Unvaccinated pregnant women are pushing NHS maternity services to ‘crisis point’, doctors warn
The growing number of unvaccinated pregnant women with Covid on labour wards is pushing some maternity services to the brink, NHS doctors have warned.
Senior midwives and obstetricians have revealed that units in certain areas are in a ‘crisis situation’, where already time-stretched staff are being forced to abandon healthy women mid-labour in order to tend to the complex needs of Covid-positive expectant mothers.
There have been problems separating Covid-positive women in birth units from those without the infection, and in some cases midwives have contracted Covid and been forced to self-isolate.
This has compounded existing staff shortages, with record numbers leaving the profession this year, and even led to birth-unit closures. NHS data shows that 300 midwives resigned in May alone – the largest monthly figure since 2009.
The concerns come a month after Britain’s most senior gynaecologist, Dr Edward Morris, President of the Royal College of Gynaecologists and Obstetricians, warned that patient safety on maternity units could be at risk, should Covid cases keep increasing.
Meanwhile, experts say too many pregnant women are still unwilling to get vaccinated, despite the efforts of health chiefs and Ministers to encourage uptake.
‘We’re seeing the same pattern we’ve seen throughout the pandemic,’ says Marian Knight, Professor of maternal and child health at the University of Oxford, who has been closely tracking Covid pregnancies since last year as part of a national surveillance study.
‘And a significant proportion of those women will become very, very unwell.’
Senior midwives and obstetricians have revealed that units in certain areas are in a ‘crisis situation’, where already time-stretched staff are being forced to abandon healthy women mid-labour in order to tend to the complex needs of Covid-positive expectant mothers
The best estimates are that 85 per cent of pregnant British women remain unvaccinated, with many hesitant about the having the jab owing to unfounded fears that it could harm their unborn child.
In reality, studies suggest that pregnant women are 13 times more likely to die from Covid than people of a similar age who are not pregnant.
And 98 per cent of pregnant women admitted to hospital with Covid have not had the jab, Prof Knight’s analysis shows.
Some end up in ICU: since September, roughly a third of all 16-to-49-year-old women admitted to ICU with Covid have been pregnant, or recently pregnant.
But the majority will be cared for on both medical wards and maternity units, including labour wards when they need to deliver.
Experts say if mothers are infected with Covid, it is far more likely they will need an emergency delivery, and much earlier than planned, owing to the risk of a decline in the mother’s health that may make them less likely to survive childbirth.
University of Oxford data shows that Covid-positive expectant mothers are up to three times more likely than others to have a premature baby.
And data this month showed that 694 premature babies were born to Covid-positive mothers between March 2020 and July this year.
Of these, 604 babies had to be admitted to neonatal critical care – hospital wards reserved for the most unwell infants – where staff are also scarce.
‘Maternity services across the country are not set up to deal with the current situation,’ says Dr Mary Ross-Davie, midwife and Director for Professional Midwifery at the Royal College of Midwives.
‘There has been a chronic staff shortage for years, and the pandemic has made this acute.
‘Midwives are exposed to a younger population, many of whom aren’t vaccinated. A lot of our work involves going into people’s houses, where people are unjabbed, and being in very close quarters with them.
‘So we have huge numbers of midwives catching Covid, and having to self-isolate.’
Staffing is just one of the challenges. ‘There is a huge pressure on services to find the physical space to treat every woman safely,’ says Dr Ross-Davie.
‘If you have a large number of women who are Covid-positive, you will have to rethink the whole system to ensure there is space to isolate patients. For this reason, lots of midwife-led maternity units have had to close.’
The best estimates are that 85 per cent of pregnant British women remain unvaccinated, with many hesitant about the having the jab owing to unfounded fears that it could harm their unborn child
Dr Chandrima Biswas, a consultant obstetrician working in an NHS hospital in London, said: ‘Last week I was up all night with a woman who was otherwise perfectly healthy, but had Covid.
‘She was 30 weeks pregnant – so had about two months to go – and deteriorated rapidly. We took her to ICU but didn’t know whether it was too early to deliver her baby. In the end we delivered, and the baby survived, but needed critical care.
