“Women and children last”—effects of the covid-19 pandemic on reproductive, perinatal, and paediatric health

Dear Editor

“Women and children last…and back of the queue if you have bipolar”

I was interested to hear the authors concerns of a “reverse Titanic” effect that could hit maternal and paediatric health as a result of the pandemic1. When reading about this, I could not help but think of the mothers and babies I see on my ward each day. Here, they also have another iceberg to contend with: this is a mother and baby perinatal psychiatric unit (MBU). The impact that COVID-19 has had on this psychiatric subspecialty has been huge but not widely displayed.

In an environment that relies on constantly building rapport with services users to ensure they feel safe on the ward and close communication across several different teams, social distancing has presented a number of challenges that have impacted on the quality of care we are able to provide to these extremely vulnerable women. The first task of the day - the ward round - highlights this well. In a room where only 4 people can be acceptably distanced, we would ideally have well above this in attendance. Starting from the consultant we would usually have the junior doctors, a staff nurse, a nursery nurse and the ward psychologist. This is before you count a patient’s care coordinator, perinatal community psychiatric nurse (CPN) or a family member. Having members of a patient’s team call in remotely sets a strange tone during consultations and ultimately makes a poor substitute for face to face contact. Is it possible to do a reliable Mental State Examination on a person you are not able to see?

Another unique issue presents itself when a woman’s partner is not allowed onto the ward. As if being a new mum and having a mental health condition was not already tough enough. The pandemic has also put a stop to support groups that many of our new parents rely on such as community mother and baby groups or Dads’ support groups facilitated by our unit. As social distancing rules are set to continue, we must also continue to weigh up the risks of breaching them or not.

What could happen if a CPN doesn’t see a mother at home? What if a high-risk woman falls through the cracks? As we persist in navigating through the icefields of this pandemic, the necessary system transformations must be constantly analysed as to what threat they pose to providing the best standards of care. Undoubtably there will be many lessons to learn, but we need to make sure there is a lifeboat left for the women on MBUs around the country as the NHS battles on to stay afloat.

1. von Dadelszen, Peter, et al. "“Women and children last”—effects of the covid-19 pandemic on reproductive, perinatal, and paediatric health." BMJ 2020;369:m2287.doi.org/10.1136/bmj.m2287