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Rose—Registered nurse and midwife
Maternity outpatients
Regional Victoria

Before COVID

In early 2020, I was an acting nurse unit manager at a maternity outpatient clinic in a large regional hospital.

Our building was offsite from the main hospital. We had a Monday-to-Friday clinic and two staff members who made home visits on Saturdays and Sundays to women who had recently had babies. We were a tight-knit group because we were offsite and a lot of our staff just worked in our area. They didn’t necessarily rotate into the hospital or the labour ward setting.

The clinic was a lively and warm place. Everybody could come to an appointment! Whole families would come in, partners and four children, and friends, mums, sisters. We didn’t restrict the numbers! We would have our face-to-face sessions. These would go for thirty or forty minutes. Sometimes we would visit people at home. On a hot day in regional Victoria, we might have a glass of water. Or we might have a cup of tea and talk about breastfeeding and watch a woman breastfeed.

It was about that time that we were called to an open forum in our education lecture theatre with about a hundred other hospital employees. A panel of experts sat at the front of the theatre and fielded information and questions about a new virus known as COVID which was beginning to spread throughout the world. They assured the staff that it was no more than an influenza or SARS-like flu. Little did they know. Little did we know. Little did we know how much would change.



During the pandemic

Personally, as a nurse and midwife, my biggest struggle throughout the pandemic was following hospital, state and national guidelines in limiting care, contact and visits with women, newborns and families. We, as a profession, know what excellent care is and how this leads to positive outcomes and experiences for our patients. COVID forced us to work in lockdowns and with restrictions that stopped us from providing the type of care we were trained for.

At our hospital, women had to come alone to ultrasounds, appointments and postnatal visits. There were no childbirth education or breastfeeding classes for some time until, eventually, a midwife filmed training staff on an iPad and the hospital uploaded the classes to the internet. Later, live Zoom classes became the norm. Early antenatal appointments prior to the third trimester were performed via telehealth video calls or phone calls only.

For a period of time, women who were COVID-positive gave birth without any support people present, except for the midwives. Some women and their partners isolated for weeks prior to delivery for fear of catching the virus and having to give birth without a partner or support person.

When travel restrictions were in place, families couldn’t have extended family support if they lived in Melbourne or outside the five-kilometre radius.

Anxiety and perinatal mental health issues skyrocketed in late 2020 and 2021 and we fielded numerous phone calls from mothers terrified not only about contracting the virus but about the impacts on their babies.

Wearing protective gear was hard. Initially the N95 face masks gave me pressure areas on my ears and nose, headaches and dehydration.

As a staff group, we had other challenges. Because our clinic was situated offsite from the main hospital building, we struggled throughout the pandemic about whether we should follow the hospital rules for inpatient, visitor or outpatient settings. At times we were forging our own regulations because the communications either weren’t disseminated to us or came too late to reflect government advice.

Vaccination brought some relief for staff, but the ever-changing COVID-19 variants kept presenting new challenges. Many pregnant women chose not to get vaccinated and most of those who chose to get vaccinated waited until their third trimester. This meant we were caring for a mostly unvaccinated cohort.

The overlap between our professional and personal lives became greater. We had staff members who were immunocompromised, or their husbands or family were. Some were isolating from children who were living out of home for the first time or starting uni. Many staff members had to home-school or navigate which parent would stay home with the children. Everyone’s sick leave entitlements dramatically decreased because they had to remain at home if they were symptomatic.

Outside of work I isolated a lot, for fear of contracting the virus and unknowingly spreading it to my colleagues, my patients and their families. I didn’t want to be responsible for our small unit of staff being furloughed or with the flow-on effect on their families and friends. I worked extra shifts to cover when staff were off sick or looking after children who were sick or stuck at home.



Where we are now

For now, we are past the height of the pandemic. Now there are more face-to-face childbirth classes. Home visits are back. Mothers can bring one support person with them to the clinic rather than everyone. We are wearing surgical masks and our patients are wearing them too.

We still have the option of telehealth or phone calls for some appointments, which I think is of benefit for women who live remotely.

There are ongoing restrictions on staff returning to work if somebody at home tests positive or if they are symptomatic.



Reflecting and thinking about the future

Reflecting upon the unprecedented, once-in-a-century and hopefully lifetime pandemic, I think we as a profession have learnt to be flexible in both clinical and organisational practice. We adjusted to the rapidly changing situation and we showed enormous resilience. Through everything that came our way, at the forefront of our frontline workers’ minds was our patients and our community and the need to keep doing what we do best: providing compassionate nursing and midwifery care.

The past three years have challenged me, both personally and professionally. It was an excruciating daily battle. At times I questioned my career choice, but I was also thankful I could work, have a steady and secure income, enjoy social interaction and achieve some level of fulfillment in such an unprecedented time.

Many of the longer-term impacts of COVID, including on babies, remain unknown and will be documented over time. Who knows how long COVID will be with us and whether we can get back to pre-COVID or when.