Even during the pandemic, it is very important that if you have any questions or concerns about yourself or your babies at any time, you contact your midwife or maternity team.

The current NHS England and NHS Improvement campaign ‘Help Us to Help You’ is a reminder to all pregnant women about the importance of attending check-ups, contacting their midwife or maternity team when something doesn’t feel right and gives reassurance that the NHS is here to see you safely.

The RCOG (Royal College of Obstetricians and Gynaecologists) is a great source of information regarding pregnancy during Covid.

Bliss, who support babies who are born premature or sick, has some excellent information on neonatal care during Covid on its website.

As Covid guidance and restrictions differ throughout England, Scotland, Wales and Northern Ireland please make sure you follow the guidance relating to where you live at www.gov.uk

If you any questions or concerns that are not covered here please contact us. For hospital care related enquiries email maternityengagement@twinstrust.org. For help and support once your babies have arrived email support-team@twinstrust.org.

You can also call our free support service, Twinline, on 0800 138 0509 or email asktwinline@twinstrust.org.

Pregnancy/Antenatal care

What is the current evidence about the risks of COVID-19 on multiple pregnancy?

Generally, pregnant women do not appear to be more likely to be seriously unwell than other healthy adults if they develop coronavirus but pregnant women have been included in the list of people at moderate risk as a precaution. This is because pregnancy in a small proportion of women can alter how your body handles severe viral infections and some viral infections, such as flu, are worse in pregnant women.

It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms.

More severe symptoms such as pneumonia, seem to appear to be more common in older people, those with weakened immune systems or long-term conditions. As yet, there is no evidence that pregnant women who get this infection are more at risk of serious complications than any other healthy individuals.

Current evidence suggests that if you do have the virus it is unlikely to cause problems with your baby’s development and there is no evidence to suggest an increased risk of miscarriage if you become infected with coronavirus and are pregnant.

If you think you may have symptoms you should use the NHS 111 online service for information, or NHS 24 if in Scotland. You should also tell your midwife or maternity team.

Should I have a flu vaccination?

The RCOG (Royal College of Obstetricians and Gynaecologists) advice states that ‘all pregnant women are encouraged to get a free flu vaccination, which is safe at any stage in pregnancy from the first few weeks right up to your due date. Most people recovery quickly from flu but developing flu during pregnancy can be serious for a small number of women and their babies. This is because pregnancy can alter how your body handles viral infections.’

Will I continue to receive specialist care for my multiple pregnancy and what changes can I expect to my care?

Your appointments remain an essential part of your maternity care. You should still receive some specialist care during your pregnancy however you may find your appointment schedule doesn’t follow what is recommended in the NICE guidelines or in our antenatal care plan.

This is because of the shortage of staff it may not be possible to have as many appointments as usual. Please check with your local maternity to find out what appointment schedules they are currently offering and whether your partner can attend them with you.

It is important that you attend all your pregnancy scans and antenatal appointments unless you are advised not to and always contact your maternity team if you have any concerns about the wellbeing of yourself and your unborn babies.

The NICE recommended schedule of antenatal care should be offered in full wherever possible. These appointments should be offered in-person as far as possible, with particular attention to those from BAME communities or those living with medical, social or psychological conditions that make them higher risk.

I have a monochorionic pregnancy, will I still have scans every two weeks?

While the recommendation is to be scanned every two weeks this may not be possible at the minute. This is because of the shortage of staff it may not be possible to have as many scans as usual. You may also have some antenatal appointments via phone or web chat rather than face to face. Even though you may not be scanned every two weeks you should not be having a large gap between scans. Please contact your maternity unit and Twins Trust if you think the gap between scans is too long.

Please check with your local maternity to find out what scanning schedules they are currently offering as it will vary from hospital to hospital and speak to your consultant or midwife early in your pregnancy to make sure you know about some of the signs and symptoms of complications in a monochorionic pregnancy e.g., TTTS. You can also find these on our website. Please contact your maternity unit immediately if you have any concerns or notice a reduction in your babies’ movements.

What is the advice for women from a Black, Asian or minority ethnic background?

