PREGNANT HEALTHCARE STAFF should not be working with confirmed or suspected Covid-19 patients, the HSE has said – a major shift from previous advice issued at the end of March.
In just a matter of days, official guidance has changed to recommend that pregnant staff “should be allocated to patients, and duties, that have reduced exposure to patients with, or suspected to have, COVID-19 infection”.
“It is specifically recommended to avoid rostering pregnant staff to COVID-specific units or wards, and redeployment to lower risk duties should be considered,” current guidance from the 15 April states.
While there is limited medical evidence of the impact of Covid-19 on expectant mothers and unborn babies, some have called for a precautionary approach that protects pregnant healthcare staff.
Pregnant women, especially in the third trimester, can be particularly vulnerable to some respiratory infections – while women who become unwell in the later stages of pregnancy are generally more vulnerable.
HSE guidance on the issue has not been consistent over the course of the pandemic as Ireland moved from only a handful of cases to around 20,000.
A guidance document for healthcare staff, circulated in January before the first case of Covid-19 was confirmed in Ireland, stated that pregnant healthcare workers should not be rostered to work with coronavirus patients.
By 12 March, the advice was updated to state that healthcare workers “who are pregnant or immunocompromised secondary to illness or treatment, and who have indicated that they would like to be redeployed” should not be rostered to work with confirmed cases.
Two weeks later, as Irish coronavirus cases rose to around 3,000, the advice changed again.
Advice dated 30 March said that pregnant healthcare workers following infection control guidance are “unlikely to be at greater risk of acquiring COVID-19 virus infection”.
Staff “do not need to be excluded from providing care to such patients”.
At this stage, Ireland was only days into drastic social distancing restrictions as health officials emphasised the need to ‘flatten the curve’.
In the same document, the HSE described recommendations from the UK’s Royal College of Obstetricians and Gynaecologist that pregnant healthcare workers after 28 weeks gestation should not be placed on front-line duties as “not evidence based”.
Current UK guidance states that “pregnant women of any gestation should not be required to continue working if this is not supported by the risk assessment”.
After 28 weeks, the advice states that pregnant staff “should be recommended to stay at home”.
Instead, the Irish Institute of Obstetricians and Gynaecologists had initially recommended that hospitals and health centres may “consider limiting” the risk of exposure for pregnant staff, especially during higher risk procedures, but only “if feasible based on staffing availability”.
The Irish Nurses and Midwives Organisation had called on the HSE to change its stance.
On 27 March, the INMO sent a letter to the HSE’s National Director of HR, Anne Marie Hoey – the union said that it is “increasingly concerned at the behaviour of managers, towards pregnant staff who have indicated a wish to be redeployed away from the front line”.
The union called for greater clarity on HSE advice for pregnant staff, adding that the “clear message must be that pregnant women of any gestation will be protected if working during the Covid-19 pandemic”.
A spokesperson for the INMO welcomed the change.
“We’re glad to have made progress and that the HSE’s position has changed. They have taken the INMO’s points on board and have updated their guidance,” the spokesperson said.
“Any healthcare workers who are pregnant should no longer be rostered in high-risk areas, with consideration given to redeployment to low or no-risk areas,” the spokesperson added.
“These are people who going into dangerous situations. If any of them are pregnant or having pre-existing conditions, it’s only right they get some extra protection at work.”
Responding to a question from TheJournal.ie on the issue of guidance to pregnant staff at the Department of Health briefing earlier this month, the HSE’s Chief Clinical Officer, Dr Colm Henry, said that generally “there are a number of variations between us and other countries in terms of advice given”.
“If there is a change in the recommendations of the UK, that’s something the expert advisory group, which meets regularly a number of times a week, will be considering. Our advice is never static,” he said.
A spokesperson for the HSE told TheJournal.ie that the organisation “in line with all health authorities continuously reviews emerging evidence related to Covid-19 to inform our response and management of this global pandemic”.
“As this is a fluid and unprecedented situation, the HSE will keep matters in review and will advise accordingly. Guidance is regularly reviewed and updated to ensure the safety of all our healthcare staff,” the spokesperson said.
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