Pregnancy during a pandemic: midwives reassure new moms
By Sue Tiffin
As Morgan Fisher enters her 30th week of pregnancy, the world looks different than she expected it to when she imagined the birth of her daughter with husband Mark.
The Haliburton residents plan to welcome their baby in June, with support from The Midwifery Services of Haliburton-Bancroft, at Peterborough Regional Health Centre. This plan hasn’t changed, although other aspects of their lives have.
“Prior to COVID, I counted myself extremely lucky,” said Fisher. “I didn’t have any form of sickness or any health issues. Baby was happy and growing just perfectly. The time flew by getting more excited as we got closer and closer to her due date.”
The first case of COVID-19 in Canada was announced in January.
“For me, I figured it was only a matter of time when it made it to our small town,” said Fisher. “For the longest time I tried my best to keep to myself and avoid as much social media as possible when the outbreaks were in Toronto. About a month ago it started to be more on my mind than normal with the changes of essential line of work being in discussion. I started to wonder if I should be more worried than I was.”
Fisher is a registered veterinary technician at Minden Animal Hospital, which has been deemed an essential service. Before that list of essential services was released by the province, friends and family members had been reaching out to her to ask how she was doing and feeling as concerns about the virus grew. They learned Fisher – who, with a love for animals is devoted to their care and well-being – was still working.
“Which resulted in them worrying for my health and expressing their concerns for me,” she said. “This got me thinking are they right, should this be something I should be risking? The [essential services] list was released and confirmed there would not be a closure of my workplace, which I was super happy about because what would people do in our community if their pets got hurt? But in saying this it brought me back to wondering if I should make a tough decision to remove myself for the safety of my unborn daughter and my family.”
Fisher spoke with her midwives, discussing her concerns, and agreed that she should take a leave from work to help protect herself and her baby.
“I was devastated to make this decision,” she said, noting it was the hardest decision she has had to make, but that the unknowns of the virus and how it might affect women and their unborn babies had her so stressed, she wasn’t functioning properly at work because it was all she could think of. “Shortly after my leave started is when the first positive case was confirmed in our county.”
delivery. Breastfeeding continues to be recommended for all infants, regardless of risk factors or exposure to [COVID-19]. This is because breastfeeding has an impressive impact on the infant’s immune system and allows the maternal immune system to support the infant.”
Now, Fisher’s main job is to take care of herself as she nears the end of her pregnancy, with support from Mark who she said has a positive outlook and is taking “things day-by-day” as they work together to ensure they are safe.
“After leaving work, getting up that next week and not having to get ready and leave the house was honestly the biggest relief, I felt like there was weight off my shoulders just knowing I didn’t have to go anywhere,” she said. “I try my best not to dive into reading or researching all this too much as it will set me into worrying and stress me out, which is what I wanted to avoid. I take extra precautions if I have to go into town to the store but other than that there is no longer the fear of not knowing who I will have contact with each day like it was before. I’m doing my part of social distancing and hoping that this curve will flatten.”
Fisher’s midwives have assured her the choices related to her birth are hers, and that they will support her in every decision, she said.
“Hospital births are still an option – there are many people reconsidering and changing to home births but we are still set on being at the hospital as the precautions that are taken in the maternity ward allow for a safe birth,” she said.
Instead of physically meeting with the midwives every two weeks, as is typical at this stage in pregnancy, Fisher, whose pregnancy has been low-risk, is meeting in person one week, and with a phone consult the next, allowing the midwives to limit the amount of clients in and out of the clinic, as well as offer more space for patients and the midwives to ensure physical distancing and safety regulations are followed.
“The midwives have been amazing support through everything,” said Fisher. “With them knowing I have been very anxious through all this they have been even better than I could have expected. They have taken the time to explain all the knowledge they know about this COVID-19, giving us all the options of what can be done and what has changed. They have been so open and supportive, I couldn’t ask for it to be any better. They have reassured me countless amounts of times we will all get through this together.”
Fisher’s hope is that by the time her daughter is born, the current health crisis is over.
“But if it’s not it will be a very devastating, lonely time,” she said. “Family visits may not be safe if the pandemic is still going on, which means introducing her to the world via social media, and video calls or meetings through a window with no contact and it breaks my heart thinking this might happen, because being our first, when we found out we were pregnant last year it made us so happy to be able to share our little one with the world, and now this will completely change everything.”
Not having the support at home after the baby is born, if people are still required to be social distancing, is terrifying for Fisher. But still, she has hope for herself and fellow pregnant women and new moms living through a life-altering experience during a global pandemic.
