Hospitals seem too risky now. Should I switch to a home birth?
On the one hand, midwives have been advocating for home births
for their low-risk patients as the best way to manage possible exposure to COVID-19 in crowded hospital settings and to reduce the need for unnecessary interventions. However, it all depends on a woman's risks—and if she even has access to a midwife. If you're pregnant and you have COVID-19, the SOGC recommends you give birth in a hospital, but otherwise there are different factors to consider. “It’s got to be a global assessment that’s individualized,” says Vanessa Poliquin, an obstetrician and reproductive diseases specialist at University of Manitoba in Winnipeg. “For somebody who is a low-risk delivery who has had a baby before without complications…you might do as well at home with a midwife,” she says. But there are still many situations where a hospital birth is preferable.
Midwives across the country are awaiting increased access to testing and personal protective equipment, says Nathalie Pambrun, president of the Canadian Association of Midwives. Her organization is urging health regions to consider "temporary birth centres" with sites and staff that are clear of COVID-19-infected people receiving acute care.
For many midwives and pregnant women, home births may be the best possible form of physical distancing. “As hospitals see a surge in COVID-19 in the coming weeks and months," says Pambrun, "it’s important to consider the important role that midwives can play in reducing the number of patients entering and overburdening these facilities, which may further spread of the virus."
How are home births and midwifery care changing during the pandemic?
Midwives, like all primary care providers, are working to adapt to the new reality of the COVID-19 pandemic. Midwives are taking extra precautions, such as wearing personal protective equipment (like other healthcare providers) and substituting virtual and phone visits when possible with clients.
Throughout the pandemic, midwives have been providing uninterrupted care for their patients—whether in a home, hospital or birth centre setting—as they closely monitor the COVID-19 outbreak, and have been seeing higher demand for home birth, as many clients want to stay as far from hospitals as possible.
However, as healthcare policymakers rush to implement new protocols, midwifery care may be affected. On Monday, March 30, the Nova Scotia government suspended midwifery-led home births and home visits, without consultation with the province’s midwives. “Unfortunately, we are facing extraordinary times and this is one of many difficult decisions we continue to make to ensure the ongoing provision of essential care,” said a press release issued by the Nova Scotia Health Authority and the IWK Health Centre paediatric hospital in Halifax. “The interruption of home birth services supports provincial efforts to minimize the spread of COVID-19 and keep Nova Scotians safe. The decision also protects small teams, like the midwives and birth attendants, so they can continue to provide midwifery services.”
Nova Scotia’s decision to suspend home births comes after the reversal of similar measures in Quebec, according to the Canadian Association of Midwives. Home births were reinstated in that province after the implementation of additional measures related to COVID-19.
“Midwives, as autonomous primary care providers, must be consulted regarding criteria around home births or births in any location,” says Pambrun. (The Canadian midwives association has yet to release an official statement as of publication.)
How will my hospital delivery be different if have coronavirus when I go into labour?
When you arrive, if you have any respiratory symptoms and/or confirmed coronavirus, you'll be given a surgical mask right away and isolated as quickly as possible. If you are undergoing a procedure that contributes to droplets in the air, such as general anesthetic or intubation, your doctors and nurses will be wearing N95 respirators—even in asymptomatic women, because of the possibility of COVID-19 infection. And nitrous oxide, a common pain medication known as laughing gas, is no longer being offered to any labouring women, because it also contributes to the spread of airborne droplets. (Luckily, there are many other pain management techniques available, including epidurals and narcotics.) The SOGC recently released guidelines for treating COVID-19
in pregnancy and childbirth.
Will my baby be separated from me after delivery if I have COVID-19?
You may have seen the heart-wrenching images of fully suited healthcare workers in China caring for newborns, but there are no plans to separate mothers and babies in North America. Moms with coronavirus will still be encouraged to breastfeed, but the SOGC is instructing mothers to wash hands frequently, shower before skin-to-skin contact and breastfeed with a mask.
That said, Canada’s new guidelines are still relatively untested, notes Barrett, so we should be ready for new recommendations that come our way, and won’t necessarily get things right from the start. “It’s sobering to know that the way we are managing is not what's being tested right now, because all the data is coming from China, where they did separate [babies]. But the reality is we couldn’t separate even if we wanted to. We don’t have the facility.”
Assuming the baby and I are both healthy, will I be discharged from the hospital faster than I'd normally be?
Possibly. The protocol for discharge after having a baby is usually 48 hours after a C-section and 24 hours after a vaginal birth, says Armson. But in these circumstances, most hospitals will be trying to get moms home sooner, or as quickly as their medical condition allows.
What if my newborn ends up with coronavirus?
If you have it or get it while still pregnant, rest assured there is still no evidence of vertical transmission from mom to baby in utero. An analysis of nine infected pregnant women who delivered at Zhongnan Hospital of Wuhan University in China earlier this year, didn’t detect the virus in cord blood, amniotic fluid or breast milk
. And for the most part, kids who get the virus appear to have only mild symptoms. However a recent study that looked at more than 2,000 infected children in China showed that a small percentage of infants, or babies under one, can get seriously ill.
What about locally? As of late last week, Barrett says there were only a handful of confirmed cases in babies in Toronto, and none of the infants has become seriously sick.
“This battle is going to be fought—and won and lost—in the older age groups, rather than pregnant moms and babies, that’s for sure,” says Barrett.