The RCOG says that ‘women from Black, Asian and minority ethnic (BAME) backgrounds are at higher risk of becoming seriously unwell and being admitted to hospital so it’s important that if you feel your symptoms are worsening or if you are not getting better, you should seek medical help.

Your maternity team may offer you additional appointments or refer you to a doctor or specialist clinic if there are any concerns about your or your baby’s health.’

The Royal College of Midwives has new guidance for midwives and maternity support workers to ensure that they are aware of the increased risks for BAME women and can pass on relevant advice and support to the women in their care.

The NHS in England has written to all maternity units in the country calling on them to take four specific actions to minimise the additional risk of coronavirus on BAME women and their babies.

How will my antenatal care be affected if I am diagnosed with COVID-19?

You should contact your midwife or antenatal clinic to inform them that you are currently in self-isolation for possible/confirmed coronavirus and ask for advice on going to routine antenatal appointments.

It is likely that routine antenatal appointments will be delayed until isolation ends. If your midwife or doctor advises that your appointment cannot wait, the necessary arrangements will be made for you to be seen. For example, you may be asked to attend at a different time, or in a different clinic, to protect others. If you do attend an appointment the hospital staff will be wearing protective equipment so don’t be alarmed if they look different to usual.

You should also be aware of your babies’ movements and any symptoms of complications and contact your maternity unit immediately if you have any concerns.

You should not attend a routine clinic.

I am pregnant and someone in my household has been exposed to COVID-19, what should we do?

Your whole household should self-isolate in line with the government guidelines and if anyone develops symptoms they should get tested. If you have an appointment scheduled during this self-isolation period please notify your maternity unit that you are self-isolating and discuss whether that will affect your appointment schedule.

Further information on what to do and when to self-isolate can be found on the NHS website.

If I have COVID-19 and I recover, will I be able to catch it again?

Those who have been infected with covid-19 develop a protective antibody- but is unclear how long the protection lasts.

I have been diagnosed with a complicated pregnancy; how will my care be affected?

The safety of mother and her babies is always your maternity team’s priority. A plan of care will be arranged with your consultant to ensure your safety and your babies, within the constraints of the current situation and taking the necessary recommended precautions.

If I am diagnosed with a complication like TTTS, is it safer to let things run their course for longer than usual or to have a hospital procedure like laser therapy?

The safest thing for you to do is to follow the advice of your health professionals and have the procedure if they are recommending it.

I have been told I will receive a steroid injection before my babies are born, could this compromise their or my immune system, and should I still have the injection?

Steroid injections won’t compromise yours or the babies immune system and are really important to help your babies if their lungs aren’t fully developed

At my latest appointment I was diagnosed with COVID-19 and threatened preterm labour. Can preterm labour be caused by COVID-19?

As this is a very new virus we are just beginning to learn about it.

Across the world, emerging reports suggest some babies have been born prematurely to women who were very unwell with coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that their babies were born early for the benefit of the women’s health and to enable them to recover.

What research is being done to monitor the effect of coronavirus on pregnant women and their babies?

The UK is conducting near-real-time surveillance (observation) of women who are hospitalised and test positive for coronavirus during pregnancy, through well-established systems already used by all maternity units – this is the UK Obstetric Surveillance System (UKOSS).

Imperial College London are also running a surveillance programme (PAN-COVID) to monitor pregnancy and neonatal outcomes for women with coronavirus. Other maternity surveillance programmes are being funded by the National Institute of Health Research (NIHR).

New evidence from a recently released study suggests it is very unlikely the virus will get passed on to your babies, even if you are infected during your pregnancy. 

You can also ask your maternity team about any local research that is taking place in your area.

Will antenatal classes still be running?

Due to the huge demand on staff in hospitals antenatal classes won’t be running during the Covid-19 pandemic.

Twins trust has moved its Antenatal classes to interactive online courses to make sure we can still support all our families during these difficult times, this and our webinars on Practical Preparing for Parenthood and Breastfeeding can be found on our website.

Birth

If I have COVID-19 when my babies are born, what should I expect to happen?

