The global emergence of COVID-19 a matter of months ago means that while its relatively thin evidence base expands, the need to interpret new findings with caution implies that the science of this agent remains unsettled.
Accepting this caveat, some midwifery related aspects of COVID-19 can be considered. Thus, in their narrative review of 13 studies of COVID-19 risks in pregnancy, Panahi et al (2020) report that the agent can cause fetal distress, miscarriage, respiratory distress and preterm delivery in pregnant women but does not infect newborns, and that the clinical symptoms of COVID-19 are the same in pregnant and non-pregnant women. But although Panahi et al (2020) note that vertical transmission in pregnancy has not been demonstrated, Rasmussen and Jamieson (2020) state that the effects of COVID-19 in early pregnancy are unknown and that no neonates had (at the time of writing) been delivered to women infected in the first and second trimesters of pregnancy.
In terms of the health of those caring for individuals with, or suspected of having, the COVID-19 infection, Rimmer (2020a) cites guidance from the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, and the Royal College of Paediatrics and Child Health that women who are more than 28 weeks pregnant should avoid direct contact with patients – whether or not they could be infected with COVID-19 – whereas those who are less than 28 weeks pregnant can undertake patient-facing roles provided they use the correct personal protection equipment (PPE).
PPE is addressed by Jamieson et al (2020) who note that although PPE is crucial to the protection of healthcare staff from COVID-19 infection, other important strategies include placing a mask on and rapidly isolating ill pregnant women, and minimising the number of personnel who enter the room of an ill patient (physical distancing). Jamieson et al (2020) also highlight the importance of training healthcare professionals on the correct way to put on and take off PPE to minimise self-contamination.
As well as the challenge of infection prevention with COVID-19, healthcare staff face a daily toll on their mental health. For example, in a Chinese cross-sectional study of 2 042 medical staff and 257 administrative staff, frontline medical staff in close contact with infected patients were 1.4 times more likely to feel fear, and twice as likely to suffer anxiety and depression compared to administrative staff (Lu et al, 2020).
Causes of trauma include high workload, lack of PPE, ineffective infection control and – surprisingly – ‘direct insult by patients, such as rude verbal insult and intentional coughing directed toward medical staff … it seems to be a specific problem with [the] coronavirus outbreak …’ (Joob and Wiwanitkit, 2020).
How might such mental challenges be eased? One NHS consultant suggested that staff working during the current pandemic could be provided with rest areas and allowed to park for free (Rimmer, 2020b), saying that all he wanted ‘rather than people saying thank you when this is finished, is for these people to be given a coffee room to sit in. To be given a kettle, coffee, milk. Maybe a Christmas dinner … not having to pay car parking charges … just a bit of kindness and thought.’ Rimmer (2020b) reports that the government had pledged £30 000 to each of 92 trusts in England in 2019/2020 to improve facilities, and more recently she reported that from 10 April, the John Lewis Partnership would deliver care packages for NHS staff to all acute hospital trusts in England, Wales and Scotland: the packages include non-clinical essentials such as toiletries, snack food, tea, coffee, socks and a well-being leaflet with information about a 24/7 counselling service (Rimmer, 2020c).
Another approach to addressing the challenge of bolstering emotional resilience among healthcare professionals is one devised by Sherezade Ruano an Arrhythmia Specialist Nurse at Imperial College NHS Trust who has investigated the role of well-being, stress and trauma in cardiac patients. Together with a licensed psychotherapist, Ruano has launched an online course at https://rhythmiabreath.com/ entitled ‘Developing emotional resilience: increase your ability to cope with life's daily challenges’. It is free to healthcare workers for 12 months.
With COVID-19 research in a state of flux, the diverse physical and mental challenges that face all healthcare workers, including midwives, demand a range of responses, some more sophisticated than others. The way forward is not entirely clear at this stage but clarity will come through the steady acquisition of robust evidence.