March 30, 2020

Midwifery

Pregnant health workers at specific risk of COVID-19: RANZCOG

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The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has urged employers to give consideration to the reallocation of pregnant health workers to lower-risk duties, working from home or to provide leaves of absence for pregnant health workers.

In a statement, the College has stated that “the risk [of COVID-19] to pregnant healthcare workers is quite specifically impacted by the nature of their professional activities and exposure”, and has recommended that pregnant workers be reallocated to roles that have reduced exposure to patients with, or suspected to have, COVID-19 infection. 

“All health care workers in direct patient contact will potentially have increased exposure to the COVID-19 virus. This will increase their risk of contracting the disease. This risk applies to pregnant health care workers”.

RANZCOG has indicated that while there is currently no evidence of an increased risk of miscarriage, teratogenicity or vertical transmission from COVID-19, there is a possibility of an increased incidence of premature birth. Further, it has said that pregnant women are potentially at increased risk of complications from any respiratory disease due to the physiological changes that occur in pregnancy, including lung function, increased oxygen consumption and changed immunity.

Because of this, RANZCOG has recommended that, where possible “pregnant health care workers should be allocated to patients, and duties, that have reduced exposure to patients with, or suspected to have, COVID-19 infection.” It further recommended that they observe strict hygiene and PPE protocols.

You can read RANZCOG’s release here.

If you are an NSW Nurses and Midwives’ Association member, and require assistance or support to access reallocation, you can Contact Us. If you are not yet a member, you can join us today.

 

Coronavirus with a baby: what you need to know to prepare and respond

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If you have a baby, you may be worried about your child catching the novel coronavirus (COVID-19), particularly after media reports of an Australian infant being diagnosed.

One important thing to note, the evidence to date states babies almost never get seriously ill from COVID-19. And even if infected, they may have no symptoms.

However, COVID-19 could affect infants in other ways. For instance, there may be difficulties accessing health care, consumer goods and child care.

Thinking about these possibilities now, and preparing for them, can help you manage what may come.

Health care access may be tricky, but there are ways

If COVID-19 becomes widespread, the health system will struggle to cope for a while.

Up to 20% of people who get COVID-19 need treatment in hospital for up to two weeks or more.

Hospitals and general practices may be overwhelmed by others sick with COVID-19, which may make it difficult to access health care if your baby gets sick for any reason.

Recognising this, the Australian government recently announced special provisions for parents of newborns to be bulk-billed when consulting a doctor or nurse via phone or videocall rather than in person.

There are also things you can do to help keep your baby healthy so they don’t need medical treatment. By protecting them, you also protect the people around them who may be more vulnerable to serious illness from COVID-19.

Think about hygiene

The first thing you can do is to practice good hygiene yourself. This includes frequently washing your hands, avoiding close contact with other people as much as you can, coughing or sneezing into your bent elbow or a tissue, and avoiding touching your eyes, nose and mouth.

Because babies put their hands in their mouths no matter what, frequently washing their face and hands and cleaning surfaces and objects they might touch will help protect them from any infection.

How about daycare?

It will come as no surprise to most parents that babies who attend daycare are sick more often.

That’s because babies and small children have an immature immune system, are in very close contact with one another, and may end up sharing saliva with one another by mouthing and touching one another and the same toys.

So, if you can, keep your baby away from daycare. However, if you need to use it, when you pick up your baby from daycare, wash their hands and face, change their clothes, then wash your own hands, before scooping them into that big, warm hug.

Make sure vaccinations are up to date

Routine vaccination is the safest, most effective way to protect babies and children from illness.

So, keep your child’s vaccinations up-to-date to minimise the chance they’ll need medical attention while the health system is dealing with the coronavirus.

If you’re breastfeeding

Breast milk contains many ingredients to help prevent and fight infection. It is recommended babies be fed only breast milk until they are six months old and continue breastfeeding with other foods into their second year of life.

Keep breastfeeding, is the latest advice.
Australian Breastfeeding Association, Author provided

If your baby is under six months and breastfeeding, offering them only breast milk protects them from a range of infections and reduces their need for medical treatment or hospitalisation.

If your baby is breastfeeding and using formula, consider replacing formula feeds with breastfeeds.

If you have stopped breastfeeding altogether, it is possible to start breastfeeding again if you want to (contact the national Breastfeeding Helpline for assistance).

If you have an older baby or toddler who is still breastfeeding, keeping breastfeeding will help protect them from other illnesses until after the coronavirus pandemic has passed.

