It is quiet on the ward. The only sound comes from five pregnant women, sitting on birthing balls and chatting to each other. About their lives and pregnancies, about the birth and what to expect. Those who had a baby before are giving advice to the others, reassuring them.
A few hours ago, they didn't know each other. Now, they are in induced labour together, soon giving birth to their children.
Among them is Jocelyn Ringer, 29-years old. It is May 2020, two months into the coronavirus pandemic, when Jocelyn is giving birth to her first baby.
When she found out she was pregnant nine months before, she had no idea her birthing experience would be characterised by social distancing, face masks and hospital visiting policies.
The ongoing coronavirus pandemic has impacted maternity services across England. To reduce the risk of spreading the virus, maternity services have been restricting the number of people attending the services since March.
"While other areas of the health service can postpone and cancel procedures, there is still an ongoing need for maternity services," Gill Walton, Chief Executive of the Royal College of Midwives says.
Women are still pregnant. Women are still having babies. The pandemic doesn't change that.
363,209 babies have been born between March and September in England and Wales — in the middle of a global pandemic. According to new data published by the National Office for Statistics (ONS) 153,464 live births occurred between April and June, the period of the strictest lockdown measures in England and Wales.
96 per cent of live births between January and September 2020 happened in NHS establishments such as NHS hospitals, maternity units and maternity wings. This means the majority of this year's birthing women has been affected by the Covid-19 restrictions on maternity wards.
Not only visiting policies on the induction, labour and postnatal wards have changed, in many NHS trusts women like Jocelyn aren't allowed to bring a partner to antenatal appointments and scans.
From face-to-face to over the phone
Luckily, most of Jocelyn's appointments and scans took place before the pandemic, meaning her husband Sam could be with her. The 26-week appointment was the last one that took place in hospital with him present. Her 34-week appointment was over the phone.
"I went back in for my 36-week appointment. This was when they realised I had pre-eclampsia. Meanwhile, my husband had to wait in the car," Jocelyn says.
Situations like these are why doulas from the Birthbliss Academy have started the #ButNotMaternity campaign. One of them is Abbi Leibert, doula and campaign manager.
Credit: Abbi Leibert
The aim of the campaign is to support parents and birth-workers through Covid-19 restrictions on induction, postnatal and labour wards as well as during antenatal care.
Abbi Leibert believes, women should not be alone in appointments when they find out news — good or bad — about their baby.
"Those scans can be great news in which case the partner should be sharing that joy. And if it's bad news, then the partner should definitely be there, not just to hear the news, but to support their partner. It's not something people should have to find out about on their own."Abbi Leibert
Sam Nightingale, a midwife working in an antenatal clinic, witnesses the impacts on women coming in for appointments alone.
Having to make decisions without their partners present is difficult for many. "But there usually is time for follow-up appointments, so the women can come back after having discussed that information with a partner," Sam Nightingale says.
Meanwhile, some NHS trusts have found ways to avoid crowded waiting rooms and allowing partners coming in for scans. It can be that women and their partners have to wait in the car park until they get a text message telling them it's their turn to come up to the appointment.
"This way, no one is waiting inside. This is working really well in quite a lot of hospitals, but it obviously takes a bit more time," Abbi Leibert says.
If, for example, the car park and the sonography department are far away from each other, it does not work as well. "They won't be able to get through enough people," Abbi Leibert explains.
Trusts to be more open
In her opinion, trusts should be more open about the reasoning behind measures and visiting policies. If trusts gave more information, it would be easier for parents to accept the measures, Abbi Leibert believes:
"I think if parents understood why certain things are happening and why it's different in each trust, then they would be more accepting of where it's impossible to change things. They might then feel more calm about it rather than thinking there's something they could and should be doing to make it better."Abbi Leibert
Even without a pandemic, the doula thinks being pregnant is already unsettling enough, especially if it's for the first time — which is why trusts should be more supportive:
"Being pregnant, especially if it's for the first time, is already unsettling enough with everything going on in your body. And then there is this extra layer of stuff that you've got no control over with the pandemic. We feel that trusts should be doing more to help with that and the best way they can help is just by giving more information and support."Abbi Leibert
Last year, for two in every five women (43%) it was the first live birth.
More support on the wards
Prior to covid, women on the labour ward would often close the curtains around their bed, creating their own private space with their partner.
"There wasn't much communication and rapport between different women on the ward", midwife Sam Nightingale says.
Now, she is seeing more support between the women on the ward. Without the partners being there, curtains are staying open, women are talking to each other, supporting each other. Sometimes it is something as little as helping a woman who had a caesarean section to reach a drink.
"That's one positive thing that we have seen out of the changes in the visiting policy," Sam Nightingale says.
Still, she is convinced that women would rather have their partners there, although they have enjoyed some of the benefits of other men not being around.
"It's a really difficult balance, but I think there are situations where women find it difficult in quite a vulnerable time after they've had a baby that there are so many unknown men around."Sam Nightingale
"Everyone needs support at the moment"
A crucial part of the #ButNotMaternity campaign is being there for parents and offering support.
Every day, Abbi Leibert is getting messages from concerned parents. Although she wants nothing more than being able to give an instant answer that would fix things, it's not that easy.
But taking five minutes to send a voice message, offering support and help, is sometimes all the parents need. "They just need somebody who is not freaking out on the other end of the phone. Someone who is calm and just talks them through things," Abbi Leibert says.
With a number of different charities and organisations being involved in the campaign, parents can be sign-posted to a range of different services.
While Birthrights offers legal support, the Association for Improvements in the Maternity Services (AIMS) is focussed on practical support. The Birth Trauma Association and Make Birth Better help women with their mental health if they have had a traumatic experience in the past.
