Many major life events have been put on pause as a result of the coronavirus pandemic — weddings, milestone birthday parties, even funerals. One thing that can’t be postponed? Giving birth. Having a baby is stressful enough without the current unprecedented strain on the healthcare system, so understandably, anxiety about child birth is at an all-time high for mothers.
With fears about contracting the virus, concerns about hospital overcrowding, plus restrictions on who can join you in the delivery room (most hospitals are capping this at one support person), more and more Canadians are considering home births: In B.C. for example, midwives, who can deliver both at home or in hospitals, have reported up to a 50% increase in requests.
To learn more about what it’s like to deliver babies in the middle of the COVID-19 outbreak, we spoke to a midwife in Hamilton, ON, on one of her first days off after working for three weeks straight. She says that, while midwives are an essential service, if more and more parents decide to deliver outside of a hospital setting, they may not be able to keep up with demand.
How has your practice changed since the pandemic started?
I work out of a clinic with a team of midwives. Before the pandemic, we would see our clients in a clinic setting every four weeks for the first 28 weeks of their pregnancy. Then, from 28 weeks to 36 weeks, we’d see them every other week. Then, weekly until they deliver. After, we would offer about two weeks of home visits.
Now, the initial appointment is over the phone. Six weeks later, we'll see the clients in the clinic, but they have to wait in their car because we've closed our waiting room. When it's the client’s appointment time, we call them on their cell phones and we do the full appointment over the phone from the parking lot. Then, we invite them up into the clinic. They bypass the waiting room, go directly into our clinic room, and we do the physical assessment — taking blood pressure and listening to the baby and measuring the growth of the baby. They’re in and out in three to five minutes.
After the birth, we’re no longer making any non-essential visits. There are some unique barriers now; [extended] families can't come visit. Our clients might be more at risk for postpartum depression because they don't have the same family support.
What are the logistics of a home birth when you’re social-distancing?
We wear full PPE (personal protective equipment) to the best of our abilities. So, we’re wearing scrubs (or a protective jumpsuit), a scrub cap, and a mask for the actual birth. During the labour part, [the mother] might may even be on the other side of the room. We encourage and coach our clients with verbal cues. The most hands-on we need to be is doing vitals and listening to the baby intermittently. Of course, with the actual delivery, we can't practise social-distancing. You have to really get in there. But we’re not doing home births for folks who are symptomatic or who have partners who are symptomatic. We're hoping the environment that we are in is very low-risk.
Have any of your patients had COVID-19?
None of my patients personally, but within my team, we've had a postpartum mom and baby test positive, and a client, who is currently pregnant, test positive.
What happens in those cases?
The baby who tested positive was assessed at the hospital and sent home. The parents were told to monitor for symptoms. The client who is still pregnant contacted public health and went through the same systems a non-pregnant person would go through. She qualified for a screening, [was found positive], and was sent home to monitor her symptoms. It hasn't really affected her care. As far we know at this point, being infected during pregnancy doesn't have a negative effect on the fetus.
How do you see coronavirus affecting your field in the long term?
If this pandemic continues beyond a few months and people are interested in a home birth — because we're really the only people who can offer them safely — we might not be able to meet that demand. At the same time, we don't know what’s coming. We could not be able to even offer home births, whether it's because we don't have enough midwives or if it's just a recommendation from hospitals [not to]. Right now, they're a little bit weary of midwives coming into the hospital knowing that we've been in and out of clients' homes. Also, if we find that more of our clients have tested positive for COVID-19, the guidelines say that there would be transfer of care to an ob/gyn team.
What do you think governments, local or national, should be doing to help?
They need to acknowledge us as an essential service and recognize that we are skilled primary healthcare providers that should be working to our full scope. Ob/gyns are absolutely wonderful and very skilled at what they do, but they take on fourfold the caseload that we do. So, the amount of time that they have to spend with each client is limited. We can take the weight off of the healthcare system by offering home births and providing more supportive care. And down the road, I think the government should know that we can even work within the hospital system if they need us.
What do you want pregnant women to know?
Try to stay calm and steady in the face of this uncertainty. We know that stress and anxiety can have worse effects on the pregnancy than the virus, so managing mental health is so important. And know where to get your information. Stay off the forums, stay off social media and go to the CDC and the World Health Organization for information.
Are you worried about contracting the virus?
It's always in the back of your mind for sure and it’s anxiety-inducing. My biggest fear is getting the virus, being asymptomatic or having mild symptoms, and not knowing I had it and then spreading it to a more vulnerable population, whether that’s my babies or my moms.
How have you been dealing with the stress?
I'm really blessed to work with the midwives that I do. We all have really amazing relationships and we can lean on one another. I have a great network of friends and family who are checking in. I’m doing yoga at home and trying to get outside and practise self-care. I do virtual sessions with my therapist, which I find very helpful. Our college and association of midwives are also offering extra support for frontline workers right now, like virtual social workers and counsellors.
Was there a special moment during a birth in the past month that reminded you why you do this?
I feel like that every day with every birth. I had a repeat client last week who had a planned home birth and it was so special to be there for that moment surrounded by her family. Suddenly the baby is born and there’s this moment of euphoria and smiles. It’s hard to capture how it feels to be part of a birth and inviting new life into the world, but that gets me through.
And now every day in the clinic, having clients come in with their stress about the pandemic and just listening to them and providing a safe space, then watching their shoulders drop. They're definitely at ease when they leave. I feel that my job is so important, and this is an integral time to be an effective midwife.
This interview was edited for length and clarity.
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COVID-19 has been declared a global pandemic. Go to the Public Health Agency of Canada website for the latest information on symptoms, prevention, and other resources.