If you’re using formula

It is easy to accidentally introduce germs into bottles while you’re preparing infant formula. So, because medical care may be hard to access, it is worth taking extra care to prevent this.

Be extra careful about preparing bottles. This means always washing your hands thoroughly with soap, washing bottles thoroughly, sterilising them after every use, and making up formula with hot water.

Remember to cool down the bottle in the fridge, give it a gentle shake, and check it’s not too hot before giving it to your baby.

Shop for supplies, such as nappies

Supply chains may be disrupted if lots of people get ill. And you may not be able to shop if you need to self-isolate at home.

It is recommended you have two to three weeks worth of supplies at home to prepare for this possibility. Consider stocking up on nappies for this length of time, or keeping washable (cloth) nappies on hand.

If you are formula feeding, buy enough infant formula for three weeks but check the expiry dates.

What if mum contracts COVID-19?

Mothers are more at risk of becoming sick from COVID-19 than their babies.

And if you’re breastfeeding and you’re infected, it is recommended you continue breastfeeding. That’s because the virus has not been found in breastmilk.

Wearing a mask when you are with your baby (including during feeding), washing hands before and after contact with your baby, and cleaning and disinfecting surfaces and any feeding equipment will help prevent your baby catching the virus from you.

If you are are hospitalised or separated from your baby, you can express breastmilk for them.

Think about keeping grandparents safe

If you or your partner get ill, someone else may need to help care for the baby or other children.

Babies like to share their saliva with their caregivers and they may be infected with COVID-19 but have no symptoms. So they may easily spread the infection to the people looking after them.

Many parents call on grandparents to help with child care. Unfortunately people over 60 are the most likely to get seriously ill or die from COVID-19.

So, if your standby carers are over 60, now is the time to think about making alternate childcare arrangements.

Talk with grandparents about how they can reduce their risk of infection if they need to look after the baby.The Conversation

Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University and Nina Jane Chad, Research Fellow, Sydney School of Public Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

Coronavirus while pregnant or giving birth: here’s what you need to know

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Having a baby is stressful enough without a coronavirus (COVID-19) pandemic and all the associated misinformation.

If you’re pregnant and/or due to give birth soon, it’s best to get information from trusted sources such as the World Health Organisation, the Royal College of Obstetricians and the Australian Government Department of Health.

Here are the key take-home messages.

It’s a new virus

As COVID-19 is a new virus, we are learning more about it every day. As most pregnant women are young and generally healthy, they’re less likely to be severely affected (which is good news). But as there is also a baby to consider, the picture can be more complex.

A baby born recently to a mother in the UK with COVID-19 recently tested positive soon after birth but we are not sure whether it was infected in the womb (unlikely) or after birth (more likely).

As far as we know, the baby is fine and the mother is being treated. Other reports on babies with COVID-19 have also shown they had mild symptoms and a good recovery.

From China’s experience to WHO advice

To date, much of our information on COVID-19 has come from China. This is where one of the first studies, involving just nine pregnant women with COVID-19, came from.

All these women had caesarean sections, none were seriously unwell and all mothers and babies recovered. The study found none of the babies appeared to get COVID-19 and there was no evidence of the virus in the baby, breastmilk or fluid surrounding the baby. It’s not clear why these babies were born by caesarean section. China has a very high caesarean section rate, which is not optimal, and this may have influenced how they responded.

The World Health Organisation’s new guidelines state:

there is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness. So far, there is no evidence on mother-to-child transmission when infection manifests in the third trimester … WHO recommends that caesarean section should ideally be undertaken only when medically justified

Why pregnant women are not more susceptible to COVID-19

Pregnant women are generally more susceptible to viruses that cause breathing problems (like the flu). Their immunity is lowered, their lungs are more compressed and they need more oxygen.

However, this doesn’t seem to be the case with COVID-19. In an analysis of 147 women with COVID-19, only 8% had severe disease and 1% were in critical condition. That’s lower than the general population.

The lowered immune response of pregnancy, which is needed to stop a woman’s body responding to her baby as a health threat, may actually provide extra protection with COVID-19. COVID-19 seems to be more severe in people with an immune system working hard dealing with other health disorders.

With COVID-19, more men than women are affected and women are less likely to get severely ill and die. To date, the death rate is 1.7% for women and 2.8% for men.

However, as the pandemic spreads this may change. Women comprise the majority of the health workforce and caregivers will be in contact with more sick people.

How can pregnant women protect themselves and others?

