Covid-19 and the Perinatal Experience

Covid-19 has tremendously changed the way we live our daily lives. There is no exception for those who are pregnant, recently gave birth, and postpartum. There is also a lot of different information out there, some true, some not helpful at all! It is tough to navigate this information, so hopefully this article will help!

Prenatal

The major components of prenatal care and Covid-19 are the ongoing research and minimal numbers, as well as changes in prenatal visits. As of a study put out in May of 2020, pregnancy does not increase the risk for Covid-19. Symptoms were shown to be no different in women who are pregnant or not pregnant. However, one study in April of 2020 stated that those who were pregnant tended to have increased fever and dry cough as symptoms. There was also a study stating that those who were pregnant did have a higher chance of landing in the ICU, however, extra precautions were made since the women were pregnant. Now if you are told by a medical professional to remain away from large crowds/work you should listen to their advice. If you are nervous about the way our world is, that is okay! Your body is under a lot of added stress growing the baby, and your lungs/heart are working overdrive making them susceptible to Covid-19. Make sure to voice these concerns with your employer and family.

As for prenatal visits, anything that can be done on the phone is done that way. Many visits do require in person as the doctor/midwife is measuring your uterus and checking the fetal heart rate. There are other appointments that require other tests as well (such as the strep test at 36 weeks).  Because of this, most prenatal doctor/midwife visits have remained the same. The main thing that have changed is ultrasounds. Many hospitals and health care networks are not allowing a second person into the ultrasound. This can be very disappointed so take time to take this in. Especially for the anatomical one at 20 weeks, many do like to have their support person there to share the potential gender reveal. If you want to celebrate the gender together, you can wait for the report to get back to your doctor (typically 3-4 days) and pick it up to read together. Lastly, the preregistration where you would have been able to visit the birthing ward/centres is now done over the phone. This is tough as it is nice to visualize where baby is going to be born. However, many hospitals have provided online virtual tours or at least images that can be helpful. Feel free to reach out if you are interested in things like this and I can help you acquire them for your hospital.

Labour and Delivery

There have been quite a few changes with the actual birthing time. Nothing that will majorly affect your experience or that would alter any birth wishes that you had. However there are some new protocols and some things not allowed. The first is visitors. Only one support person can enter the hospital with you. This person is encouraged to remain in the hospital for the duration of the stay, however is allowed to leave and come back if needed. They will just be screened as they enter again. Unfortunately, this support person cannot change throughout the stay, i.e. your spouse can’t leave and your mother comes in.  This does not pertain to doulas. Doulas are allowed in our local birthing centre and most across Ontario. However, some are still saying no, so be sure to check before hiring a doula (or I can find out for you through my network). This does not mean you can’t have a doula, it just means they would be virtually supporting you, which is something to prepare for.

During labour, some hospitals require you to wear a mask at all times. Initially when Covid-19 began hospitals would keep the baby away from the mom to avoid any transmission of the disease. However, now they have realized that it is better for the baby to grow its immunity via mom (i.e. skin to skin and breastfeeding) and that a mask is sufficient to protect the baby. Hospitals in areas with low numbers do not require masks for the parents (Walkerton is one of these hospitals).  Hospital staff will have all required PPE on at all times.

One thing to note that is universal across all hospitals in Ontario is that nitrous gas (laughing gas) is not allowed during labour. This is due to the fact that Covid-19 can affect your lungs and nitrous gas can make your lungs vulnerable (completely fine in a regular situation though – for future pregnancies).

If you are not birthing in a hospital but rather at home with a midwife, not much has changed other than PPE.  The midwife will bring their own PPE and explain any new protocols with you during your prenatal visits. If numbers were to increase than the Ontario Midwives Association has regulations in place that may eliminate home births (however this would be a drastic increase in cases).

If mom is positive for Covid-19, there are studies that show an increase in risk for cesarean section (65% compared to the 17% average in Ontario). However, the good news is there was no increase risk for severe outcomes. In another study, out of 75 babies born to a mother positive for Covid-19 only one was positive (and this was 36 hours later). In another study, out of 755 women only 2% of the babies tested positive (but they stated there was a major knowledge gap in the care provided to these mothers/babies). There is no evidence for inutero infection (scientists have been studying cord blood, amniotic fluid, vaginal discharge, and swabbing the baby and have found all negative).  At the 24-hour blood testing, they will also test baby for Covid-19. Then, if positive they will test again at 48 hours (regardless of symptoms).

Postpartum

The major change for postpartum is the mental component. Many women (and their spouses) go into their maternity leave thinking about mommy and me groups, toddler music, family outings, swimming lessons and more. This has changed dramatically – and I feel you in this pain! You will feel the need to grieve and that’s okay! You’ve lost something you thought you would have after carrying this little peanut for 9 months. Embrace the feelings and let your friends and family know. Then reassess, who can I visit safely, where can I go that would be safe, who do I have in my life that I can rely on. This may be zoom dates with your friends from university/college/high school, more visits from grandparents, joining a mommy group on Facebook. I have a variety of resources for this and I am happy to share whenever you need them!

In conclusion, do not stress, the health care world is different but there are a lot of people there to support you! If you ever have questions please do not hesitate to reach out either on social media or via email (torrachtobairn@gmail.com).

By Christine Brown (September, 2020)

Good resources:

Royal College of Obstetricians and Gynaecologists (https://www.rcog.org.uk/)

Evidence Based Birth (https://evidencebasedbirth.com/)

Ontario Midwives (www.ontariomidwives.ca or https://www.ontariomidwives.ca/sites/default/files/IPAC%20Protocols/2020-04-09-guidance-for-provision-of-midwife-led-settings-and-home-birth-in-the-evolving-coronavirus-covid-19-pandemic.pdf)

Midwives Grey Bruce (http://midwivesgreybruce.com/)

Huron Midwives (https://www.huronmidwives.ca/)

Provincial Council for Maternal and Child Health (https://www.pcmch.on.ca/)

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