You will be informed where to go as there will be a dedicated isolation room, you will be cared for a midwife in full PPE and they will speaking on a walkie talkie to their colleagues, these are all precautions to ensure that the virus is not spread. Anyone who enters the room will be in full PPE. Guidance on birth partners being present will vary so please check with your local maternity unit.

Will I be able to see my babies after birth?

Yes, if that is your choice. Provided your baby is well and doesn’t require care in the neonatal unit, you will stay together after you have given birth and be able to have skin to skin contact.

A discussion about the risks and benefits should take place between you and your family and the doctors caring for your baby (neonatologists) to individualise care for your baby.

This guidance may change as knowledge evolves.

Will they automatically have COVID-19 if I have it?

There is currently no evidence to suggest that they will automatically have Covid-19 if you have it.

I’m worried about going to the hospital to give birth, what precautions should I take?

To help you and your birth partner stay Covid fee prior to the birth, self-isolating is a good idea in the last few weeks and to continue to follow the government advice on hand washing, wearing masks and distancing.

I have a C-section booked in the next few weeks, and I’ve heard that hospitals are going to get busier, should I ask for it to take place earlier?

Your health care team will advise of the best timing for the safe delivery of your babies.

I’ve heard that birth partners may not be allowed in hospitals, is this the case in the UK? Why are these restrictions in place? Who will support me if I cannot bring my birth partner?

Most units will still allow one birth partner to be present as long as they do not have Covid-19 however there is a possibility that visitor restrictions may be reintroduced in response to an increased local or national transmission risk. You will need to check the latest guidance for your local area.

If you are being induced you may have to go to hospital on your own and your midwife will let you know when your labour is established and your birth partner will then be able to join you for the birth. Check with your hospital whether they allow partners to stay.

If you go into spontaneous labour your birth partner will accompany you to hospital and remain with you until the birth.

The RCOG Covid guide for parents has some great advice for birth partners.

I have been booked in to have my babies early, is this still safe to do or should I wait until they are nearer to full term?

Your health care team will advise of the best timing for the safe delivery of your babies. Our care pathways show the recommend timing to have the babies based on your type of pregnancy.

What should we take to the birth?

As you and your birth partner will be in the delivery room until the baby is born it is important you bring all essential things with you (but try to remain as minimal as possible). Please bring a mask and additional snacks and drinks that you prefer to eat/drink. Make sure you’ve got chargers and things to occupy you both during labour e.g., music and downloads to watch. Your birth partner should ensure they have a mask and enough food and drink to sustain them through labour and birth. There will be very limited catering facilities available for birth partners and vending machines won’t be available.

Postnatal care

What postnatal support is available in hospitals at the moment? I’m worried that I won’t be able to buy formula, is there any breastfeeding support available?

There is likely to be less breast feeding support available in the hospital after birth. Twins trust has some really useful information to help you establish breast feeding on our website and also breast feeding peer supporters who can help you. It is also a good idea to have some formula milk in prior to the birth as a backup.

Will I be able to stay with my babies after birth?

As long as you and your babies don’t need any additional care you will stay with your babies after birth and will be discharged as soon as feeding is established and you all safe to leave.

What will happen if they need neonatal care? Will my partner and I be allowed to see them and look after them on the neonatal unit? What happens if I or my partner have symptoms of COVID-19 – will we be let in or will we be able to see them? Will I be able to establish breastfeeding if any of my babies are in the neonatal unit?

As long as you are free of Covid -19 you should be able to visit your babies in neonatal care. No-one who has any symptoms will be allowed into neonatal care to protect the very sick babies and also the staff. There may be restrictions to the amount of time you are allowed to spend in neonatal care and around partners visiting so do check with your maternity team.

Establishing breastfeeding is really important and will be encouraged where possible, if visiting is restricted then you can still express milk at home and bring the milk in for the babies to be fed your breast milk when you aren’t there to breast feed. This will also keep your milk production going.

The Bliss website has some excellent information on Neonatal care during the Covid-19 pandemic.

Will my midwife/health visitor visit me at home? I am worried about the risks.

You may have less visits than usual, but you should make sure the essentials checks still take place. Expect your midwife/health visitor to be wearing protective equipment when they visit you.

For further information, please see the latest advice from the RCOG here.