Pregnant women should do the same things as the general public to protect themselves, including:

  • covering the mouth when coughing (by coughing into the crook of your elbow)
  • avoiding people who are sick
  • asking people who are unwell to avoid visiting
  • washing hands often with soap and water or an alcohol-based sanitizer and
  • avoiding large gatherings.

It would be sensible not to travel overseas at the moment; you may have to self-isolate when you return.

Women who think they may have contracted COVID-19 can now consult their GP or other health professional with a bulk billed telehealth call (video call) rather than having to go in person.

Women who are pregnant or have new babies are given priority for telehealth services.

If you have been asked to self-isolate due to contact with someone with COVID-19, or have the illness, make sure you contact your midwife or obstetrician by phone and follow the advice of your health care provider.

What about going to hospital for antenatal visits and birth?

Keep going to appointments but don’t stress if you miss a couple, and early discharge might be a good idea if you’re able.

If you are booked into a birth centre or hospital, lots of precautions are in place to minimise the risk of infection. Birth will proceed as planned in the vast majority of cases and going home early would be ideal and may be encouraged if you and your baby are well.

Be aware some hospitals are restricting visitors and even support people, other than the partner, to try and reduce risk to the community.

Can the baby be infected with COVID-19 in the uterus?

The placenta is a very efficient filtering system and does an amazing job protecting babies from harm. The Zika virus was an exception to this.

There is no evidence of increased complications, though if a woman was very unwell (with high temperature or pneumonia, for instance) then the baby may be born prematurely.

This may be due to deliberate intervention by health professionals if the woman is very sick.

In general, though, a COVID-19 diagnosis should not lead to a decision for an early birth, unless ending the pregnancy is thought to be beneficial to the mother due to her overall condition.

There is not enough evidence that COVID-19 increases miscarriage and it is too early to know other longer-term impacts on the baby.

What should I do after the birth?

The benefits of breastfeeding are so significant the WHO recommends this should begin within an hour of birth. Skin-to-skin contact should be supported immediately following birth if the baby is well.

If the mother is too ill, she should be assisted to express her milk. Breastfeeding is particularly effective against infectious diseases because it transfers antibodies and other important immune factors to the baby. If the woman or the baby have an infection, the composition of breastmilk even changes to increase important components that help the baby fight infection. So, if you were thinking of giving up breastfeeding, perhaps continue until this pandemic ends.

WHO recommends women who have COVID-19 should wash their hands before and after contact with the baby, use a medical mask when near the baby if they have symptoms (such as coughing), and routinely clean and disinfect surfaces they may have touched.

What else can you do?

When the seasonal flu vaccine becomes available, get vaccinated. We know this can be protective during pregnancy. It is free for pregnant women and there are no risks to your baby from flu vaccine. You will not be protected from COVID-19 but you will get some protection from the flu (which can be very problematic for pregnant women). The last thing you want is to have the flu and COVID-19 at the same time.

Free flu vaccinations will be available from GPs mid-April but if women want them earlier, they can get them for a fee at the pharmacy from end of March.

Most of all, try and stay calm and talk to your midwife or doctor if you are getting very worried.The Conversation

Hannah Dahlen, Professor of Midwifery and Higher Degree Director, Western Sydney University and David Ellwood, Professor of Obstetrics & Gynaecology, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Midwife’s registration cancelled over false renewal declarations

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A midwife’s registration has been cancelled by the State Administrative Tribunal of Western Australia, after she admitted to providing false declarations regarding her recency of practice.

From 2012 to 2017, midwife Joy Jones declared that she had met the Nursing and Midwifery Board of Australia’s recency of practice requirements, when she knew or ought to have known that these declarations were incorrect. Based on these declarations, the Board renewed her registration as a midwife.

Ms Jones admitted that the submission of the false declarations constituted professional misconduct. She had her registration as a midwife cancelled by the Tribunal, and was ordered to pay $1,350 towards the Board’s costs.

The NSW Nurses and Midwives’ Association recommends that members abide by their respective codes of conduct at all times. If members are in need of assistance, including with matters of recency of practice or professional conduct, you can contact the Association here.

Private system delivers poor value on maternity

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Mothers relying on private health cover pay much more than those who use a public hospital, according to new research.

The study separated women into those who gave birth in the public or private system, and women were matched for similar birth circumstances, such as having a caesarean or giving birth vaginally.

“Fees were consistently higher in all time periods for private births compared with public births: 500 per cent higher in pregnancy, 1200 per cent higher at the time of birth, and 180 per cent higher in the first year postpartum,” the study, published in the journal Birth Issues in Perinatal Care, found.

