Pregnancy during a pandemic: COVID-19

This is an unprecedented time for many. The uncertainty around the coronavirus is especially difficult for those in the midst of needing the healthcare system on a regular basis, such as pregnant people. Here are some pregnancy considerations during the COVID-19 pandemic:

Schedule of visits
The first change pregnant people may notice is to their scheduled prenatal visits. Expect a call or email to screen for symptoms or exposure before visits. You will be asked not to attend your visit if you are sick. Midwives and doctors are working on ways to provide care to patients who are sick and keep everyone safe. Care may be provided via video calls or telephone if necessary. If appropriate, your visits may be a little less frequent than usual. Your midwife or doctor will discuss any changes and ensure you know who to contact between visits should the need arise. 

Clinic visits
Most clinics are making changes to minimize the amount of people interacting at the office. For scheduled visits some clinics are asking you to call from the parking lot and wait for a call to come in. You may go directly into a room upon arrival and if not, people are being asked to sit at least two meters away from each other. Currently, many offices are asking that non-essential support people and children not be brought to appointments if possible.

Continuity of care
You may have additional healthcare workers involved in your care depending on how this pandemic unfolds. Midwives, obstetricians, nurses and other staff can also be affected by COVID-19 and may be working with reduced staff. Your midwife or doctor will do their best to ensure your care continues without interruption. It is always a good idea to stay informed, have a general idea of important aspects of care that are coming up next and speak up if you think something is being missed. 

Postpartum recommendations have always included limiting visitors. With COVID-19 spreading quickly you want to be extremely careful about who comes to visit after your baby is born. It is very unlikely that you will be able to have any visitors at the hospital (beyond your one chosen support person), so please remind them that any visits will take place once you’re discharged. Screen your visitors, not just regarding recent travel, but also social distancing practices. If they have been at every mall, grocery store and other place that’s open, it may not be wise to have them visit your newborn. Be picky, the safety of your family is at stake. Information regarding COVID-19 infections and newborns is limited, but we know the newborn immune system is not fully developed, so why take any unnecessary chances? Ensure that anyone wishing to support you and visit during the postpartum period knows the criteria required (by you) for them to visit.

Expect to be screened for symptoms of COVID-19 every time you enter the hospital. Many hospitals are only allowing entrance through specific doors to ensure this takes place. Know where to enter the hospital as it may no longer be through the expected entrance.

Many hospital labour and delivery units are limiting birthing people to just one support person. This may change your birthing plans so please look into options for virtual support if you were planning on having a larger birth team. For the safety of everyone, your support person cannot be ill.

Hospital resources may be distributed differently due to COVID-19. This could mean less operating rooms (ORs), conversion of some units into dedicated COVID-19 spaces, and other changes. How does this affect the labour, delivery and maternal newborn units? Well, less ORs can affect cesarean section booking and timing. Units that have a dedicated anesthesiologist may no longer have one, which affects timing and availability of epidurals for labouring patients. These are just a few of the possible scenarios, and of course, this depends on the situation at each hospital. An overrun healthcare system has far reaching effects, which is why it is so important to stop the spread and flatten the curve. 

Early Discharge
The typical postpartum stay is 24 hours for a normal vaginal delivery and 48 hrs for cesarean section deliveries. Severely affected hospitals may discharge people earlier if the delivery was uncomplicated and mother and baby are well.

In Ontario, midwives continue to offer choice of birth place, offering home, hospital and birth centre options. Make yourself aware of the options where you live. If you or someone living in your house has COVID-19 at the time of the birth, home birth may not be recommended. Talk to your midwife about home birth plans. 

Postpartum visits
Postpartum appointments may also be affected by this pandemic. Similar to prenatal care, screening measures will be in place and the location of visits may change. Doctors providing newborn care will have their own protocols in place, so make sure you contact them before your baby’s first visit. Midwives see clients at home during the initial postpartum period and may need to alter the schedule of visits based on the current situation. 

Stay informed
A very good COVID-19 pregnancy specific resource is the National Perinatal Association website. They have compiled pregnancy related information about the virus and link to valuable sources such as the CDC. Your midwife or doctor will also be a resource for up to date facts and what to do if you think you have COVID-19.

In closing
Having seen COVID-19 cases overwhelm other healthcare systems it’s puzzling that it’s not being taken more seriously by countries that still have a chance to avoid similar outcomes. This article mentions just some of the obvious ways pregnancy can be affected, but there’s no way to predict all of the possibilities. During a stage of life when you are thinking beyond yourself, pregnant people are likely amongst those taking this pandemic very seriously. Try not to overwhelm yourself with things beyond your control and simply focus on your role. Let’s all do our part by social distancing in order to flatten the curve and stop the spread. 

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