The Australian College of Midwives (ACM) is calling on the federal government to explore innovative ways to increase community-based maternity services amid the COVID-19 pandemic, such as setting up clinics in empty schools and community halls and expanding access to home birthing, in a bid to reduce pregnant women potentially being exposed to the virus in hospitals.
In a letter addressed to Health Minister Greg Hunt, ACM says heightened health security measures and the rapid spread of the virus has triggered a spike in enquiries from pregnant women and midwives seeking information about community-based maternity care and access to home birthing services as an alternative to hospitals to lessen their risk of exposure to COVID-19.
The letter says Homebirth Australia, the peak consumer body for homebirth in Australia, received a similar flood in interest for maternity care outside the hospital system, and worryingly, reports that some women are choosing not to access any care over fears regarding the virus, rather than care in existing public or private maternity facilities.
Arguing women should have access to safe alternative ways of receiving maternity care across antenatal, labour, birth and postnatal, ACM is calling on the federal government to urgently consider creative ways to bring maternity services out into the community to reduce COVID-19 risks for women and families.
Speaking to the ANMJ, ACM Midwifery Advisor Ruth King said pregnant women are contacting the organisation on a daily basis wanting to know their options regarding maternity care, including antenatal, postnatal and birthing, in the face of the global coronavirus pandemic.
The chief concern surrounds – ‘How is this going to affect me and my pregnancy and my baby’.
Troublingly, ACM says information from health services reveals some pregnant women are not even turning up to their antenatal appointments as fears grow.
“There’s a level of anxiety with regard to how they’re going to be accessing their healthcare and also what the outcomes will be when it comes to having their baby and then the type of postnatal care and support they’re going to get,” Ms King says.
“A lot of the community connections that people normally tap into, so women’s groups, friends, postnatal mums and bubs groups, all of those things have been put on hold.”
Ms King says ACM is asking the federal government to consider creative strategies to expand the rollout of community-based maternity services in response to COVID-19.
“It’s essential because what we’re doing is we’re taking healthy women and we’re removing them from people who are unwell with COVID-19 who are going to hospital,” Ms King explains.
“You want to remove them from the source and also keep them distanced. It then enables the people who are working in that health system to focus purely on those who are sick. It helps to target the healthcare delivery so that you’re not putting people into an environment that don’t need to be there and putting people at risk.”
Ms King stressed pregnant women with higher risk factors would still need to receive maternity care in hospitals and that ACM’s push was centred on taking healthy people out of the equation to reduce their risk of being infected with COVID019, as well as easing the burden on the health system.
She suggested midwifery services, such as Midwifery Group Practices, already exist in hospitals and can be up-scaled to enable midwives or teams of midwives to provide greater antenatal and postnatal care in the community amid COVID-19.
Births would still take place in the home, at birthing centres, or hospitals, she added.
“We’re saying there’s an opportunity to expand those services. For hospitals that don’t already have them in place, we think they could learn off others hospitals that already have that system in place or even work with private midwives and look to engage the private midwifery community to come and mentor their midwives to assist them or set up satellite services outside the hospital.”
The range of outside the box options proposed by ACM includes setting up makeshift antenatal and postnatal clinics in empty schools, community halls and churches, and even looking to hotel rooms as birthing options.
“There’s a lot of options available that could be used to provide individualised care to women that reduces their exposure to big groups of people sitting in the waiting room of a hospital, where they’ve had to run the gauntlet of that entire hospital to get to that clinic.”
Ms King says both the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the UK’s Royal College of Obstetricians and Gynaecologists have released valuable information and guidelines for pregnant women to help them understand the facts about COVID-19 infection and pregnancy.
“At this point, there’s no known risk of vertical transmission, so mother to baby, during pregnancy,” Ms King says.
“However, there is a risk immediately after birth. So if a mum has COVID-19 during pregnancy she can pass it on to her baby afterwards.”
Ms King encouraged pregnant women, who are likely more susceptible to COVID-19 due to their immunity being lower, to practice good hand hygiene and follow social distancing protocols.
“My advice would be don’t miss your antenatal appointments and make sure you check-in and find ways of connecting with your midwife, obstetrician or GP.
“I would try to avoid those busy waiting rooms and sitting in an overcrowded waiting room. That’s why we’re pushing to get them [pregnant women] out into the community.
“The most important thing is keeping mothers and their babies safe and we do have the resources to make that happen we just have to think creatively and we’ve got to be prepared to make some strategic steps and changes. It will mean a lot of change but good change.”
Alongside ACM’s push, Homebirth Australia is also running a campaign to raise awareness about the limited access to maternity services outside hospitals in the wake of COVID-19, encouraging people to email their local MPs about the issue and importance of continuity of midwifery care.
The goal of the campaign is to push ministers to make recommended changes to Medicare and regulatory processes to enable maternity care at home to be more accessible and affordable.
“The lack of access to and affordability of maternity care within our communities is driving women to go it alone, sometimes choosing freebirth – birth at home without a medical provider in attendance – in this instance not from a position of power, but from a position of fear,” a letter supporters are being asked to send to MPs reads.
ACM is supporting Homebirth Australia’s calls for the government to approve actions from the 2018 MBS report that would make access to birth in the community easier.
It says it can be achieved by ensuring rebates for intrapartum care provided by Privately Practising Midwives (PPMs) are included and accepted into Medicare, making birth in the community more affordable, coupled with appropriate regulatory changes to boost the number of PPMs to increase accessibility for women.
“At the moment there’s no rebatable item yet for birth at home.” Ms King says.
“There’s rebateable items for antenatal care, postnatal care and birthing in hospital but there’s nothing yet for birth at home so that’s really important.”
Ms King says other key areas for consideration include current homebirth exemptions and lowering restrictions on midwife endorsement to allow more private midwives to enter the space.
She implored the government to act swiftly on ACM’s initiatives as the COVID-19 epidemic escalates.
“We think it’s imperative work starts now,” she says.
“For the next couple of months, there’s going to be significant numbers of women having babies and requiring healthcare services for antenatal and postnatal requirements so it’s really imperative that a solution is found now to get those women out of those health hotspots and back out into the community.”