“I guess it would all come down to having people understand we are scared, but for anyone going through a pregnancy during this time or has had a baby recently, having them know we are all in this together no matter how lonely it may feel at times and we can all only hope this will make us stronger women at the end of this tunnel.”
Registered midwife Stephanie Simon of Midwifery Services of Haliburton-Bancroft said local midwives are continuing to be available for families, and reminds women in their pregnancies to try to hold onto joy as they live through a life-altering experience during a pandemic. /Submitted
The Midwifery Services of Haliburton-Bancroft, which have an average of nine clients due each month, initiated screening prior to every in-person visit, and have decreased in-person visits to the minimum, as recommended by the World Health Organization, supplementing with phone and video visits between in-person calls. In-person, the midwives have requested that only pregnant clients attend while their support people join by phone. Visits to labs and ultrasounds have been decreased with more bloodwork being done in office, including no longer requiring women to attend the hospital to receive Rhlg injections.
“This pandemic affects us all and like all health-care providers, we’re trying to balance safe and appropriate care with pandemic safety and minimizing infection, while also trying our best to respect midwifery values and the fact that birth is a life-changing event,” said Stephanie Simon, registered midwife with Midwifery Services of Haliburton-Bancroft.
“During appointments with families, we certainly notice that this is a huge stressor for women in pregnancy and the postpartum. We’re doing our best to relay accurate and up-to-date information to all of our families.”
That information was being compiled by midwives as the incidents of COVID-19 infections spread.
“We are fortunate, in some ways, that China was able to accumulate and share some early data from their outbreak,” said Simon. “The information available is overall reassuring. Pregnant women do not appear to be more susceptible to [COVID-19] compared to the general population, nor do they appear to experience any greater severity in symptoms. This doesn’t mean that pregnant women can’t get severely ill from [COVID-19], it simply means they are no less likely to do so than another healthy individual. This is actually positive as many other respiratory infections, such as some strains of influenza, impact pregnant women to a greater degree. So we are thankful for that.”
Some cases of newborns with COVID-19 have been reported, but Simon said that even in those cases, research has been generally reassuring.
“Children tend to experience a mild illness and recover well,” she said. “There is currently no evidence that the virus can be transmitted from pregnant women to the baby before birth (vertical transmission). There is conflicting data as to whether COVID-19 increases preterm labour; we don’t have any clear information on this yet. We do urge pregnant women and their families to minimize in-person interaction with others outside of their home and isolate for the final weeks of pregnant to minimize the chance of being ill during delivery as this certainly will alter our approach to clients preparing to give birth during the pandemic have been asking the midwives about alternative plans, possible risks, and best practices to be safe.
“It’s been a big discussion topic in almost every appointment,” said Simon. “The biggest concerns are how to minimize their risk of contracting [COVID-19]and what the hospital environment might look like should they plan or need to go there. Things are changing quickly so we are doing our best to ensure that we are providing up to date and accurate information.
“Although the Canadian governing bodies have not offered any pregnancy-specific recommendations, other health authorities have encouraged pregnant women to practice social distancing and work from home if able and if not, to stop work at or around 28 weeks. We have been suggesting that women in the final month of pregnancy consider self-isolating to reduce the potential for illness during labour and delivery and subsequently risk to the infant.
“Ideally, everyone, whether pregnant or not, should limit their interactions to immediate family members who they live with. For low risk women, we have been having more discussions about choice of birthplace and particularly about home birth. We have ample research that supports home birth as a safe, if not safer, location for birth in healthy women. Certainly, with the current situation, more women are pursuing or considering home birth as this is an environment where families can control their exposure. We will continue to support women in their choice of birthplace. If a woman has COVID-19 we are recommending a hospital birth.”
Simon said that, “one noticeable change for us is that the midwives no longer have in-person interactions among ourselves to protect one another in case of exposure to [COVID-19].” Though they do have access to some personal protective equipment, Simon said they have been “made aware that further access to items such as gloves and masks are restricted and may become difficult to acquire as this goes on.”
For those experiencing their pregnancy and birth during this time, Simon offers this:
“It’s tough and being in a pandemic can overshadow the joy that usually accompanies pregnancies. Try to hold onto that. We know pregnancy is often an uncertain and overwhelming season of life in general. We’re still available 24/7 by paging service and will continue to be here for families. We will provide updates as available via social media. For those who aren’t yet our clients, please still contact us so that we can be a support for you. Take care of yourselves. Make a physical and mental health goal each day. Do things that bring you joy. Check out some online prenatal classes. Stay home and wash your hands.”