By: 15 April 2020
RCOG publishes new standards for antenatal and postnatal care amid coronavirus crisis

The Royal College of Midwives and Royal College of Obstetricians and Gynaecologists has published new standards for UK NHS trusts and boards on how to safely manage antenatal and postnatal care services during the coronavirus pandemic.

Maternity care has been shown repeatedly to be essential. Studies in the UK and internationally have shown that if women do not attend antenatal services they are at increased risk of maternal death, stillbirth, and other adverse perinatal outcomes.

Many elements of antenatal care require in-person assessment, including blood pressure and urine checks, measurement of fetal growth and blood tests.

There is a shortage of evidence about rationalising antenatal visit numbers, but evidence from lower and middle income countries suggests that attendance at five visits or fewer is associated with an increased risk of perinatal mortality. There is no appropriate evidence about replacing this minimal antenatal care with remote assessment.

Gill Walton, CEO of the Royal College of Midwives, said:

“We know that this is a worrying time for pregnant women and they are, understandably, doing all they can to ensure the health and safety of themselves and their baby. Antenatal appointments are there to do just that, which is why it’s so important to continue to attend them.

“If you are pregnant, with no coronavirus symptoms, you should continue to go to your antenatal appointments as usual, while following the social distancing guidance of keeping a two-metre distance from others and using private transport if possible. Even if you have symptoms, contact your midwife and they will work with you to ensure you continue to get the care and support you and your baby need.”

The guidance suggests that maternity services should aim to maximise the use of remote means to provide additional antenatal consultations. Remote consulting enables greater compliance with social distancing measures recommended for pregnant women and maternity staff. Clinics can be run effectively using telephone or video consultations instead of face to face encounters. 

Risk assessment for the provision of face-to-face antenatal care should be undertaken to ensure that women with particular vulnerabilities, including psycho-social and safeguarding issues, as well as medical and obstetric complications, are prioritised.

The guidance for adaptation of maternal medicine services to safely reduce face-to-face contact during the evolving coronavirus pandemic, includes offering virtual consultations where appropriate, ensuring women are seen in one-stop clinics that cover all medical and obstetric needs in the same visit, avoiding unnecessary hospital admissions and offering new innovations, such as home monitoring of blood pressure, where it is safe to do so.

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:

“We welcome the rapid and largely successful implementation of remote access to antenatal care throughout the UK, ensuring women receive high-quality care and regular access to essential services while minimising the need for travel to antenatal clinics and face-to-face contact with healthcare staff.

“However it’s important to remember that some pregnant women have underlying conditions that require additional antenatal monitoring to ensure the wellbeing of the woman and her baby.

“The guidance published today seeks to offer pragmatic advice to doctors and midwives on the management of common medical disorders in pregnancy during the coronavirus pandemic. It recognises that antenatal care is essential, and balances the need to provide appropriate care to ensure the best possible pregnancy outcomes for women and their babies against the need to protect particularly vulnerable women from the risk of coronavirus infection.”

Guidance from the Royal College of Obstetricians and Gynaecologists and UK government

National guidance on coronavirus infection in pregnancy and Q&As for pregnant women and their families

Guidance for maternal medicine in the evolving coronavirus (Covid-19) pandemic

Guidance for antenatal and postnatal services in the evolving coronavirus (Covid-19) pandemic

UK government guidance on social distancing for all vulnerable people, including pregnant women