Authors' reply re: Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care

Sir,

We wish to thank Yoong et al. for their interest in our report on modifications to standard maternity care in the UK surveyed during the COVID‐19 pandemic, ¹ and for their subsequent letter. ² We had reported the extent to which maternity services had been modified in the UK, in response to a need to protect staff and service users from the risk of infection with SARS‐CoV‐2, but also in response to staff shortages caused by redeployment and periods of staff self‐isolation. An international survey of maternity and newborn health workers identified that similar service modifications were also implemented worldwide, and staff perceived that women feared attending for maternity care because of the presumed risk of being infected with SARS‐CoV‐2. ³ At the time of our manuscript submission, the impact of service reconfiguration in the UK had not yet been established. Although the widespread impact remains unknown, we welcome the recent Office for National Statistics report showing that rates of stillbirth and preterm birth in England and Wales during the first three‐quarters of 2020 have not risen, and in fact have fallen in line with trends over recent years. ⁴

Yoong et al. report on the impact of the COVID‐19 pandemic on obstetrics and gynaecology training‐grade doctors in London. ² Although some training issues have been caused by the uncertainty of working within a health service during a rapidly evolving pandemic, other concerns have been caused by staff redeployment away from maternity care, without any decrease in demand for this urgent and emergency service. The international survey described above also identified that 90% of staff from low‐ and high‐income countries experienced higher stress levels than usual, and maternity services were impacted by acute staff shortages. ³ In October 2020, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) published a statement intended to reduce the impact of the COVID‐19 pandemic on maternity services during the winter of 2020/21; ⁵ this statement included a recommendation that maternity service staff should not be redeployed elsewhere within the hospital, and a request that health service leaders recognise the current challenges and pressures on maternity staff and provide appropriate continuing support for wellbeing. We hope that this, along with the continually updated RCOG/RCM guidance and support resources available on the RCOG COVID web pages (www.rcog.org.uk) for trainees and all other maternity service staff, will continue to be accessed by our colleagues over the winter period, and that they find these useful in alleviating their concerns and fulfilling their needs.