Uncertainty surrounding COVID-19 has many Australians in a heightened state of health anxiety. So, it's unsurprising that pregnant women have experienced fears around pregnancy, birth and caring for a newborn. But there is an upside for pregnant women according to one diligent midwife.

A report by the Australian College of Midwives, which surveyed 3000 pregnant women, found that many felt isolated, alone and unsupported during the pandemic. As a result, there has been an attempt to find alternative maternity options, such as home birth.

Common concerns reported were a lack of face-to-face appointments, personal needs and birth choices not being met, caring for other children, inconsistent information and the cancellation of maternity services.

Lack of face-to-face appointments
While face-to-face appointments were still offered in selected places, many antenatal and postnatal appointments were via telehealth or other digital means.

Lack of support
Many felt unsupported given the changes in care due to the pandemic, including a lack of support from health care professionals and support that they wanted from their partner and family.

Personal needs not being met
In response to the restrictions, women discussed that access to necessities, quality care, support throughout pregnancy, birth and the postnatal period and choices were not being met.

Birth choices being impacted
Women feared not having their choices upheld, such as having their partner and support person present at the birth.

Caring for other children
Restrictions and social distancing meant limited options for childcare and that children were not permitted at appointments. There was also the fear that partners would miss the birth due to having to care for other children.

Sarah Hadgkiss experienced this concern, explaining that her antenatal appointments were challenging with two-year-old twins and no family support in Queensland.

"I wasn't allowed to bring the twins to my appointments or to visit in the hospital. I had to do a lot of it on my own without hubby by my side."

Inconsistent and insufficient messages and information
Women stated that there had been a lack of information and where it was provided, it was often inconsistent.

Cancellation of services
Cancellation of antenatal classes and services, such as breastfeeding classes, had also prompted women to source alternative options of care.

Margaret Sommeling, a clinical midwife specialist, said midwifery through the pandemic had presented challenges, but also opportunities for pregnant woman and their family.

"At the height of lockdown, notifications were sent daily by organisations and department managers."

The significant policy changes affecting birthing women included:

• Number of support people in the birth suite
• Wearing of PPE equipment
• Partners not being able to stay for women in single rooms
• Numbers of visitors reduced (if any allowed)
• Limiting appointment times
• Increased phone appointments (in-between face-to-face appointments)
• Hospital tours and antenatal education services cancelled

As a midwife operating in a continuity of care model as part of a public hospital with a homebirth option, Ms Sommeling has experienced minimal disruption.

"Fortunately, the homebirth program hasn't been affected by the pandemic lockdowns. In fact, inquiries tripled."

This increased interest is due to concerns about lockdown restrictions affecting birth choices and a desire for consistent communication, said Ms Sommeling.

"Women don't need to worry about who can look after the children. They're able to be present if they're not sleeping - if mum's birthing at stupid o'clock in the morning!

"What a great way to normalise birth instead of viewing it from a medicalised or pathological perspective.

"Women also have a direct line of communication with me. This one-on-one relationship tends to act as a buffer for the ever-rapid changes occurring. And any anxiety that may arise during pregnancy can be reduced."

Choosing home birth isn't straightforward for many clients, explained Ms Sommeling, with concerns about eligibility and what happens if complications develop.

"There is the expectation of meeting certain criteria to be eligible for the homebirth program, such as having an uncomplicated, low-risk pregnancy."

As a result of fears surrounding restrictions on the number of people allowed in the hospital birthing suite, one client decided on homebirth, explained Ms Sommeling.

"I had to jump through the organisational hoops, but after receiving approval from her obstetrician at 35 weeks, this incredible mama went on to have a water birth at home in the presence of her partner, mother and two-year-old.

"It would not have been achievable at the hospital as only her partner would have been allowed in."

There are also concerns about caring for a newborn without the support of friends and family. Still, isolation has a positive side, said Ms Sommeling.

"It heightened both perceived and real fears about coming home from the hospital with a newborn. But what I've seen is more successful breastfeeding relationships.

"Without the interruption of visitors, extended family, the mother can rest, recover and be attentive to the feeding cues and newborn needs as well as attend to self-care."

Partners and children also benefited from a focus on life as a new family without the usual distractions of visitors.

"I've seen them bond to the new sibling without the interruptions to the children's usual routine by family or friends that don't usually make an appearance at home."

At the time of writing, Melbourne is at the beginning of another six-week lockdown, but Ms Sommeling is confident that it's birth as usual.

"I'll be here with my positivity and reassuring smile, brainstorming individualised support plans and isolation survival tips for pregnancy, birth and postpartum in a COVID-19 world. As the current catchphrase goes, we're all in this together!"