Frightening times for all #healthworkers. In #maternity & #SRH services we must continue with exceptional demands of #COVID19. A few thoughts from previous #epidemics to make our work safer for patients & colleagues:

Slow Down: In maternity we are prepared for fast changing situations. Emergencies and quick decisions. Reduce the adrenaline. Breathe slowly and think through actions before taking them.

Stop and ask yourself: Do I have my PPE on properly? Do I need to do whatever I’m about to do? It’s not about limiting healthcare, it’s about making healthcare safe for everyone.

Think ahead: Expect actions to take a little longer than usual. Team members should not feel pressured to rush applying their PPE. There will be a learning curve, for individuals and the team. Planning ahead will allow more time for preparation and efficiency.

Dry-run, debrief and adapt: Now is the time to get familiar with how #COVID19 patients will move through the department. Practice a transfer to theatre and responding to emergencies. Walk around and look at what needs improving. Review and develop strategies over time.

Be honest: Vaginal & CS birth with #COVID19 are safe. Interventions are according to obstetric indication & woman’s preference. Helping women decide includes discussing possible longer time intervals than in usual times while staff apply #PPE & become familiar with protocols

Avoid high stress situations (e.g. Crash CS) where mistakes with #PPE or confusion are more likely. If the labour looks like it is heading towards operative delivery give advice early, make decisions early, take time, be calm, be safe.

#Contraception: Social changes can increase demand. Easy & continued access to contraception is a priority activity in health emergencies. Ask patients if they want or need contraception. Be aware of where services are available.

Women need access to safe #abortion care. Social change, economic downturn & uncertainty can increase demand. Ensuring continued access to abortion services is vital. Knowing how and where to refer is all of our responsibility.

Vulnerable groups: Changes in the economy & social behaviour can increase risks of exploitation, abuse & violence. We should be on the look-out for concerning signs. Be prepared for an increase in women needing additional support.

#Communication: When women & their families fear health facilities they avoid them, delay attending or listen to alternative information sources. Giving patients clear, transparent & honest advice helps them make timely decisions. In an epidemic trust is everything.

Have slack in the system: Colleagues may be off work self-isolating, caring for children or relatives. The work roster will need a buffer to allow for shortages in staff. As a team ensure rest time is built into the work pattern: A tired team makes mistakes.

Task Shifting: Everyone should be prepared to take on new roles (including doctors). Helping with basic patient care, stocking cupboards, administrative tasks, etc. We’re all in this together.

Look after each other: Everyone reacts differently to stress. Listen to your colleagues’ concerns. Share your own. Be kind to one another. There will be some difficult times ahead.

Stress is tiring. People become unwell. Tired staff have less resilience, & we all need resilience. If you see a colleague needs a break, help them to take it. We don’t always recognise our own exhaustion, look out for early signs of burn out & encourage R&R.

#COVID19 is new. We are learning #maternity and #SRH impacts together. This thread is based on experience in other #epidemics ( #Ebola, #Lassa, #Measles), in different geographical and political contexts. It’s transferrable, but not precise.

Guidance can be found at @RCOG, @WHO and @PHE. Expect guidance to change over time & expect more voices to join the chorus. Share what you learn. We are all in this together.