"Everybody is struggling at the moment and everyone needs support. It's important to just be there for each other. We are just helping wherever we can rather than hinder."Abbi Leibert
Her commitment doesn't go unnoticed. Recently, Abbi Leibert has been featured as Mental Health Activist in the 2020 Marie Claire Future Shaper Awards for her engagement in the #ButNotMaternity campaign.
Staying informed to cope with uncertainty during pregnancy
During her pregnancy, Jocelyn was feeling very nervous and uncertain as nobody really knew what was going on and what the situation would be like on her due date.
After she finished work on 13 March, she had to stay home, hoping all of this will be okay in a few weeks.
"I had signed up to do hypnobirthing as I was nervous about birth, but all antenatal classes got cancelled", she says.
Instead of on-site classes, she then was watching midwives on Instagram and kept googling everything.
Staying informed is also what Abbi Leibert advises women: "It makes a massive difference to your stress levels just to know what's going on rather than just reading headlines and thinking that the worst is always going to happen."
What the new NHS guidelines mean for women and their partners
In the next weeks, #ButNotMaternity will take a closer look at trusts that have kept their restrictions minimal throughout the whole of lockdown to write case studies. Ideally, the information will be shared within the trusts, Abbi Leibert says:
"I think some trusts don't have the ability to lessen restrictions because of their staffing levels and budget, but some of them maybe just haven't thought of these ways to do it."Abbi Leibert
On 14 December, NHS England has released new guidelines, urging the NHS trusts to let women have a partner with them at all stages of their maternity journey. Following the guidelines, which replace a previous framework published in September, NHS trusts should make it possible for partners to accompany women to all appointments and throughout birth.
According to the document, women should have access to support in the following situations:
Together with the release of guidelines in September one week after the campaign started this is another big milestone for Abbi Leibert and the other campaigners.
But while Abbi Leibert is hopeful that those will initiate positive changes in maternity services, she thinks the guidelines can be ambiguous. "Although they are guidelines, the NHS trusts don't have to implement them."
As a result, the policies and rules regarding visitors and birthing partners vary from trust to trust.
For this reason, #ButNotMaternity have created a list with NHS trusts and their current restrictions which they are currently updating.
Partners allowed in during birth
But one thing that has been the same for all NHS trusts across England is birthing partners being allowed in for the birth. For Abbi Leibert, it is important to stress that this will always be the case and always has been.
"There's an awful lot of parents who think that their partners are going to miss the birth. It's a very low percentage of people where that has happened. It's not that it doesn't happen. Otherwise we wouldn't be campaigning."Abbi Leibert
But because partners aren't allowed to be in when the woman is in active labour, it sometimes happens that the partner doesn't make it in time.
"The way they measure active labour is different from place to place - and it can be a really quick process as well", Abbi Leibert explains. "If your husband is 20 minutes away in the car park, it can be that he doesn't make it there in time."
Jocelyn on giving birth without her husband
For Jocelyn, the unlikely event of giving birth without her partner became reality. When she had her baby, her husband was six minutes too late.
Credit: Jocelyn Ringer
After she has been induced at 12pm on 4th May 2020, Jocelyn is spending some time with the other four women on the ward, chatting to them and getting advice. By 11pm all of them are gone. Being high risk, Jocelyn has to stay the whole of her labour. "I was freaking out a bit, so I put my music on and tried to zone out," Jocelyn says.
Because it is her first baby and because she is two weeks early, the midwives don't believe how fast her labour is progressing.
"They didn't check how dilated I was. I kept asking if my husband could come, they kept saying, no, there is no delivery room for you!"Jocelyn Ringer
At 4am Jocelyn's water breaks. Instantly, she needs to push, while being on the corridors on the way to a delivery room, squeezing a midwife's hand for reassurance.
34 minutes later, on 5 May 2020 at 4.34 am, she gives birth her baby girl. Another six minutes later, her husband arrives.
"I have never had to be so brave in my life! But when you have to be, girl power kicks in, and you do it! The thought of it is so scary, but your body just knows what to do."Jocelyn Ringer
Challenges after the birth
The challenges don’t end after the birth. "Becoming a mum in lockdown was very lonely, worrying and scary," Jocelyn says. "My friends and family had to meet Margot from a distance either at the door or the window. Nobody could hold her for months or even help me."
Apart from a health visitor coming by once and a six-week-check up at the doctors, there weren’t any baby groups to go to.
After the birth, Jocelyn stayed in hospital for two days, went home for one night before having to go back in for six nights as she had postpartum-preeclampsia.
"The whole time I wasn’t allowed any visitors. It was really hard on my husband not seeing us. When I came out of hospital, Margot was over a week old and Sam was shocked in how much she had changed in that week."Jocelyn Ringer
Today Margot is seven months old. While it was a challenging time, there were also some unexpected positives. Jocelyn found a good friend on the ward and enjoyed the time she had with her baby alone: "The time without visitors gave us the chance to establish breastfeeding, for lots of skin-to-skin cuddles and to get a bit of a routine. But it was so hard in the beginning."
"I feel so proud of myself that I made it through and now have the best bond with my baby girl."Jocelyn Ringer
One thing that stayed with Jocelyn was the support on the induction and postnatal ward: "All the girls were there for each other. We made a real community out of the ward. You are without your family, but you are not alone."
What experiences have you made with maternity services during the pandemic? Tweet about it using #ButNotMaternity or comment below.
I want to hear from you: what experiences have you made with maternity services during the pandemic? #butnotmaternity https://t.co/6aomlWiqkq
— Vanessa Fillis (@FillisVanessa) December 16, 2020