‘The mother is still ventilated, and we’ve now had to arrange for her to transfer to another hospital on the other side of London, because she has deteriorated further, and we don’t have access to the specialist treatment she needs.’
There is some evidence that the problem may already be compromising the care of non-infected women.
‘Covid-positive expectant mothers in hospital need a lot more close monitoring,’ says Dr Biswas, who is also an adviser to the Healthcare Safety Investigation Branch, which investigates issues of maternity safety.
‘If they are in labour, they will need detailed heart-monitoring every few hours. We’re supposed to have one midwife to every pregnant woman. But if you’re running those tests on the Covid patient every few hours, you can’t be with another woman in labour.
‘If there are not enough midwives to go around, it’s feasible the patient who doesn’t have Covid will miss out on adequate care.’
Last week, midwives spoke out about situations whereby Covid-positive women were treated in the same ward as those without the infection, risking spread.
‘There are situations where patients will be waiting for the results of Covid tests in waiting rooms or on wards near non-infected women,’ says Dr Biswas.
‘Generally speaking, once we know women are positive, they are moved into a separate room.’
Dr Biswas says pregnant women with Covid are moved between wards, depending on the stage in their pregnancy.
‘Last week I had a Covid-positive woman who wasn’t sick enough to be ready for delivery, so she was on a medical ward.
‘But she had to come to the maternity unit to have specialist care, before she was moved back. I wasn’t particularly happy about that.’
The concerns were voiced in the same week that scientists published the most convincing evidence to support the most-feared risk of Covid in pregnancy: the virus spreading from mother to baby.
So far, a handful of babies have been born with Covid. None has been seriously ill, but scientists have been unsure as to the route of transmission.
Researchers at University College London analysed samples of foetal tissue, including the intestines and kidneys, and detected the presence of receptor cells, which offer the virus a gateway to the body, in the gut.
They concluded that the unborn baby could, theoretically, swallow Covid-infected amniotic fluid, and catch the virus.
The moment Asya, 35, first met her son Daniel, ten days after his birth in December. She caught Covid before vaccination was offered to her age group and she passed on the virus to him
‘Previous studies have looked at whether the virus could infect the placenta,’ explains Dr Victoria Male, expert in reproductive immunology at Imperial College London.
‘But we know it does not. This study notes that the guts of unborn babies are a potential site at which they could get infected.’
Unvaccinated people are 14 times more likely to die of Covid-19 than those who are fully vaccinated, an American study has found.
Dr Julian Tang, clinical virologist at the University of Leicester, adds that the research is further confirmation that unborn babies can become infected.
‘But it is relatively rare, affecting around two to six per cent of pregnancies,’ he says.
Last week reports surfaced of one such pregnancy.
A 35-year-old woman named Asya, from South-East London, contracted Covid in December and was forced to deliver dangerously early at 27-and-a-half weeks.
Although she says her Covid symptoms were ‘bad, but manageable at home’, she realised her baby wasn’t moving as much as he had been, and was then admitted to hospital.
She was also suffering from a urinary tract infection, and it is unclear whether it was this or Covid that triggered the premature birth.
The newborn, whom she named Daniel, tested positive for Covid-19 and was transferred to a neonatal unit where he was treated for bleeds on his brain and his lung – related to the birth, rather than Covid – and stayed for eight weeks.
‘We were separated for ten days,’ recalls Asya.
‘The first time we met, he was in an incubator, and I was in full PPE, despite the fact we both already had Covid. He is fine now, but it was awful.
‘It’s really sad just to wonder what would have happened if I’d been able to be vaccinated then.
‘I have had both the vaccines now and I’m going to get the booster. And I very much recommend that pregnant women get it.’
Last Thursday the Government revealed new safety data showing that having the Covid-19 vaccine in pregnancy does not raise the risk of stillbirth, low baby birthweight or premature births.
In the same announcement, health chiefs revealed that 84,000 pregnant women have now been vaccinated.
