Maternity restrictions impact human rights

Excluding partners from any area of maternity services, but in particular requiring a woman or birthing person to give birth alone, is a profound restriction of both her and her partner’s right to a family and private life under Article 8 of the European Convention of Human Rights. This right can be restricted, but only if the restriction is necessary and proportionate. Guernsey’s decision to exclude partners from the birth of their own child runs contrary to both national guidance from the NHS England and Royal Colleges, as well as international guidance from the World Health Organization, which have all been clear from the outset of the pandemic about the need for women to be supported by a companion of choice during birth, including during an operative birth unless under general anaesthetic.

Restrictions in other areas of maternity services must also be proportionate under ECHR. The expectation that women and their partners should be tested every 96 hours from a week before their due date/required to self isolate, far exceeds anything we have seen imposed anywhere in the UK.

The latest NHS England guidance (published 14 December) makes clear that partners are not visitors and maternity services need to make any adjustments necessary as soon as possible to allow partners to be present at every stage of maternity care, including at scans. You may want to be aware of the legal opinion recently obtained by Birthrights, which states that even if partners cannot attend in person, they should be permitted to be involved in an appointment remotely, unless a maternity provider can give a good reason for declining that request having considered all the relevant evidence, including on the clinical benefits of partner involvement.

Having been contacted by pregnant women from Guernsey who are very concerned and anxious about the restrictions in maternity services, we ask you to make publicly available the risk assessment that underpins the decisions to exclude partners and other supporters from maternity services. We are keen to understand how the human rights impact has been factored into the decision-making process. We also ask that they review any remaining restrictions immediately, in particular the exclusion of partners from caesarean births, which we believe to be disproportionate and completely unjustified, and publish a timeline for lifting any restrictions which cannot be lifted with immediate effect.

MARIA BOOKER

Birthrights

Union House

111, New Union Street

Coventry

CV1 2NT

Editor’s note: a spokesperson for Health and Social Care responds:

As we have said frequently over the past year, whilst working to minimise the impact of Covid-19 on our community, decisions to scale down or stop certain services in health and social care are not taken lightly.

I am pleased to say that we are now in stage two of our exit from lockdown and partners are now able to attend antenatal scans and caesarean sections.

We fully understand that partners not being able to attend antenatal scans or caesarean sections was extremely distressing. We also acknowledge that pregnant women can feel very anxious and vulnerable without their partner or another family member being there with them.

However, pregnant women are never on their own and our staff have worked hard to ensure that women were fully supported during their appointments and procedures. This isn’t limited to our maternity services, the same applies to all other health and care services that have been impacted by Covid-19.

A risk assessment is carried out for every stage of lockdown and our exit from lockdown plans. These have to take into account the nature of our health and social care services. We have a finite number of staff in the Bailiwick and we only have one hospital available. In the UK, we would have the option to send patients to alternative locations in the event staff or premises were impacted by Covid-19. We do not have this luxury here in the Bailiwick. Similarly, it is not possible to rapidly access short-term staff to plug gaps caused by isolating clinicians. We simply have to protect essential services.

In the first lockdown in 2020 we had an incident where staff in paediatrics and neonates contracted Covid-19. These services on the islands were severely threatened, to the point that at one stage a key service was dependent on a single member of staff, while others had to be put into isolation or tested positive. In addition so far from this second lockdown partners attended the Princess Elizabeth Hospital whilst symptomatic in separate incidents and subsequently tested positive for Covid-19.

Both had specifically denied having symptoms when they were questioned by staff at the time of attending the hospital but admitted to having them when contact tracing was carried out after testing positive.

As a direct result of a positive case attending the hospital as a partner (having denied symptoms), the consequences were: 16 members of nursing and midwifery staff had to be isolated as direct contacts, requiring extraordinary measures to maintain key services, the infection of a member of staff who had multiple contacts across the hospital, resulting in the need to isolate large numbers of key staff in all of those areas, including theatres and ICU. Around 400 contacts had to be tested – a huge amount of work for the scheduling team, testing teams, lab staff and contact tracers.

We were, for a short period of time, left with only one specialist in isolation in a key critical speciality which requires 24/7 cover.

In addition, operations scheduled to take place had to be cancelled, other staff had to cover additional shifts etc. when already under considerable pressure and the risk to the island of more cases and prolonged lockdown were both significantly increased.

You can see from the list above, one Covid-19 positive person attending the hospital had a significant impact. This is the reason that these hard decisions are taken and why, for a short period of time, partners have not been allowed to attend outpatient appointments, antenatal scans, caesarian sections etc.

As we said at the start of this response, partners are now able to attend antenatal scans (subject to necessary PPE and social distancing requirements) and caesarian sections.

All of the decisions taken, however difficult, have been necessary to safeguard women’s rights to safe, high-quality maternity care in the Bailiwick and there is, therefore, no contradiction with the advice from the World Health Organization. The steps have been proportionate to the very real risk posed by Covid-19 in a jurisdiction the size of Guernsey and have been taken as transparently as possible. No decision is made without seeking to balance the rights of individual pregnant women against our overall duty to ensure high levels of both safety and service at all times and therefore is in line with our obligations under the human rights law.

HSC staff continually monitor and adapt to the challenges faced across all of its many services. In the case of maternity services during the second period of lockdown, the process continued and plans were implemented dynamically each day to ensure that high levels of safety and service were maintained at all times.