“Obstetric services were the largest source of fees paid by mothers who gave birth in private hospitals ($1296), followed by diagnostic imaging ($262) and specialists ($221). For each type of service, the fees for mothers who gave birth in private hospitals were higher than for similar mothers who gave birth in public hospitals.”

The study found women who gave birth in public hospitals saw general practitioners more often, while both groups of women used similar numbers of diagnostic imaging services.

“The standout finding is just how much more mums do pay if they do choose to give birth in a private hospital, and how long the out-of-pocket costs are incurred for,” said Griffith University associate professor Emily Callander, who led the study.

“It’s not just at the time of birth but those costs continue during the child’s first year of life.
 I found it surprising how many thousands of dollars mums who choose to give birth in 
private hospitals do pay. Private health insurance does not protect you from high out-of-pocket costs.”

One in six Australian women in their 30s have had an abortion – and we’re starting to understand why

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Abortion is a common experience for Australian women. Around one in six have had an abortion by their mid-30s, according our new research published today in the Australia New Zealand Journal of Public Health.

Narratives about abortion often stigmatise women who have had one, or seek to access to one. But our research shows women from all walks of life may have an abortion: married, single, child-free, and mothers. In fact, women who have already had children are more likely to have a termination than those who haven’t.

Women make decisions about whether or not to have an abortion in the context of their complex lives. And it’s by no means an easy decision.

Our research investigated the factors associated with abortion as women move from their late teens into their mid-30s. We found women with lower levels of control over their reproductive health, whether through family violence, drug use or ineffective contraception, are more likely than their peers to terminate a pregnancy.

If we want to reduce the rate of unintended pregnancies and abortion in Australia, we need to empower women to have control over their fertility and support them with appropriate health services.

Women’s experiences

We used data from five surveys of the Australian Longitudinal Study on Women’s Health to examine factors associated with “induced” abortions which were not undertaken because of a foetal abnormality.

We looked at a cohort of more than 9,000 women born between 1973-78 who were first surveyed at ages 18-23 years. At the fifth survey they were aged 31-36 years.

Overall, by their mid-30s, 16% of the women in this study had reported at least one abortion.

We also looked at the proportion of women who reported a new abortion at each survey. At the first survey, when women were aged 18-23, 7% reported having had an abortion. In subsequent surveys, 2-3% of women reported having an abortion since the last survey. While most women reported only one new abortion, around one in ten reported two abortions, and around 2% reported three abortions.

Abortion is understandably more common for women when they are in their 20s than it is when women reach their 30s. This may be because many women in their 30s are actively trying to be pregnant, or may be using contraception more effectively if they’re trying to avoid becoming pregnant.

Compared with married women, those who were in a de facto relationship, were single, or divorced were more likely to have had an abortion.

Women with children were more likely to have an abortion than women who did not have children. In the fourth survey, the majority of women (72%) said they hoped to have one or two children, 20% wanted three or more, while 8% didn’t want to have children.

Perhaps unsurprisingly, women who had an abortion in the later surveys were more likely to have previously reported using ineffective contraception, or to have had a past abortion, than women who didn’t terminate a pregnancy in their 30s.

Women whose alcohol use had recently become riskier and women who reported using any illicit drugs in the past 12 months were also more likely to have an abortion.

Violence was also a big factor. Women who recently experienced partner violence were more likely to terminate a pregnancy than women who reported no violence. Even women who reported childhood sexual abuse had a significantly increased likelihood of abortion in their twenties (but not in their 30s).

In fact, women reporting violence of any kind, and at any time, had a significantly increased likelihood of having an abortion.

What can we do about it?

Australia is going through a much-needed process of law reform to ensure women across the country have access to abortions as part their women’s health service. Queensland is the most recent state to remove abortion from the criminal code.

Alongside this, we need to improve training and resources to for health providers to identify and help women who may be at risk of unintended pregnancy, particularly those who are using illicit drugs or are experiencing partner violence.

We need better ways of reaching all vulnerable women, but especially young women experiencing reproductive coercion.

We also need to ensure that all women are provided with good access to information about effective contraceptive choices. While the oral contraceptive pill and condoms are the most common methods Australian women use, long-acting reversible methods (such as intra-uterine devices and implants) can be good options for many women wanting effective contraception.The Conversation

Jayne Lucke, Chair, Australian Research Centre in Sex, Health & Society, La Trobe University and Angela Taft, Professor and Director, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.