IntroductionOn 11th of March 2020 the World Health Organization declared the Coronavirus disease (COVID-19) outbreak a pandemic(1). Human-to-human transmission of COVID-19 has been established and from the 16th of March Public Health England (PHE), declared that vulnerable individuals including the pregnant population should be even more stringent about following the social distancing rules(2). This decision was most likely informed by the knowledge that pregnancy changes the immune system, which can lead to the development of more severe symptoms following a viral infection. To date 148,377 people have tested positive for SARS-CoV2, with 20,319 of those hospitalised having sadly died in the UK(3). The numbers of infected will no doubt include pregnant women and so every maternity unit should be as prepared as possible, in an ever evolving situation.The Royal Surrey NHS Foundation Trust has a maternity unit that delivers approximately 2,700 babies annually. As a smaller obstetric unit we face different challenges in regards to our physical facilities and staffing, compared to larger obstetric units. We approached the need for rapid adaptation of our services using the following concepts as highlighted by the Centers for Disease Control and Prevention (CDC)(4): 1) limiting the entry of pathogens on to the unit, 2) isolating symptomatic patients or patients living with a symptomatic individual and 3) protecting our staff. We also, implemented the recommendations by the Royal College of Obstetricians and Gynaecologists (RCOG)(5), which aligned with the aforementioned concepts.This article shares the practical steps we took , as well as the challenges and successes a small maternity unit have had so far in a dynamic climate, with constantly emerging and changing guidelines for providing evidence-informed clinical care during the COVID-19 pandemic.Limiting the entry of pathogens onto the maternity unitStructural changes that reduce patient flow throughout the maternity department were instigated early on, to minimise infection opportunities for both our women and staff, in groups thought to be negative, suspected or confirmed SARS-CoV2 positive. The hospital now only has two main entrance points. All patients arriving at the Accident and Emergency department (A&E), are screened for symptoms and have their temperature taken. At the main entrance, entry is restricted to those with an appointment and visitors are only allowed under extraordinary circumstances.Our pregnancy advice telephone service has COVID-19 symptom screening questions; aiding in the direction of pregnant women to designated ‘hot’ or ‘cold’ assessment areas in our unit. Details of these are discussed later in the commentary. Initially labelled ‘dirty’ and ‘clean’, our ‘hot’ areas are where patients suspected to have or with confirmed COVID-19 are reviewed and managed. Conversely, ‘cold’ areas are where women who are deemed low risk for having COVID-19 are seen.In line with national guidance, the unit has streamlined obstetric antenatal clinics – offering telephone consultations as a default. Any woman who requires a face-to-face consultation as per clinical need is screened on arrival by the entrance to the outpatient department with questions and her temperature is taken.Much of our community midwifery care is run from General Practice surgeries. As many reduced their face-to-face services, and we planned for lower staff numbers; we concentrated our community provision into two existing sites and one new central one – procured from a local private provider so as not to unduly increase footfall at the hospital. Informal feedback from our women via social media has been overwhelmingly positive, as they feel safer avoiding the main hospital. Where telephone consultations have replaced face to face appointments, as per the RCOG guidance(6), a temporary ‘drive-through’ service allows blood pressure and urine dip checks.Isolating patients with a contact history or symptomsOne of our main ‘hot’ areas is our designated ‘pregnancy pod’. It is a stand-alone suite of clinical rooms that are situated directly behind our A&E, that were repurposed. The suite is fully equipped with an assessment room, ultrasound machine, cardiotocograph and trolley available for emergency transfers. This area is for both emergency and routine attendances that cannot be postponed beyond the self-isolation period recommended by the Government. All pregnant women who have had contact with or are suspected of or confirmed COVID-19 enter via A&E. As an extension of the ‘hot’ A&E area, all staff working in the ‘pregnancy pod’ wear the appropriate personal protective equipment (PPE). We offer acute gynaecology, early pregnancy, antenatal and postnatal care in this environment.On delivery suite, all rooms have ensuite bathrooms. Those with a double door were prioritised for COVID-19 suspected or confirmed cases. Retrofitting additional doors has also increased our isolation capacity.Protecting our staffScreening all women at entry and adequate provision of PPE are key to staff protection. Staff who require shielding, work from home completing telephone consultations. Those who do not meet criteria but nonetheless have medical comorbidities are prioritised to work at the ‘drive-through’. The woman remains in her vehicle whilst blood pressure checks, blood tests and urine dips are carried out. Adjacent to the maternity ‘drive-through’, the pharmacy ‘drive-through’ allows collection of prescriptions from telephone consultations. All services are by appointment only to reduce congestion.