Women’s Health Services under COVID 19 with Dr. Jane Dickson

Dr. Jane Dickson shares some of the main concerns around Women’s Health during the Corona Virus pandemic and urges women still to present to A and E or the GP if they have health difficulties during this period

I was delighted to be invited to be a speaker at the WEN Café on Women’s Health, with WEN Ambassador, Dr Olwen Williams, MBE. We are both passionate leading practitioners in women’s health and have a long history of supporting each other’s work in Sexual Health across the UK. My main job is to lead the abortion service at Aneurin Bevan University Health Board.

COVID-19 has presented those of us working in women’s health with many challenges and concerns. Routine medical work in hospitals has been suspended and this has led to the misunderstanding that all medical services have been affected. There has been a fall in A and E attendances for emergency ‘Non-COVID” conditions and presentations to GPs for symptoms requiring urgent attention e.g. cancer symptoms, have fallen. The fear and confusion around service provision change could be just as harmful as contracting the virus itself. It is vital for women to receive the message that ‘normal’ healthcare still exists, and they should not be afraid of accessing it in its new delivery forms, such as telephone or video consultation.

In Sexual Health, all emergency services still exist for women needing them. This includes an assessment of sexual assault, management of STI symptoms, emergency contraception, and post-exposure prophylaxis for HIV. Most services are now operating telephone consultations with collection or postal services for routine contraception e.g. pills.  ‘Routine’ functions, such as long-acting contraception (intrauterine devices/coils, implants) or testing for sexually transmitted infections where there are no symptoms have been suspended. Guidelines have been re-written for long-acting contraception  as evidence suggests that they work for longer than the product license states. https://www.fsrh.org/news/new-fsrh-patient-guide-advice-for-women-seeking-contraception/

Working in abortion care has been especially challenging. There is concern that some women may not realise that abortion services are still available and may then present later in their pregnancies when abortion procedures are more difficult. Fortunately, the Welsh Government has acted to allow two crucial changes to allow continued service provision:

• The management of abortion via teleconsultation
• The ability to provide abortion medicine for women to take in their homes (usually this would have to be done in a clinic setting).

This has transformed service delivery. We now undertake our medical assessments by phone, only seeing women face to face where there is a medical necessity, such as a scan needed to confirm there is not an ectopic pregnancy. Women are able to collect their abortion medication or if they are isolating, unwell, or unable to collect themselves, it can be sent by registered post. In my own service, we have noticed a 50% increase in demand for abortion care in recent weeks and many women are stating that their decision has been influenced by COVID-19, either social or financial insecurity or just an inability to cope with any more children.

As part of our service delivery in a traditional health care setting, we are able to directly ask about coercion or domestic violence in a safe environment for women. We, as practitioners, are especially aware that domestic violence is increasing during this enforced period of social lockdown. One of the safeguards we have implemented is to provide women with a code word via email before they are called so that they can alert the nurse that they speak to, that they are in danger and we can take appropriate action.

Antenatal Pregnancy and Childbirth care under COVID restrictions concerns were raised during the Café. The RCOG and Royal College of Midwives have produced very useful guidelines that encourage women to access their antenatal care. One misconception was that women might not be able to have a birth partner; however, the guidance very clearly states that women should be allowed a birth partner. If a chosen partner is symptomatic for COVID-19, an alternative birth partner can be chosen.

Finally, Olwen and I were asked: “What our vision for improvement for women’s healthcare in Wales would be?” We both believe that all our doctors should be trained about gender inequality from the outset, and I would like all women to be able to access a women’s health specialist in GP surgeries. I’m incredibly lucky that there is one in my General Practice (a man!) and I believe all women in Wales should have access to this care.

It was an absolute pleasure to be able to speak to so many women, dispel some of the myths around current Women’s Health Service provision under COVID 19, and to share much-needed information and advice to women around Wales.

Remember, Staying Safe also means asking for emergency help if you need it.

Dr. Jane Dickson is Vice President (Strategy) of the Faculty of Sexual and Reproductive Healthcare (FSRH) and a consultant in Sexual and Reproductive Healthcare at Aneurin Bevan University Health Board

@TheSexDoctorUK