Pictured is Asya, 35, from South-East London, who contracted Covid in December and was forced to deliver dangerously early at 27-and-a-half weeks
Analysis shows this is likely to be between only 12 to 15 per cent of all pregnant women, despite efforts to boost jab uptake, including pop-up jab clinics in antenatal clinics.
The high level of vaccine hesitancy among pregnant women has been blamed on mixed messages about the safety of the jab.
At the beginning of the vaccine roll-out the Joint Committee on Vaccination and Immunisation (JCVI) advised that only pregnant women who were at high risk from Covid should get the jab. The decision was based on the fact pregnant women had not been included in the vaccine safety trials – as is standard with any vaccine.
But in April, data from 130,000 pregnant women in the US showed the jab to be safe and effective.
Health chiefs then changed tactic: mothers-to-be should be offered the jab at the same time as everyone else in their age group.
But the UK’s maternity health bodies, the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG), were slow to update their advice.
Only in July did the RCOG start ‘strongly advising’ expectant mothers to get the jab, so thousands of midwives offered incorrect advice.
In July, the MoS revealed that more than a third of maternity staff failed to recommend that patients have the vaccine.
Some mothers-to-be were told by midwives that the vaccine could be ‘another thalidomide’ – the morning sickness drug that caused disability in the 1960s. Others were told the jab could increase the risk of miscarriage.
Elsie Gayle, a midwife who worked in the NHS for 30 years before recently starting her own private practice, said: ‘Midwives have always been taught to exercise the utmost caution when it comes to giving any treatment or medicine to pregnant women – including vaccines – because of the unknown risks to the baby.
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‘Our guidance talks about caution with every single drug, even paracetamol. And there’s a strong emphasis on not coercing pregnant women into having any intervention or taking a medication.
‘Now all of a sudden the Government is telling us to take the opposite approach.’
The pressure Covid infections are placing on Britain’s maternity units is exacerbating staffing problems. NHS workers have told us their workload was becoming insurmountable even before Covid.
‘We have more and more midwives going off sick with Covid, or stress, or they’re finally taking the annual leave that they haven’t taken for two years,’ says Dr Biswas.
‘And that means we have gaps. If we don’t have the staff to support inductions, for instance, we have to delay them.
‘So women may be waiting for days and days, or they have to be transferred to another hospital that does have the staff to cope.
‘Some of the hospitals we would transfer to are now closed because of the staffing problems, which is yet another difficulty.’
Other maternity staff told the MoS of alarming consequences of a lack of space, including women giving birth in corridors.
‘I’ve seen letters from trusts that say, ‘Our maternity doors are closed, we haven’t got enough beds,’ ‘ says Kay Knight, a doula (birthing partner) who supports patients in NHS hospitals.
‘I was recently supporting a woman through a home birth, but her baby was positioned at a dangerous angle so the hospital told her to come in as a matter of emergency.
‘But when we arrived, there were no staff available. We sat in a side room for more than two hours with no midwife and no pain relief.’
Knight, along with Gayle and thousands of midwives across the country, has launched a campaign calling on the Government to urgently overhaul Britain’s maternity units, recruit thousands more staff and offer pay rises to existing staff.
One simple act that would help to ease the crisis is the reintroduction of bursaries for student midwives, says Dr Ross-Davie.
The incentive, which granted trainees between £1,000 and £4,000, were replaced in 2017 with a student loan, a move that was said to result in a 23 per cent drop in applications.
‘It means we have a different type of person coming into the workforce now,’ says Dr Ross-Davie.
‘In the past, we’d have lots of mature students able to cope well with challenging medical situations. But now, older people can’t afford to study for three years.’
A spate of maternity deaths over the past five years sparked a review into the nation’s maternity services by the Health and Social Care Committee.
Published in July, it recommended urgent action to address a series of problems, including the staffing shortfall.
‘If you keep a service chronically understaffed and underfunded long enough, staff run out of steam,’ says Dr Ross-Davie.
‘We don’t have the number of midwives we need to run a quality maternity service.’