Coronavirus: London ambulances ‘can no longer guarantee’ response to home-birth emergencies

Women planning home births in London will no longer be guaranteed an ambulance response in the case of emergency,  as a result of “current pressures” from Covid-19, a local health authority has warned.

In an email circulated on Christmas Eve and seen by The Independent, London Ambulance Service NHS Trust warned that it was “no longer in a position” to ensure a response is provided to those women choosing to have their birth at home or within one of the capital’s three birthing centres.

The trust said it was “critical that this information is communicated to [pregnant] women, to inform their planning and future choices”.

Health services across the capital are under increasing pressure as the numbers of Covid infections and hospitalisations continue to rise.

Hospital trusts have started to cancel operations and are redeploying nurses and doctors to cope with an expected increase in demand, amid mounting concern that London could run out of critical care beds within weeks.

After the city was named as the leading coronavirus hotspot in the UK – government data showed that cases have trebled in just two weeks – the LAS has moved to tailor its emergency response services.

It acknowledged that “many staff within maternity units are experiencing unparalleled challenges, including a reduction in critical staffing levels”, which has limited the number of midwives who can attend home births in the capital.

Where possible, the service said, it will “utilise the experience of the existing maternity team … to prioritise care, to continue to keep mothers and their babies safe at this time and minimise the impact on maternity units”.

At the beginning of the pandemic, a number of trusts across the UK suspended home births, insisting that it was safer to attend hospital instead.

Experts urged caution over home births, saying that while they may seem a logical option in the climate of social distancing, they can require additional resources and are not suitable for women who may have the coronavirus.

The Hillingdon Hospitals NHS Foundation Trust in London and NHS Greater Glasgow and Clyde were among those that paused such services back in March. The latter said: “This is to allow us to concentrate our maternity staff in our hospitals to cover those who are absent from work because they are either self-isolating or symptomatic.”

The Royal College of Midwives noted that two midwives were required to be away from a maternity unit for a home birth, and that there would be times during the pandemic when this would not be possible.

Both trusts have since resumed home-birth services within their regions, though Hillingdon Hospitals Foundation Trust warned this month that “there still may be times that home birth cannot be offered” because of the impact of Covid-19 on the NHS workforce.

The London trust said “all women/families will be assessed at the time of delivery for risks or presence of Covid-19 in the home environment and an individual plan will be implemented”.

Similarly, NHS Lothian, in Scotland, announced back in June that women who wanted a home birth would have to sign an agreement promising to provide a series of safeguards for the attending midwife.

The arrangement in the Lothians includes a limit of one birthing partner and the need for a separate changing space for midwives.

A representative of London Ambulance Service NHS Trust said: “Like NHS bodies across the country, we have seen a significant rise in demand for our services due to the COVID-19 pandemic.

“As a result, and to help ensure we can continue to provide care to our sickest patients, we are asking hospital maternity teams and parents-to-be to consider whether to go ahead with higher risk births in London’s three birthing units or in people’s home. This is because these women may need conveying to hospital via ambulance.

“Where such births are due to go ahead, we ask the hospitals to arrange alternative ambulance services ie private providers.”