when we see people because their baby is quiet, we don't find a problem with the baby.’ This validates their experience today as a common one. However, this information needs to go hand in hand with ‘but we do need to see you, in case it is the time when we need to act fast to help your baby.’ This reinforces the messages to both report the problem and to be seen as it can become an emergency.
Other resources
Pregnancy leaflets are free of charge and are available in 11 different languages. Call The Midwife posters are pictorial and therefore ideal for displaying in antenatal areas for illiterate or non-English speaking parents. Ambulance Calls cards compliment home birth packs and contain the key wording in obtaining a critical category 1 response from an ambulance service. Social media campaigns such as ‘Don't Stay At Home’ are there for Trusts to share on their individual maternity pages, to help more babies arrive safely during the pandemic.
The charity's website is kept up to date with current information on coronavirus, for both parents and professionals.