The effect of COVID-19 on intrapartum care: a case review from early in the pandemic
The COVID-19 pandemic has had a marked impact on maternity services in the UK. Those who are pregnant are identified as a higher risk population and there have been significant changes in the structure of antenatal, intrapartum and postnatal care. This case of interest explores a moderate case of SARS-CoV-2 during the intrapartum period in the early stages of the pandemic which was managed by a multidisciplinary approach. The family are well and are now fully recovered. Midwifery accounts recall uncertainties regarding personal protective equipment. Obstetricians recall minimalising patient contact where appropriate and anticipating for obstetric emergencies to reduce delays. Despite challenges, staff recall excellent multidisciplinary team work and the use of technology to facilitate communication between service user and birth partner.
Coronavirus-2019 (COVID-19), also referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first observed in Wuhan, China in December 2019. Following vast and rapid global spread, COVID-19 was characterised as a pandemic by the World Health Organization on 11 March 2020. COVID-19 has seen over one million fatalities globally, with pregnant women being identified as an at-risk cohort; antenatal physiological adaptations increase intolerance to hypoxia, alongside both pregnancy and SARS-CoV-2 being implicated by decreased lymphocytes, NKG2A inhibitory receptors and increased ACE2, IL-9, IL-10 and IP-10 (Phoswa and Khaliq, 2020). Low-to-middle income countries have noted particularly severe effects on maternity care, with Nepal documenting a 50% increase in stillbirth rate and reduction in hospital birth since the beginning of the virus (Ashish et al, 2020).
The COVID-19 pandemic has had a significant impact on maternity services in the UK. Multiple changes occurred regarding the structure of antenatal care and access to antenatal education to reduce risk and exposure, alongside regulations surrounding birthing partners and hospital visiting. While visiting and attendance to antenatal appointments and ultrasound scans are reinstated in most hospitals, some restrictions are still observed, including that of 24-hour visiting policies for birth partners. This has had an effect on both women and birthing people, and the staff delivering the service.
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